Poverty is an important influence on health and despite continuing economic growth, poverty and health inequalities persist. Current public policy aims to reduce the inequalities in the health, by focussing on the social factors influencing health, improving access to health and personal social services for those who are poor or socially excluded and by improving the information and research base in respect of the health status and service access for the poor and socially excluded groups. It is important that processes for target setting and evaluation involve people experiencing poverty, at all levels through consultative and participative structures and processes and in the roll-out of primary care teams. A number of projects throughout the country aim to address health inequalities using community development. These are essentially about widening participation in the development, planning and delivery of health services and ensuring that the community is actively involved in the decision making process about health services in their area.
Buss, Paulo Marchiori
This paper analyses the relationship between globalization, poverty and health, defining and presenting the main characteristics of contemporary globalization. It also establishes the characteristics of poverty today, both globally and regionally. Reviewing articles and world reports, it presents a set of evidence on the relationships between globalization and poverty, as well as their influence on health. Furthermore, it presents the opportunities offered by globalization, through a series of worldwide initiatives prompted by actions among countries under the aegis of the United Nations in general and the WHO in particular, in addition to intergovernmental alliances and coalitions and other civil society representatives.
Discusses the prevalence and rise of poverty in the United States, which is found particularly among women, children, and those from minority groups. Discusses the positive association between poverty and mental health problems. Describes the impact of poverty on women, and the need for research to discover the psychological impact of poverty. (JS)
Gupta, Rajeev; Kumar, Praneet
There is a close association between social circumstances and health. In India, there is a significant burden of both communicable and non communicable diseases. Risk factors responsible for these conditions are underweight, unsafe sex, unsafe water, poor sanitation and hygiene, indoor smoke pollution, zinc, iron and vitamin A deficiency, tobacco use, high blood pressure, and high cholesterol. All these risk factors are influenced by social factors and in India the more important factors are poverty and illiteracy. Changing lifestyles as a result of rising incomes are significant risk factors for non communicable diseases. The social evils that influence poverty and health are macrolevel national and regional issues such as physical geography, governance patterns and failures, geopolitics, economic policy, natural resources decline, population growth, the demographic trap and the fiscal trap. Household and microlevel factors include the poverty trap, cultural barriers, lack of innovation and saving, absence of trade or business, unemployment, technological reversal, adverse productivity shock, social issues related to females, and adolescent social issues. Social determinants important for non communicable diseases, defined by the World Health Organization include the social gradient, stress, early life events, social exclusion, improper work conditions, unemployment, lack of social support, addiction, food scarcity or excess and uneven distribution, lack of proper transport, and illiteracy or low educational status. There are multiple pathways through which social factors influence health, and pathophysiological mechanisms involve homeostatic and allostatic changes in response to stress, neuroendocrine changes and altered autonomic functions, and abnormal inflammatory and immune responses. A concerted action to eradicate these social evils shall have to focus on reducing poverty, improving educational status and providing equitable and accessible healthcare to all.
Poverty and ill-health are intertwined. Poor countries tend to have worse health outcomes than better-off countries. Within countries, poor people have worse health outcomes than better-off people. This association reflects causality running in both directions: poverty breeds ill-health, and ill-health keeps poor people poor. The evidence on inequalities in health between the poor and non-poor and on the consequences for impoverishment and income inequality associated with health care expenses is discussed in this article. An outline is given of what is known about the causes of inequalities and about the effectiveness of policies intended to combat them. It is argued that too little is known about the impacts of such policies, notwithstanding a wealth of measurement techniques and considerable evidence on the extent and causes of inequalities. PMID:11953787
Racine, Andrew D
The persistence of child poverty in the United States and the pervasive health consequences it engenders present unique challenges to the health care system. Human capital theory and empirical observation suggest that the increased disease burden experienced by poor children originates from social conditions that provide suboptimal educational, nutritional, environmental, and parental inputs to good health. Faced with the resultant excess rates of pediatric morbidity, the US health care system has developed a variety of compensatory strategies. In the first instance, Medicaid, the federal-state governmental finance system designed to assure health insurance coverage for poor children, has increased its eligibility thresholds and expanded its benefits to allow greater access to health services for this vulnerable population. A second arm of response involves a gradual reengineering of health care delivery at the practice level, including the dissemination of patient-centered medical homes, the use of team-based approaches to care, and the expansion of care management beyond the practice to reach deep into the community. Third is a series of recent experiments involving the federal government and state Medicaid programs that includes payment reforms of various kinds, enhanced reporting, concentration on high-risk populations, and intensive case management. Fourth, pediatric practices have begun to make use of specific tools that permit the identification and referral of children facing social stresses arising from poverty. Finally, constituencies within the health care system participate in enhanced advocacy efforts to raise awareness of poverty as a distinct threat to child health and to press for public policy responses such as minimum wage increases, expansion of tax credits, paid family leave, universal preschool education, and other priorities focused on child poverty.
Madulu, Ndalahwa F.
The Wami Rivers basin is an important area due to its diversified use which benefits a multi-diversity of stakeholders. While large scale irrigated sugar production is the main issue of concern upstream, there are other equally important socio-economic activities which include biodiversity and environmental conservation, domestic water supply, livestock water needs, and fishing. A large water supply project has just been completed downstream of the Wami River to provide water for the Chalinze township and surrounding villages. Other important undertakings include irrigated rice farming in Dakawa area, livestock keeping activities, and the establishment of the Sadani National Park (SANAPA) and the Wami-Mbiki Wildlife Management Area (WMA). The Wami River basin forms significant parts of both the Wami-Mbiki WMA and the SANAPA wildlife conservation areas. Regardless of its importance, the basin is increasingly being degraded through deforestation for agricultural expansion, timber, and more important charcoal making. The basin is also being polluted through disposal of excess molasses from the sugar industry, and use of poisonous substances and herbs in fishing. The worsening environmental condition in the basin has become a health threat to both people in the surrounding villages and wildlife. To a large extent, such changes are intensifying poverty levels among the local population. These changes are raising concerns about the long-term environmental sustainability and health implications of the current water use competition and conflicts in the basin. The purpose of this paper is to examine the main water resource use conflicts and how they affect environmental sustainability in the long-run. It also intends to establish linkages between wildlife management, pastoralism, agricultural activities and how such linkages influence poverty alleviation efforts in the basin. An attempt has been made to examine the environmental and health implications of human activities
Rusen, I D; Squire, S Bertel; Billo, Nils E
The International Union Against Tuberculosis and Lung Disease (The Union) held its 40th World Conference on Lung Health in Cancun, Mexico, between 3 and 7 December 2009. It was attended by over 2000 delegates from 104 countries around the world. The conference featured four stimulating plenary sessions and an extensive selection of scientific symposia. A total of 1125 abstracts were also presented from five broad categories: clinical trials and TB basic science, clinical research for treatment and care, epidemiology, education, advocacy and social issues, and policy and program implementation. In addition, the conference was preceded by a series of well-attended postgraduate courses and workshops.
Mowafi, M; Khawaja, M
This glossary addresses the complex nature of poverty and raises some conceptual and measurement issues related to poverty in the public health literature, with a focus on poor countries. PMID:15767376
Braveman, Paula; Gruskin, Sofia
Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions' work. Equity and human rights perspectives can contribute concretely to health institutions' efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector. PMID:12973647
Noting that the failures of the U.S. health care system are compounding the problems faced by low-income Americans, Alan Weil argues that any strategy to reduce poverty must provide access to health care for all low-income families. Although nearly all children in families with incomes under 200 percent of poverty are eligible for either Medicaid…
Korenman, Sanders D; Remler, Dahlia K
We develop and implement what we believe is the first conceptually valid health-inclusive poverty measure (HIPM) - a measure that includes health care or insurance in the poverty needs threshold and health insurance benefits in family resources - and we discuss its limitations. Building on the Census Bureau's Supplemental Poverty Measure, we construct a pilot HIPM for the under-65 population under ACA-like health reform in Massachusetts. This pilot demonstrates the practicality, face validity and value of a HIPM. Results suggest that public health insurance benefits and premium subsidies accounted for a substantial, one-third reduction in the health inclusive poverty rate.
Del Rey Calero, Juan
Social capital is the social structure which facilitates the actions of individuals, stimulates production and allows for success. Poverty maintains basic needs unmet (food, health, autonomy) over time and unvoluntarily. Social exclusion does not allow individuals to participate in society. The following dimensions are assessed: financial poverty, social inclusion, employment, health and education. Social participation, work integration, empowerment, self-esteem, and personal achievement should be promoted. In Europe 15% of people is exposed to poverty; in Spain corresponding figures are 13.4%, while for the elderly reached 21%. Extreme poverty affects 6.2% population and severe poverty 14.2%. Women and those living in Andalusia, Canary Islands and Extremadura are particularly affected, health inequality are for elderly, immigration, gender, social class, and should be reduced 10% for 2010. The Gini indez measures the income distribution; in the European Union (EU) it is 0.29 while in Spain is 0.33. Poverty and health are inversely correlated, health care expenditure in Spain is 7.5% og GDP. Life expectancy in U.E. is 75.5 years for men and 81.6 years for women, while in Spain it is 78 and 83.1 respectively. Infant mortality in EU is 4.5/1000, 4.1 per thousand in Spain. Lastly, the number of children per women in EU is 1.47 and in Spain 1.3.
This book is concerned with the impact of poverty on health, focusing on families with young children in the United Kingdom. It draws together information from a wide range of disciplines to provide workers in the health and welfare fields with a better understanding of the complex interconnections between living conditions, lifestyles, and health…
Tampubolon, Gindo; Hanandita, Wulung
Community and facility studies in developing countries have generally demonstrated an inverse relationship between poverty and mental health. However, recent population-based studies contradict this. In India and Indonesia the poor and non-poor show no difference in mental health. We revisit the relationship between poverty and mental health using a validated measure of depressive symptoms (CES-D) and a new national sample from Indonesia - a country where widespread poverty and deep inequality meet with a neglected mental health service sector. Results from three-level overdispersed Poisson models show that a 1% decrease in per capita household expenditure was associated with a 0.05% increase in CES-D score (depressive symptoms), while using a different indicator (living on less than $2 a day) it was estimated that the poor had a 5% higher CES-D score than the better off. Individual social capital and religiosity were found to be positively associated with mental health while adverse events were negatively associated. These findings provide support for the established view regarding the deleterious association between poverty and mental health in developed and developing countries.
Aue, Katja; Roosen, Jutta; Jensen, Helen H
Previous studies have found poverty to be related to lower levels of health due to poor health behavior such as unhealthy eating, smoking or less physical activity. Longer periods of poverty seem to be especially harmful for individual health behavior. Studies have shown that poverty has a dynamic character. Moreover, poverty is increasingly regarded as being a multidimensional construct and one that considers more aspects than income alone. Against this background this paper analyzes the relationship between health behavior and persistent spells of income poverty as well as a combined poverty indicator using data of the German Socio-Economic Panel (2000-2010). Next to cross-sectional logistic regression models we estimate fixed-effects models to analyze the effect of persistent poverty on dietary behavior, tobacco consumption, and physical activity. Cross-sectional results suggest that persistent poverty is related to poor health behavior, particularly regarding tobacco consumption and physical activity. Results also show that multidimensional and dynamic aspects of poverty matter. Complementary panel analyses reveal negative effects for the combined poverty indicator only for dietary behavior in the total sample. However, by analyzing the sample by gender we identify further effects of persistent poverty on health behavior. The analyses show that not only do individuals in poverty but also those in precarious situations show health-damaging behavior more often.
Callander, Emily J; Schofield, Deborah J
Longitudinal analysis of Wave 5 to 10 of the nationally representative Household, Income and Labour Dynamics in Australia dataset was undertaken to assess whether multidimensional poverty status can predict chronic income poverty. Of those who were multidimensionally poor (low income plus poor health or poor health and insufficient education attainment) in 2007, and those who were in income poverty only (no other forms of disadvantage) in 2007, a greater proportion of those in multidimensional poverty continued to be in income poverty for the subsequent 5 years through to 2012. People who were multidimensionally poor in 2007 had 2.17 times the odds of being in income poverty each year through to 2012 than those who were in income poverty only in 2005 (95% CI: 1.23-3.83). Multidimensional poverty measures are a useful tool for policymakers to identify target populations for policies aiming to improve equity and reduce chronic disadvantage.
The process of urbanization could be described as one of the major global environmental changes directly affecting human health today. Populations particularly affected are in developing countries where rapid urban growth has been accompanied by massive urban poverty. Urban environmental health impacts, particularly the impact on adults of an environment of poverty, are still poorly understood. Definitions of the urban environment tend to be physical, excluding the complex ramifications of a social setting of disadvantage. This paper provides a brief overview of existing knowledge on the links between environment, poverty and health in urban areas of developing countries, with an emphasis on the policy implications implied by research on health differential between groups within cities. The paper argues that urban poverty and inequalities in conditions between groups within cities present a central crisis confronting urban policy in terms of human health and quality of life. The paper suggests that definitions of the urban environment tend to consider only the physical, and not the social complexity of the urban setting. The review concludes that the scale and the complexity of the urban crisis in developing countries demands a real commitment to re-thinking the management of cities to address multiple deprivation. The paper suggests that this challenges urban professionals who continue to act with a bias towards unintegrated single sector solutions despite claims to the contrary.
This study is based on scientific publications, statistics and field observations. It shows the importance of livestock in the economy and in the risk management strategies implemented by poor farming households. A comparison of livestock performance trends with the evolution of rural poverty in developing countries indicates that growth in livestock production alone is not enough to reduce rural poverty. To help reduce poverty, sustainable production should be based on productivity gains. Prerequisites for improving productivity include better public policies, enhanced research and the reduction of animal disease risk. The study draws attention to the economic, social and environmental consequences of inadequate support for animal health and production in the least developed countries, especially those of sub-Saharan Africa.
Williamson, Swapna; Seewoodhary, Ramesh; Dampies, Lavona
Poverty is a global issue that affects the health and quality of life of millions of people. It predisposes people to many health conditions, including sight loss or blindness as a result of the immune system becoming compromised. Blindness is common in areas of the world where there is extreme poverty. In the UK, poverty has become a major social issue, contributing to many health problems, including eye conditions. These eye conditions can result in sight loss if they are not managed effectively. Psychosocial care is an essential aspect of patient care, because poverty and sight loss are interrelated. Healthcare practitioners have a significant role in the management and prevention of blindness. Blindness caused by poverty is largely preventable, and health promotion is an important strategy in care management.
The right to health as a fundamental human right is enshrined in the World Health Organization’s charter and has been reaffirmed in international agreements spanning decades. This new journal reminds us of the essential characteristic of poverty as a violent abuse of human rights. The context of poverty – its social, political and economic dimensions – remain in the reader’s mind as evidence is provided on technical solutions to managing the infectious diseases that afflict poor populations world-wide. Applying a health systems framework to a discussion on infectious diseases of poverty emerges from the papers in this journal’s first edition. Many of the articles discuss treatments, indicating the importance of pharmaceuticals for neglected diseases. Delivery strategies to reach impoverished populations also figure within this first round of papers. Innovative programs that provide diagnostics and treatment for infectious diseases to hard-to-reach rural and urban communities are needed clearly needed, and some good examples are discussed here. Future editions will explore other health system components, broadening the evidence base to increase understanding of effective and sustainable interventions to reduce the burden of infectious disease among the poor. The editors are to be congratulated on the release of this inaugural issue of the journal Infectious Diseases of Poverty. We look forward to reading subsequent editions. PMID:23848993
Mishra, C P
Since the inception of planning process in India, health planning was an integral component of socio-economic planning. Recommendations of several committees, policy documents and Millennium development goals were instrumental in development of impressive health infrastructure. Several anti-poverty and employment generation programmes were instituted to remove poverty. Spectacular achievements took place in terms of maternal and child health indicators and expectancy of life at birth. However, communicable diseases and undernutrition remain cause of serious concern and non-communicable diseases are imposing unprecedented challenge to planners and policy makers. Estimates of poverty based on different criteria point that it has remained a sustained problem in the country and emphasizes on revisiting anti-poverty programmes, economic policies and social reforms. Poverty affects purchasing power and thereby, food consumption. Energy intake data has inherent limitations. It must be assessed in terms of energy expenditure. Energy balance has been least explored area of research. The studies conducted in three different representative population group of Eastern Uttar Pradesh revealed that 69.63% rural adolescent girls (10-19 years), 79.9% rural reproductive age group females and 62.3% rural geriatric subjects were in negative energy balance. Negative energy balance was significantly less in adolescent girls belonging to high SES (51.37%), having main occupation of family as business (55.3%), and highest per capita income group (57.1%) with respect to their corresponding sub-categories. In case of rural reproductive age groups, this was maximum (93.0%) in SC/ST category and least (65.7%) in upper caste group. In case of geriatric group, higher adjusted Odd's Ratio for negative energy balance for subjects not cared by family members (AOR 23.43, CI 3.93-139.56), not kept money (AOR 5.27, CI 1.58-17.56), belonging to lower and upper middle SES by Udai Pareekh Classification
Richter, L M
Very great advances have occurred in disciplinary and professional knowledge of infant development and its influence on subsequent development. This expertise includes the ways in which early experiences affect the capacity of mature individuals for social adjustment and productive competence, and promising methods of intervention to promote infant mental health and prevent adverse sequelae of risk conditions. However, very little of this knowledge has been applied in work among infants and children living in conditions of poverty and underdevelopment. This lack of application continues despite the enormous threats to the well-being of infants and young children brought about by the combined effects of poverty and the AIDS pandemic, especially in southern Africa. Protein-energy malnutrition, maternal depression, and institutional care of infants and small children are cited as illustrative of areas in which interventions, and their evaluation, are desperately needed in resource-poor countries. An argument is made for the critical importance of considering and addressing psychological factors in care givers and children in conditions of extreme material need. An example is provided of a simple intervention model based on sound developmental principles that can be implemented by trained non-professionals in conditions of poverty and underdevelopment.
Noting that the failures of the U.S. health care system are compounding the problems faced by low-income Americans, Alan Weil argues that any strategy to reduce poverty must provide access to health care for all low-income families. Although nearly all children in families with incomes under 200 percent of poverty are eligible for either Medicaid or the State Children's Health Insurance Program (SCHIP), the parents of poor children often lack health insurance. Parents who leave welfare normally get a year of coverage but then lose coverage unless their employer provides it, and many employers of low-wage workers do not offer health insurance. Similarly, parents who take low-paying jobs to avoid welfare usually have no coverage at all. This lack of coverage discourages adults from working and may also affect the health of children because adults without health insurance are less likely to take their children for preventive care. Weil proposes creating a federal earned income health credit (EIHC) and redefining the federal floor of coverage through Medicaid and SCHIP. His aim is to make health insurance affordable for low-income families and to make sure enough options are available that individuals and families can get coverage using a combination of their own, their employer's, and public resources. Weil would expand Medicaid eligibility to include all families whose income falls below the poverty line. The EIHC would be a refundable tax credit that would be available to parents during the year in advance of filing a tax return. The credit, which would be based on taxpayer earnings and family structure, would phase in as earnings increase, reach a plateau, and then phase out farther up the income scale. The credit would be larger for families with dependents. The EIHC would function seamlessly with the employee payroll withholding system. It would be available only to adults who demonstrate that they had health insurance coverage during the year and, for adults
Girard, Gustavo A
Although poverty is not a new phenomenon, currently it has peculiar characteristics: globalization, inequity, new features in education, exclusion, gender inequalities, marginalization of native peoples and migrations, difficulties found by different sectors to have access to technology, and unemployment. These characteristics are seen not only in countries considered to be developing nations, but affect the whole world. The present international financial crisis, this time originating in industrialized countries, represents an aggravating factor, the consequences of which are still difficult to estimate. It has a particular impact on adolescents and young people in terms of health as a whole, mortality rates, violence, nutrition, reproductive health, HIV/AIDS, substance abuse, mental health, and disabilities, all being aggravated by the difficulties of access to ap propriate health services. Social capital is seriously affected, and this entails a strong and deleterious impact not only on present generations but also on future ones. It is a challenge that cannot be ignored.
This article opens by tabulating selected family planning (FP) indicators from the 24 poorest countries (those with a gross national product (GNP) of up to $300 per capita). Consideration of what is poverty and who are the poor concludes that poverty is hard to define but that is it a combination of low income, low life expectancy, illiteracy, and low educational levels; that is, the result of a denial of choices and opportunities. The poorest countries by this criteria differ somewhat from the poorest chosen according to GNP, but most are located in sub-Saharan Africa. The use of national data is complicated by the fact that huge differences exist between rich and poor within countries. The poorest countries have the lowest use of FP, the most restrictive abortion laws, high incidences of mortality associated with unsafe abortion, and high maternal mortality rates. International population and FP assistance is embarrassingly low and unfairly allocated. International assistance must be increased to break the cycle of poverty and improve reproductive health. The International Planned Parenthood Federation (IPPF) believes that improvement of reproductive health for the impoverished is a basic condition for human development and reduction of global inequity. In its policy statement on this topic, the IPPF recommends that local FP associations 1) constantly reevaluate how to maximize their impact on the most vulnerable, 2) be pioneers in the field of sexual and reproductive health, 3) reassess priorities in light of diminishing donor funding, 4) become advocates for increased resources and to further the work they are undertaking, and 5) strengthen collaboration with other development agencies working in the field.
Strasser, Sheryl; Smith, Megan O.; Pendrick Denney, Danielle; Jackson, Matt C.; Buckmaster, Pam
Background: Poverty is a pervasive condition linked to a myriad of health conditions and severe health outcomes. Public health professionals are at the forefront of addressing poverty-related issues and require education that enhances their understanding and cultural competence. Purpose: The purpose of this research was to evaluate the impacts of…
Almost half of young children in the United States live in poverty or near poverty. The American Academy of Pediatrics is committed to reducing and ultimately eliminating child poverty in the United States. Poverty and related social determinants of health can lead to adverse health outcomes in childhood and across the life course, negatively affecting physical health, socioemotional development, and educational achievement. The American Academy of Pediatrics advocates for programs and policies that have been shown to improve the quality of life and health outcomes for children and families living in poverty. With an awareness and understanding of the effects of poverty on children, pediatricians and other pediatric health practitioners in a family-centered medical home can assess the financial stability of families, link families to resources, and coordinate care with community partners. Further research, advocacy, and continuing education will improve the ability of pediatricians to address the social determinants of health when caring for children who live in poverty. Accompanying this policy statement is a technical report that describes current knowledge on child poverty and the mechanisms by which poverty influences the health and well-being of children.
Anakwenze, Ujunwa; Zuberi, Daniyal
Rapid urbanization globally threatens to increase the risk to mental health and requires a rethinking of the relationship between urban poverty and mental health. The aim of this article is to reveal the cyclic nature of this relationship: Concentrated urban poverty cultivates mental illness, while the resulting mental illness reinforces poverty. The authors used theories about social disorganization and crime to explore the mechanisms through which the urban environment can contribute to mental health problems. They present some data on crime, substance abuse, and social control to support their claim that mental illness reinforces poverty. The authors argue that, to interrupt this cycle and improve outcomes, social workers and policymakers must work together to implement a comprehensive mental health care system that emphasizes prevention, reaches young people, crosses traditional health care provision boundaries, and involves the entire community to break this cycle and improve the outcomes of those living in urban poverty.
Burns, J K
The relationship between poverty and mental health is indisputable. However, to have an influence on the next set of sustainable global development goals, we need to understand the causal relationships between social determinants such as poverty, inequality, lack of education and unemployment; thereby clarifying which aspects of poverty are the key drivers of mental illness. Some of the major challenges identified by Lund (2014) in understanding the poverty-mental health relationship are discussed including: the need for appropriate poverty indicators; extending this research agenda to a broader range of mental health outcomes; the need to engage with theoretical concepts such as Amartya Sen's capability framework; and the need to integrate the concept of income/economic inequality into studies of poverty and mental health. Although income inequality is a powerful driver of poor physical and mental health outcomes, it features rarely in research and discourse on social determinants of mental health. This paper interrogates in detail the relationships between poverty, income inequality and mental health, specifically: the role of income inequality as a mediator of the poverty-mental health relationship; the relative utility of commonly used income inequality metrics; and the likely mechanisms underlying the impact of inequality on mental health, including direct stress due to the setting up of social comparisons as well as the erosion of social capital leading to social fragmentation. Finally, we need to interrogate the upstream political, social and economic causes of inequality itself, since these should also become potential targets in efforts to promote sustainable development goals and improve population (mental) health. In particular, neoliberal (market-oriented) political doctrines lead to both increased income inequality and reduced social cohesion. In conclusion, understanding the relationships between politics, poverty, inequality and mental health
Das, Jishnu; Do, Quy-Toan; Friedman, Jed; McKenzie, David; Scott, Kinnon
The relationship between poverty and mental health has received considerable attention in the recent literature. However, the associations presented in existing studies typically rely on limited samples of individuals and on proxy indicators for poverty such as education, the lack of tap water, or being unemployed. We revisit the relationship between poverty and mental health using data from nationally representative household surveys in Bosnia and Herzegovina, Indonesia and Mexico, along with special surveys from India and Tonga. As in previous studies, we find that individuals who are older, female, widowed, and in poor health are more likely to report worse mental health outcomes. Individuals living with others with poor mental health are significantly more likely to report worse mental health themselves. The size of the coefficients and their significance are comparable across the five countries. In contrast to previous studies, the relationship between higher education and better mental health is weak or non-existent. Furthermore, there is no consistent association between consumption poverty and mental health - in two countries mental health measures are marginally worse for the poor; in two countries there is no association; and in one country mental health measures are better for the poor compared to the non-poor. Moreover, the sizes of the coefficients for both education and consumption poverty are small compared to other factors considered here. While the lack of an association between consumption poverty and mental health implies that poor mental health is not a "disease of affluence", neither is it a disease of poverty. Changes in life circumstances brought on, for instance, by illness may have a greater impact on mental health than levels of poverty. Effective public health policy for mental health should focus on protecting individuals and households from adverse events and on targeted interventions following such adverse changes.
Fierman, Arthur H; Beck, Andrew F; Chung, Esther K; Tschudy, Megan M; Coker, Tumaini R; Mistry, Kamila B; Siegel, Benjamin; Chamberlain, Lisa J; Conroy, Kathleen; Federico, Steven G; Flanagan, Patricia J; Garg, Arvin; Gitterman, Benjamin A; Grace, Aimee M; Gross, Rachel S; Hole, Michael K; Klass, Perri; Kraft, Colleen; Kuo, Alice; Lewis, Gena; Lobach, Katherine S; Long, Dayna; Ma, Christine T; Messito, Mary; Navsaria, Dipesh; Northrip, Kimberley R; Osman, Cynthia; Sadof, Matthew D; Schickedanz, Adam B; Cox, Joanne
Child poverty in the United States is widespread and has serious negative effects on the health and well-being of children throughout their life course. Child health providers are considering ways to redesign their practices in order to mitigate the negative effects of poverty on children and support the efforts of families to lift themselves out of poverty. To do so, practices need to adopt effective methods to identify poverty-related social determinants of health and provide effective interventions to address them. Identification of needs can be accomplished with a variety of established screening tools. Interventions may include resource directories, best maintained in collaboration with local/regional public health, community, and/or professional organizations; programs embedded in the practice (eg, Reach Out and Read, Healthy Steps for Young Children, Medical-Legal Partnership, Health Leads); and collaboration with home visiting programs. Changes to health care financing are needed to support the delivery of these enhanced services, and active advocacy by child health providers continues to be important in effecting change. We highlight the ongoing work of the Health Care Delivery Subcommittee of the Academic Pediatric Association Task Force on Child Poverty in defining the ways in which child health care practice can be adapted to improve the approach to addressing child poverty.
Hanandita, Wulung; Tampubolon, Gindo
That poverty and mental health are negatively associated in developing countries is well known among epidemiologists. Whether the relationship is causal or associational, however, remains an open question. This paper aims to estimate the causal effect of poverty on mental health by exploiting a natural experiment induced by weather variability across 440 districts in Indonesia (N = 577,548). Precipitation anomaly in two climatological seasons is used as an instrument for poverty status, which is measured using per capita household consumption expenditure. Results of an instrumental variable estimation suggest that poverty causes poor mental health: halving one's consumption expenditure raises the probability of suffering mental illness by 0.06 point; in terms of elasticity, a 1% decrease in consumption brings about 0.62% more symptoms of common mental disorders. This poverty effect is approximately five times stronger than that obtained prior to instrumenting and is robust to alternative distributional assumption, model specification, sample stratification and estimation technique. An individual's mental health is also negatively correlated with district income inequality, suggesting that income distribution may have a significant influence upon mental health over and above the effect of poverty. The findings imply that mental health can be improved not only by influencing individuals' health knowledge and behaviour but also by implementing a more equitable economic policy.
Elliott, John O; Charyton, Christine; Lu, Bo; Moore, J Layne
Epidemiology literature demonstrates socioeconomic status as an important variable for outcomes in persons with epilepsy. However, no previous studies have analyzed the association between poverty and epilepsy in the United States. Forty-one percent (246/604) of persons with a history of epilepsy (PWHE) in the 2005 California Health Interview Survey (n=43,020) had an annual income <200% Federal Poverty Level (FPL), adjusted lifetime prevalence rate 0.5% [98.33% CI 0.4-0.7]. Four groups are presented in the analyses: (1) those with a history of epilepsy <200% FPL, (2) those with a history of epilepsy > or =200% FPL, (3) those not reporting a history of epilepsy <200% FPL and (4) those not reporting a history of epilepsy > or =200% FPL. PWHE in poverty reported significantly higher amounts of serious psychological distress, based on the validated Kessler 6 (K6) scale, than both non-epilepsy populations. After adjusting for demographics and other comorbid conditions, logistic regression analyses show PWHE in poverty are significantly more likely to report fair or poor self-rated health status when compared to the PWHE not in poverty and both non-epilepsy populations. PWHE in poverty are also more likely to report > or =14 generally unhealthy days and > or =14 physically unhealthy days in the past 30 days compared to the PWHE not in poverty and both non-epilepsy populations. Psychological well-being needs to be incorporated into any comprehensive treatment strategy for managing epilepsy.
da Fonseca, Marcio A
According to the US Census Bureau, the poverty rate for children under 18 years of age increased to 22% in 2010. Poverty leads to adverse health outcomes in children and adolescents such as harmful effects on learning, psychosocial development, physical health, productivity and family life. Because the citizens and residents of a country are its most valuable assets, it is unwise to allow housing instability, food insecurity and hunger to continue to exist at its current levels. Reducing poverty is likely to prevent illnesses, decrease hospitalizations, and lead to lower health care costs. There is also a need for intervention strategies to ensure equitable access to healthy foods across the world. Children who are food insecure are more likely to be in poor health and to have poor nutritional outcomes. Poverty may lead to poor dental health due to malnutrition or incorrect diet and it may also have an effect on the child's behavior in the dental office. An understanding of poverty will lessen the anger, frustration and prejudice that pediatric dentists may feel when working with low-income families. This manuscript presents a concise overview of the effects of poverty in children's lives.
The experience of poverty during childhood is a potent predictor of a variety of adverse health outcomes during middle and late adulthood. Children who live in poverty are more likely as adults than their peers to develop and die earlier from a range of diseases. These effects are especially strong for cardiovascular disease and type II diabetes. Most disturbingly, these effects appear in large part to be biologically embedded such that later improved life circumstances have only a modest ameliorative effect. Considering these findings and the relatively high rates of child poverty in nations such as Canada, UK, and USA, those concerned with improving the health of citizens should focus their attention on advocating for public policy that will reduce the incidence of child poverty.
Thomas, Stephen B; Quinn, Sandra Crouse
The aim of this article is to examine the intersection of race and poverty, two critical factors fueling persistent racial and ethnic health disparities among urban populations. From the morass of social determinants that shape the health of racial and ethnic communities in our urban centers, we will offer promising practices and potential solutions to eliminating racial and ethnic health disparities.
Snowden, Lonnie R
African Americans' poverty and deep-poverty rates are higher than those of Whites, and African Americans' poverty spells last longer. Furthermore, nonpoor African Americans are especially likely to slip into poverty, and over the course of a lifetime, very many African Americans will experience poverty. Accordingly, African Americans are disproportionately likely to be assisted by safety net programs providing income support and health and social assistance. When mental health-related outcomes are assessed, U.S.-focused and international studies of safety net programs sometimes find that adults and children show a decline in symptoms of mental illness after participating. All things being equal, these improvements can disproportionately benefit African Americans' mental health. Safety net programs' mental health-related impact should be routinely assessed when evaluating the programs' economic and social outcomes and the impact they have on African Americans' mental health. Policy research of this kind can help us to understand whether these very large interventions show society-wide mental health-related improvement in the disproportionately large number of African Americans who participate in them.
Adena, Maja; Myck, Michal
Using a sample of Europeans aged 50+ from 12 countries in the Survey of Health, Ageing and Retirement in Europe (SHARE), we analyse the role of poor material conditions as a determinant of changes in health over a four- to five-year period. We find that poverty defined with respect to relative income has no effect on changes in health. However, broader measures of poor material conditions, such as subjective poverty or low wealth, significantly increase the probability of transition to poor health among the healthy and reduce the chance of recovery from poor health over the time interval analysed. In addition to this, the subjective measure of poverty has a significant effect on mortality, increasing it by 65% among men and by 68% among those aged 50-64. Material conditions affect health among older people. We suggest that if attempts to reduce poverty in later life and corresponding policy targets are to focus on the relevant measures, they should take into account broader definitions of poverty than those based only on relative incomes.
Lieberman, Alicia F.; Osofsky, Joy D.
Young children growing up in poverty face chronic risk factors, including abuse and neglect, severe maternal depression, parental substance abuse, harsh parenting, and family and community violence as well as greater exposure to physical risks, including substandard housing, lack of access to resources, and environmental toxins. The authors offer…
Fuller-Rowell, Thomas E; Evans, Gary W; Ong, Anthony D
Social-class discrimination is evident in many societies around the world, but little is known about its impact on the poor or its role as an explanatory variable in the link between socioeconomic status and health. The current study tested the extent to which perceived discrimination explains socioeconomic gradients in physical health. Participants were 252 adolescents (51% male, 49% female; mean age = 17.51 years, SD = 1.03 years) who participated in Wave 3 of an ongoing longitudinal study focusing on the developmental consequences of rural poverty. Physical health was operationalized as allostatic load, a measure of cumulative wear and tear on the body caused by overactivation of physiological systems that respond to stress. Mediation analyses suggested that 13% of the effect of poverty on allostatic load is explained by perceived discrimination. The findings suggest that social-class discrimination is one important mechanism behind the influence of poverty on physical health.
Yehya, Nadine A; Dutta, Mohan J
With the global financial meltdown, the crisis of poverty has deepened in communities across the United States. This essay reports results from a culture-centered project on fostering spaces for listening to the voices of the poor in CrossRoads County, Indiana. It highlights the intersections of health and poverty as they emerge from the narratives of mothers utilizing the Supplemental Nutrition Program for Women, Infants, and Children (WIC). Depression, humiliation, and inaccessibility to health care and healthy living outline the struggles of women as they negotiate their access to health. The articulations of agency are situated around competing cultural narratives that, on the one hand, draw on the threads of individual responsibility which resonate through mainstream discourses of poverty in the United States and, on the other hand, interrogate the structural erasure of the basic capacities of health.
Wherry, Laura R; Kenney, Genevieve M; Sommers, Benjamin D
Over the past 30 years, there have been major expansions in public health insurance for low-income children in the United States through Medicaid, the Children's Health Insurance Program (CHIP), and other state-based efforts. In addition, many low-income parents have gained Medicaid coverage since 2014 under the Affordable Care Act. Most of the research to date on health insurance coverage among low-income populations has focused on its effect on health care utilization and health outcomes, with much less attention to the financial protection it offers families. We review a growing body of evidence that public health insurance provides important financial benefits to low-income families. Expansions in public health insurance for low-income children and adults are associated with reduced out of pocket medical spending, increased financial stability, and improved material well-being for families. We also review the potential poverty-reducing effects of public health insurance coverage. When out of pocket medical expenses are taken into account in defining the poverty rate, Medicaid plays a significant role in decreasing poverty for many children and families. In addition, public health insurance programs connect families to other social supports such as food assistance programs that also help reduce poverty. We conclude by reviewing emerging evidence that access to public health insurance in childhood has long-term effects for health and economic outcomes in adulthood. Exposure to Medicaid and CHIP during childhood has been linked to decreased mortality and fewer chronic health conditions, better educational attainment, and less reliance on government support later in life. In sum, the nation's public health insurance programs have many important short- and long-term poverty-reducing benefits for low-income families with children.
Wherry, Laura R.; Kenney, Genevieve M.; Sommers, Benjamin D.
Over the last thirty years, there have been major expansions in public health insurance for low-income children in the U.S. through Medicaid, the Children’s Health Insurance Program (CHIP), and other state-based efforts. In addition, many low-income parents have gained Medicaid coverage since 2014 under the Affordable Care Act. Most of the research to date on health insurance coverage among low-income populations has focused on its impact on health care utilization and health outcomes, with much less attention to the financial protection it offers families. We review a growing body of evidence that public health insurance provides important financial benefits to low-income families. Expansions in public health insurance for low-income children and adults are associated with reduced out-of-pocket medical spending, increased financial stability, and improved material well-being for families. We also review the potential poverty-reducing effects of public health insurance coverage. When out-of-pocket medical expenses are taken into account in defining the poverty rate, Medicaid plays a significant role in decreasing poverty for many children and families. In addition, public health insurance programs connect families to other social supports such as food assistance programs that also help reduce poverty. We conclude by reviewing emerging evidence that access to public health insurance in childhood has long-term effects for both health and economic outcomes in adulthood. Exposure to Medicaid and CHIP during childhood has been linked to decreased mortality and fewer chronic health conditions, better educational attainment, and less reliance on government support later in life. In sum, the nation’s public health insurance programs have many important short and long-term poverty-reducing benefits for low-income families with children. PMID:27044710
Bauer, Irmgard L
The spectrum of challenges for public health in a global context is ever expanding. It is difficult for health professionals to keep informed about details of key issues affecting global health determinants such as poverty. Tourism is seen as one strategy to eliminate poverty in developing countries and to improve global health, but the industry struggles with keeping its promise. Apart from often negative impacts on the well-being of local communities, it also turns out not to be as altruistic as it appears at first sight. Discourses largely focus on power and control of the non-poor over the poor despite all the rhetoric to the contrary. Economic aspects still dictate the debate rather than local people's understanding of well-being. Only with a major shift in the approach to local populations, acknowledging the communities' right to self-determination and accepting them as equal partners with access to genuine benefits, will this disturbing imbalance be redressed and allow better health for more people possible. Public health professionals should question claims about the beneficial influence of tourism in poor regions and not lower their vigilance for poverty-related health problems, so that the poor are not overlooked when all other stakeholders are busy with their own agenda.
We use data from the British Household Panel Survey to analyse changes in poverty of self-reported health from 1991 to 2008. We use the indices recently introduced by Bennett and Hatzimasoura (Poverty measurement with ordinal data. Institute for International Economic Policy, IIEP-WP-2011-14, 2011), which can be interpreted as ordinal counterparts of the classical Foster et al. (Econometrica 52(3):761-766, 1984) poverty measures. We decompose changes in self-reported health poverty over time into within-group health poverty changes and population shifts between groups. We also provide statistical inference for the Bennett and Hatzimasoura's (Poverty measurement with ordinal data. Institute for International Economic Policy, IIEP-WP-2011-14, 2011) indices. Results suggest that when "fair" self-reported health status is chosen as a health poverty threshold all of the used indices indicate the growth of health poverty in Britain. However, when the health poverty threshold is lower ("poor" self-reported health status) the increase in health poverty incidence was compensated by decreasing average health poverty depth and improving health inequality among those who are poor with respect to health. The subgroup decompositions suggest that the most important factors accounting for the changes in total health poverty in Britain include a rise of both health poverty and population shares of persons cohabiting and couples with no children as well as an increase of the population of retired persons.
Sicchia, Suzanne R; Maclean, Heather
Poverty and other forms of inequity undermine individual and population health and retard development. Although absolute poverty has reportedly declined in recent years, research suggests that relative poverty or the gap between the rich and poor within and between countries has been exacerbated over this same period. There is growing concern about the feminization of poverty, and the impact globalization is having on this important social problem. Gender inequality persists in all regions, and women and girls continue to be over-represented among the world's poor. This suggests that women are not consistently benefitting from the economic, political and social gains globalization can offer. Instead, it appears that poor women and girls, particularly those living in developing countries, are disproportionately burdened by the costs of these swift changes to the detriment of their personal health and well-being. Immediate action is needed to correct these disparities and ensure that globalization supports both national and international commitments to poverty reduction, and the, promotion of women's health and human rights.
Coll-Black, Sarah; Bhushan, Anjana; Fritsch, Kathleen
Evidence increasingly shows that poverty and gender inequalities are important determinants of health and influence the opportunity for timely and appropriate health care. These findings suggest that health professionals need to have a sound understanding of health inequalities and their causes, as well as of how they can be addressed. However, through surveys to health ministries and educational institutions in 2001, the World Health Organization Regional Office for the Western Pacific found that awareness of, and capacity to respond to, poverty and gender concerns in health was weak. In response, the Regional Office initiated a project to develop materials to support the integration of poverty and gender concerns into health professional education curricula. The multimodule publication, Integrating Poverty and Gender into Health Programmes: A Sourcebook for Health Professionals, supports evidence-based and participatory learning. The experience to date suggests that the publication might be meeting a long-felt need for such a response.
Duncan, Greg J.; Ziol-Guest, Kathleen M.; Kalil, Ariel
This article assesses the consequences of poverty between a child's prenatal year and 5th birthday for several adult achievement, health, and behavior outcomes, measured as late as age 37. Using data from the Panel Study of Income Dynamics (1,589) and controlling for economic conditions in middle childhood and adolescence, as well as demographic…
There is a huge global burden of disease and mortality. The principal underlying cause is regarded as poverty. This is associated with a global order of fear, over-consumption, over-population and violence, which can interact in a vicious circle. It is proposed that the solution to the problem is not only the relief of poverty, but the institution of a new order in which the individual is sovereign. This in turn requires a trinity of ideals for the individual: self-control to avoid over-consumption, altruism to cope with fear, and peace to manage violence.
Animals are vital to ensuring food security for individuals, families and communities in countries around the world. In this, the latest article in Veterinary Record's series promoting One Health, Andy Stringer, director of veterinary programmes at the Society for the Protection of Animals Abroad, discusses how improving animal health, particularly of poultry and working equids, has the potential to reduce poverty and promote food security and sustainable livelihoods in low-income countries.
Abernathy, Thomas J.; Webster, Greg; Vermeulen, Marian
Examines data on 1,759 adolescents to assess the effect of low socioeconomic status on their health. Results confirm the relationship between income and health. Explains how the pathway to poor health care operates through the social environment, lifestyle differences, access to care, and self-esteem problems. Findings do suggest that physical…
Kim, Jinhyun; Yang, Bong-Min; Lee, Tae-Jin; Kang, Eunjeong
An empirical perspective on the relationship between health and poverty is examined in Korea. Combining selection and causation models, the authors developed a simultaneous equations system with health and poverty as exogenous variables. Based on a national health survey, the possible impact of health on household poverty was tested. The authors found that poor health determines household poverty in several ways, controlling for other confounding factors. Feasible strategies to reduce illness in low-income classes include monitoring the poor with their health status, extending the Medicaid program, and expanding public hospitals for the poor class to access to health services.
Kirkwood Community Coll., Cedar Rapids, IA.
This document contains materials for a college course in health management developed for the State of Iowa. The course syllabus lists the course title, hours, number, description, prerequisites, learning activities, instructional units, required text, 13 references, evaluation criteria, course objectives, and course competencies. It is followed by…
Ross, Lori E; O'Gorman, Laurel; MacLeod, Melissa A; Bauer, Greta R; MacKay, Jenna; Robinson, Margaret
Bisexuality is consistently associated with poor mental health outcomes. In population-based data, this is partially explained by income differences between bisexual people and lesbian, gay, and/or heterosexual individuals. However, the interrelationships between bisexuality, poverty, and mental health are poorly understood. In this paper, we examine the relationships between these variables using a mixed methods study of 302 adult bisexuals from Ontario, Canada. Participants were recruited using respondent-driven sampling to complete an internet-based survey including measures of psychological distress and minority stress. A subset of participants completed a semi-structured qualitative interview to contextualize their mental health experiences. Using information regarding household income, number of individuals supported by the income and geographic location, participants were categorized as living below or above the Canadian Low Income Cut Off (LICO). Accounting for the networked nature of the sample, participants living below the LICO had significantly higher mean scores for depression and posttraumatic stress disorder symptoms and reported significantly more perceived discrimination compared to individuals living above the LICO. Grounded theory analysis of the qualitative interviews suggested four pathways through which bisexuality and poverty may intersect to impact mental health: through early life experiences linked to bisexuality or poverty that impacted future financial stability; through effects of bisexual identity on employment and earning potential; through the impact of class and sexual orientation discrimination on access to communities of support; and through lack of access to mental health services that could provide culturally competent care. These mixed methods data help us understand the income disparities associated with bisexual identity in population-based data, and suggest points of intervention to address their impact on bisexual mental
Striking disparities in access to healthcare and in health outcomes are major characteristics of health across the globe. This inequitable state of global health and how it could be improved has become a highly popularized field of academic study. In a series of articles in this journal the roles of power and politics in global health have been addressed in considerable detail. Three points are added here to this debate. The first is consideration of how the use of definitions and common terms, for example 'poverty eradication,' can mask full exposure of the extent of rectification required, with consequent failure to understand what poverty eradication should mean, how this could be achieved and that a new definition is called for. Secondly, a criticism is offered of how the term 'global health' is used in a restricted manner to describe activities that focus on an anthropocentric and biomedical conception of health across the world. It is proposed that the discourse on 'global health' should be extended beyond conventional boundaries towards an ecocentric conception of global/planetary health in an increasingly interdependent planet characterised by a multitude of interlinked crises. Finally, it is noted that the paucity of workable strategies towards achieving greater equity in sustainable global health is not so much due to lack of understanding of, or insight into, the invisible dimensions of power, but is rather the outcome of seeking solutions from within belief systems and cognitive biases that cannot offer solutions. Hence the need for a new framing perspective for global health that could reshape our thinking and actions.
Chowdhury, A Mushtaque R; Bhuiya, Abbas; Chowdhury, Mahbub Elahi; Rasheed, Sabrina; Hussain, Zakir; Chen, Lincoln C
Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the first paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing women-centred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households. Government and non-governmental organisations have pioneered many innovations that have been scaled up nationally. However, these remarkable achievements in equity and coverage are counterbalanced by the persistence of child and maternal malnutrition and the low use of maternity-related services. The Bangladesh paradox shows the net outcome of successful direct health action in both positive and negative social determinants of health--ie, positives such as women's empowerment, widespread education, and mitigation of the effect of natural disasters; and negatives such as low gross domestic product, pervasive poverty, and the persistence of income inequality. Bangladesh offers lessons such as how gender equity can improve health outcomes, how health innovations can be scaled up, and how direct health interventions can partly overcome socioeconomic constraints.
dos Santos Oliveira, Simone Helena; Alves Monteiro, Maria Adelane; Vieira Lopes, Maria do Socorro; Silva de Brito, Daniele Mary; Vieira, Neiva Francenely Cunha; Barroso, Maria Grasiela Teixeira; Ximenes, Lorena Barbosa
The population impoverishment is a social reality whose overcoming is necessary so that we can think about health as a positive concept. This study proposes a reflection on the coping strategies adopted by the Conjunto Palmeira, a Brazilian community in the Northeast, and their interface with health promotion. This community's reality is an example of overcoming social exclusion for different regions of Brazil and other countries. The history of the Conjunto and the collective strategies of empowerment for coping with poverty and search for human development are initially presented. After that, we establish the relationship of those strategies with the action fields for health promotion. Finally, we consider that the mutual responsibility of the community with its health and its relationship with the environment in which they live are means of promoting transformation towards the conquest of a worthy social space.
Striking disparities in access to healthcare and in health outcomes are major characteristics of health across the globe. This inequitable state of global health and how it could be improved has become a highly popularized field of academic study. In a series of articles in this journal the roles of power and politics in global health have been addressed in considerable detail. Three points are added here to this debate. The first is consideration of how the use of definitions and common terms, for example ‘poverty eradication,’ can mask full exposure of the extent of rectification required, with consequent failure to understand what poverty eradication should mean, how this could be achieved and that a new definition is called for. Secondly, a criticism is offered of how the term ‘global health’ is used in a restricted manner to describe activities that focus on an anthropocentric and biomedical conception of health across the world. It is proposed that the discourse on ‘global health’ should be extended beyond conventional boundaries towards an ecocentric conception of global/planetary health in an increasingly interdependent planet characterised by a multitude of interlinked crises. Finally, it is noted that the paucity of workable strategies towards achieving greater equity in sustainable global health is not so much due to lack of understanding of, or insight into, the invisible dimensions of power, but is rather the outcome of seeking solutions from within belief systems and cognitive biases that cannot offer solutions. Hence the need for a new framing perspective for global health that could reshape our thinking and actions. PMID:27694651
Fitzsimons, Emla; Goodman, Alissa; Kelly, Elaine; Smith, James P
Using data from the British Millennium Cohort Study (MCS), an ongoing longitudinal study of a cohort of 18,827 children born in the UK in 2000-2001, we investigate important correlates of mental health issues during childhood. MCS respondents were sampled at birth, at age 9 months, and then when they were 3, 5, 7 and 11 years old. Each sweep contains detailed information on the family's SES, parenting activities, developmental indicators, parental relationship status, and indicators of parental mental health. The Strengths and Difficulties Questionnaire (SDQ) and the related Rutter scale were used to identify behavioral and emotional problems in children. In this paper, childhood problems are separated into four domains: hyperactivity, emotional symptoms, conduct problems, and peer problems. We focus on two aspects of this relationship at ages 5 and 11-the role of temporary and persistent poverty and the role of temporary and persistent mental health problems of mothers and fathers. At ages 11 and 5, without other controls in the model, persistent and transitory poverty have strong estimated associations with all four domains, with somewhat stronger estimated effects for persistent poverty. After a set of controls are added, we document that both persistent levels of poverty and transitions into poverty are strongly associated with levels of and transitions into childhood mental health problems. Similarly, sustained levels and transitions into mothers' mental health problems are strongly associated with levels and transitions into children's mental health problems. This is much less so for fathers.
Sedda, Luigi; Tatem, Andrew J.; Morley, David W.; Atkinson, Peter M.; Wardrop, Nicola A.; Pezzulo, Carla; Sorichetta, Alessandro; Kuleszo, Joanna; Rogers, David J.
Background Previous analyses have shown the individual correlations between poverty, health and satellite-derived vegetation indices such as the normalized difference vegetation index (NDVI). However, generally these analyses did not explore the statistical interconnections between poverty, health outcomes and NDVI. Methods In this research aspatial methods (principal component analysis) and spatial models (variography, factorial kriging and cokriging) were applied to investigate the correlations and spatial relationships between intensity of poverty, health (expressed as child mortality and undernutrition), and NDVI for a large area of West Africa. Results This research showed that the intensity of poverty (and hence child mortality and nutrition) varies inversely with NDVI. From the spatial point-of-view, similarities in the spatial variation of intensity of poverty and NDVI were found. Conclusions These results highlight the utility of satellite-based metrics for poverty models including health and ecological components and, in general for large scale analysis, estimation and optimisation of multidimensional poverty metrics. However, it also stresses the need for further studies on the causes of the association between NDVI, health and poverty. Once these relationships are confirmed and better understood, the presence of this ecological component in poverty metrics has the potential to facilitate the analysis of the impacts of climate change on the rural populations afflicted by poverty and child mortality. PMID:25733559
Karim, F; Tripura, A; Gani, M S; Chowdhury, A M R
Many studies have examined the health inequities between different social groups, often measured by individual independent variables, such as education, gender, ethnicity, geography, rich, poor, etc. Although inequities are increasingly widening, a few studies have looked at the health inequity between different poverty groups within the poor. The present study, using equity terms, examined the use of health services in two rural areas of Bangladesh. Using a multistage sampling method, a total of 80 villages were selected from the Bogra and Dinajpur sadar thanas (subdistricts) for the study. A total of 4003 households in these villages were visited for data collection on mortality and fertility, while data related to use of health services was collected from a subsample of 1032 households. A poverty index, constructed using three variables (household landholding, education level of head of household, and self-rated categorization of household's annual food security), categorized the households into three groups: extreme poor, moderate poor and non-poor. Overall, the data revealed considerable inequities in many study indicators between the poor and the non-poor. However, inequities of varying degrees were also found between the extreme poor and the moderate poor. Lower levels of inequities were found between the poor and the non-poor in the use of health services, which were easily accessible and free of charge (immunization, vitamin A capsule, etc.). On the whole, the extreme poor were less likely to use health services than the moderate poor and the non-poor, suggesting the need for a more appropriate programme to address their pressing health needs.
Beeber, Linda S.; Perreira, Krista M.; Schwartz, Todd
Poverty increases maternal stress by heightening exposure to negative life events, job loss, chronic strains, poor housing, dangerous neighborhoods, and conflict with partners, culminating in crippling depressive symptoms, the most prevalent mental health threat. Depressive symptoms interfere with the provision of the strong maternal support needed to counter the hardships of poverty, thus placing infants and toddlers at risk for delayed language, social, and emotional development. Initial clinical trials in high-risk mothers have shown promise, and successive tests of interventions will be strengthened if mothers who have mental health risks can be accurately targeted for inclusion. This article reports on a sequential, data-driven process by which high-risk mothers were targeted for intervention in two trials currently in progress to reduce depressive symptoms. An iterative process of using data to identify at-risk mothers and validate the presence of risk factors helped hone the recruitment and design of the intervention trials. This report also offers guidance for further study. PMID:17954677
Wickham, Sophie; Anwar, Elspeth; Barr, Ben; Law, Catherine; Taylor-Robinson, David
There are currently high levels of child poverty in the UK, and for the first time in almost two decades child poverty has started to rise in absolute terms. Child poverty is associated with a wide range of health-damaging impacts, negative educational outcomes and adverse long-term social and psychological outcomes. The poor health associated with child poverty limits children's potential and development, leading to poor health and life chances in adulthood. This article outlines some key definitions with regard to child poverty, reviews the links between child poverty and a range of health, developmental, behavioural and social outcomes for children, describes gaps in the evidence base and provides an overview of current policies relevant to child poverty in the UK. Finally, the article outlines how child health professionals can take action by (1) supporting policies to reduce child poverty, (2) providing services that reduce the health consequences of child poverty and (3) measuring and understanding the problem and assessing the impact of action.
Wickham, Sophie; Anwar, Elspeth; Barr, Ben; Law, Catherine; Taylor-Robinson, David
There are currently high levels of child poverty in the UK, and for the first time in almost two decades child poverty has started to rise in absolute terms. Child poverty is associated with a wide range of health-damaging impacts, negative educational outcomes and adverse long-term social and psychological outcomes. The poor health associated with child poverty limits children's potential and development, leading to poor health and life chances in adulthood. This article outlines some key definitions with regard to child poverty, reviews the links between child poverty and a range of health, developmental, behavioural and social outcomes for children, describes gaps in the evidence base and provides an overview of current policies relevant to child poverty in the UK. Finally, the article outlines how child health professionals can take action by (1) supporting policies to reduce child poverty, (2) providing services that reduce the health consequences of child poverty and (3) measuring and understanding the problem and assessing the impact of action. PMID:26857824
Buytaert, W.; Baez, S.; Veliz Rosas, C.
Over the last decades, near real-time environmental observation, technical advances in computer power and cyber-infrastructure, and the development of environmental software algorithms have increased dramatically. The integration of these evolutions is one of the major challenges of the next decade for environmental sciences. Worldwide, many coordinated activities are ongoing to make this integration a reality. However, far less attention is paid to the question of how these developments can benefit environmental services management in a poverty alleviation context. Such projects are typically faced with issues of large predictive uncertainties, limited resources, limited local scientific capacity. At the same time, the complexity of the socio-economic contexts requires a very strong bottom-up oriented and interdisciplinary approach to environmental data collection and processing. Here, we present the results of two projects on integrated environmental monitoring and scenario analysis aimed at poverty alleviation in the Peruvian Andes and Amazon. In the upper Andean highlands, farmers are monitoring the water cycle of headwater catchments to analyse the impact of land-use changes on stream flow and potential consequences for downstream irrigation. In the Amazon, local communities are monitoring the dynamics of turtle populations and their relations with river levels. In both cases, the use of online databases and web processing services enable real-time analysis of the data and scenario analysis. The system provides both physical and social indicators to assess the impact of land-use management options on local socio-economic development.
Health insecurity has emerged as a major concern among health policy-makers particularly in low- and middle-income countries (LMICs). It includes the inability to secure adequate healthcare today and the risk of being unable to do so in the future as well as impoverishing healthcare expenditure. The increasing health insecurity among 150 million of the world's poor has moved social protection in health (SPH) to the top of the agenda among health policy-makers globally. This paper aims to provide a debate on the potential of social protection contribution to addressing health insecurity, poverty, and vulnerability brought by healthcare expenditure in low-income countries, to explore the gaps in current and proposed social protection measures in healthcare and provide suggestions on how social protection intervention aimed at addressing health insecurity, poverty, and vulnerability may be effectively implemented.
Health insecurity has emerged as a major concern among health policy-makers particularly in low- and middle-income countries (LMICs). It includes the inability to secure adequate healthcare today and the risk of being unable to do so in the future as well as impoverishing healthcare expenditure. The increasing health insecurity among 150 million of the world’s poor has moved social protection in health (SPH) to the top of the agenda among health policy-makers globally. This paper aims to provide a debate on the potential of social protection contribution to addressing health insecurity, poverty, and vulnerability brought by healthcare expenditure in low-income countries, to explore the gaps in current and proposed social protection measures in healthcare and provide suggestions on how social protection intervention aimed at addressing health insecurity, poverty, and vulnerability may be effectively implemented. PMID:26927589
Nikulina, Valentina; Widom, Cathy Spatz
Childhood neglect and poverty often co-occur and both have been linked to poor physical health outcomes. In addition, Blacks have higher rates of childhood poverty and tend to have worse health than Whites. This paper examines the unique and interacting effects of childhood neglect, race, and family and neighborhood poverty on adult physical health outcomes. This prospective cohort design study uses a sample (N=675) of court-substantiated cases of childhood neglect and matched controls followed into adulthood (M(age)=41). Health indicators (C-Reactive Protein [CRP], hypertension, and pulmonary functioning) were assessed through blood collection and measurements by a registered nurse. Data were analyzed using hierarchical linear models to control for clustering of participants in childhood neighborhoods. Main effects showed that growing up Black predicted CRP and hypertension elevations, despite controlling for neglect and childhood family and neighborhood poverty and their interactions. Multivariate results showed that race and childhood adversities interacted to predict adult health outcomes. Childhood family poverty predicted increased risk for hypertension for Blacks, not Whites. In contrast, among Whites, childhood neglect predicted elevated CRP. Childhood neighborhood poverty interacted with childhood family poverty to predict pulmonary functioning in adulthood. Gender differences in health indicators were also observed. The effects of childhood neglect, childhood poverty, and growing up Black in the United States are manifest in physical health outcomes assessed 30 years later. Implications are discussed.
This paper briefly examines the impact on reproductive health of social inequalities and poverty in Latin America and the Caribbean. The need to improve the quality of health services and to develop appropriate programs that promote reproductive rights is emphasized.
Laterveer, Leontien; Niessen, Louis W; Yazbeck, Abdo S
Since 1999, the International Monetary Fund and World Bank have required low-income countries soliciting for debt relief and financial support to prepare a Poverty Reduction Strategy Paper (PRSP). The objective of this study is to arrive at a systematic assessment of the extent to which the first batch of interim PRSPs actually addresses the health of the poor and vulnerable. A literature study was used to design and test a semi-quantitative approach to assess the pro-poor focus of health policies in national documents. The approach was applied to the existing interim proposals for 23 Highly Indebted Poor Countries. Results show that a majority of proposals lack country-specific data on the distribution and composition of the burden of disease, a clear identification of health system constraints and an assessment of the impact of health services on the population. More importantly, they make little effort to analyze these issues in relation to the poor. Furthermore, only a small group explicitly includes the interests of the poor in health policy design. Attention to policies aiming at enhancing equity in public health spending is even more limited. Few papers that include expenditure proposals also show pro-poor focused health budgets. We conclude that our systematic assessment of a new international development policy instrument, PRSP, raises strong concerns about the attributed role of health in development and the limited emphasis on the poor, the supposed primary beneficiaries of this instrument. There is a need and an opportunity for the international development community to provide assistance and inputs as poor countries shift their policy thinking from an interim stage to fully developed national policies. This paper presents a menu of analytical and policy options that can be pursued.
dramatically in the past 20 years, in conjunction with a national trend toward sedentary lifestyles . Obesity is widely recognized as a health risk. The...negative effects of obesity and other known health risks, such as smoking, heavy drinking, and poverty , have been well documented. But until now, no one has...Kenneth Wells, examined the comparative effects of obesity, smoking, heavy drinking, and poverty on chronic health conditions and health expenditures
Yang, Kyeongra; Woomer, Gail Ratliff; Agbemenu, Kafuli; Williams, Lynne
The study aim was to evaluate the effectiveness of a poverty simulation in increasing understanding of and attitudes toward poverty and resulting in changes in clinical practice among nursing seniors. A poverty simulation was conducted using a diverse group of nursing professors and staff from local community agencies assuming the role of community resource providers. Students were assigned roles as members of low-income families and were required to complete tasks during a simulated month. A debriefing was held after the simulation to explore students' experiences in a simulated poverty environment. Students' understanding of and attitude toward poverty pre- and post-simulation were examined. Changes in the students' clinical experiences following the simulation were summarized into identified categories and themes. The poverty simulation led to a greater empathy for the possible experiences of low income individuals and families, understanding of barriers to health care, change in attitudes towards poverty and to those living in poverty, and changes in the students' nursing practice. Use of poverty simulation is an effective means to teach nursing students about the experience of living in poverty. The simulation experience changed nursing students' clinical practice, with students providing community referrals and initiating inter-professional collaborations.
Kim, Pilyoung; Neuendorf, Cynthia; Bianco, Hannah; Evans, Gary W
Childhood poverty is associated with stress dysregulation which contributes to psychological illness in later ages. The adverse effects of childhood poverty on stress regulation may be mediated in part by the use of disengaging strategies to cope with stress. However, the relations among childhood poverty, coping strategies and psychopathology throughout childhood to adolescence have not been explored. This prospective, longitudinal study included 185 low- and middle-income adolescents at age 17. Chronic exposure to poverty from birth to early adolescence (age 13) was prospectively associated with increases in the use of disengagement versus engagement coping four years later. Increased use of disengagement coping between the ages of 13 and 17 explained the indirect link between poverty exposure since birth and both externalizing and internalizing symptoms at age 17. The findings provide evidence for a coping pathway underlying the link between prolonged exposure to childhood poverty and mental health sequelae. Copyright © 2015 John Wiley & Sons, Ltd.
It is generally agreed that spending on education and health is key to poverty reduction, but simply allocating more resources to these sectors does not ensure that poverty actually declines. On the basis of four in-depth case studies (on Indonesia, Madagascar, Peru and Tanzania) and three Technical Papers on malnutrition and primary education in…
This commentary contrasts "Piercing the Bubble" by proposing "pull" (rather than "push") strategies as a way for business schools to more meaningfully engage poverty and social exclusion. By reframing poverty issues in such a manner that they connect with core business student interests of career opportunities, current management practices, and…
Komro, Kelli A.; Flay, Brian R.; Biglan, Anthony
Living in poverty and living in areas of concentrated poverty pose multiple risks for child development and for overall health and wellbeing. Poverty is a major risk factor for several mental, emotional, and behavioral disorders, as well as for other developmental challenges and physical health problems. In this paper, the Promise Neighborhoods…
We examine the European Union (EU) countries and within-country areas (i.e., large urban areas, small urban areas, and rural areas) that are the most disadvantageous with respect to multidimensional poverty and in each of the investigated dimensions, i.e., health, education, and living standards. To this end, we construct the Multidimensional Poverty Index and its sub-indices: the Poverty in Health Index, Poverty in Education Index, and Poverty in Standard of Living Index. All of these indices provide information regarding the fraction of people who live in poverty, as well as information on the poverty intensity experienced by the poor. Our results indicate that the scale of poverty in the EU countries is diversified, with Denmark and Sweden being the most affluent countries, and Latvia, Bulgaria, and Romania being the most disadvantageous. We demonstrate that there are countries with no differences in the levels of poverty within a country, such as Denmark, Sweden, Spain, Finland, and the Czech Republic, and countries, usually less affluent ones such as Romania, Bulgaria and Lithuania, where considerable geographical inequality is present. In general, in countries with a high and moderately high number of poor, the worst situation with respect to the scale of poverty is observed in rural areas, and the best situation is observed in large urban areas, with the exception of Greece, Italy, and Portugal, where in large urban areas, the situation is the worst. In countries with a low number of poor, in general, the poverty is relatively higher in large urban areas.
Bryant-Davis, Thema; Ullman, Sarah E.; Tsong, Yuying; Tillman, Shaquita; Smith, Kimberly
A substantial body of research documents the mental health consequences of sexual assault including, but not limited to, depression, posttraumatic stress disorder (PTSD), substance use, and suicidality. Far less attention has been given to the mental health effects of sexual assault for ethnic minority women or women living in poverty. Given African American women’s increased risk for sexual assault and increased risk for persistent poverty, the current study explores the relationship between income and mental health effects within a sample of 413 African American sexual assault survivors. Hierarchical regression analyses revealed that after controlling for childhood sexual abuse there were positive relationships between poverty and mental health outcomes of depression, PTSD, and illicit drug use. There was no significant relationship between poverty and suicidal ideation. Counseling and research implications are discussed. PMID:20397989
Bryant-Davis, Thema; Ullman, Sarah E; Tsong, Yuying; Tillman, Shaquita; Smith, Kimberly
A substantial body of research documents the mental health consequences of sexual assault including, but not limited to, depression, posttraumatic stress disorder, substance use, and suicidality. Far less attention has been given to the mental health effects of sexual assault for ethnic minority women or women living in poverty. Given African American women's increased risk for sexual assault and increased risk for persistent poverty, the current study explores the relationship between income and mental health effects within a sample of 413 African American sexual assault survivors. Hierarchical regression analyses revealed that after controlling for childhood sexual abuse there were positive relationships between poverty and mental health outcomes of depression, posttraumatic stress disorder, and illicit drug use. There was no significant relationship between poverty and suicidal ideation. Counseling and research implications are discussed.
Tyer-Viola, Lynda A; Cesario, Sandra K
The Millennium Development Goals (MDG) that target alleviating poverty, improving primary education, and fostering gender equity are important as a foundation to promote world health. Achieving these goals will create an environment for healthy lives for women and children. Poverty, education, and gender equality, although undeniably linked, need to be addressed individually. Nurses have the capacity and political will to address MDGs and to contribute to the health and well-being of the world population.
Hamui-Sutton, Alicia; Irigoyen-Coria, Arnulfo; Gómez-Clavelina, Francisco Javier; Fernández-Ortega, Miguel Angel
One of the biggest challenges that Mexico faces is to fight against the poverty. The transition of a characteristic welfare model from the government in a closed economy, to an open economy where the functions of the State are limited, has modified the modalities of the social politics against poverty. Six indispensable conditions are identified for poverty's reduction: 1. Economic development with stability in order to generate more and better jobs for poor people. 2. To improve regional economies. 3. To improve home conditions of poor people. 4. To elevate education levels (to encourage an authentic heath education). 5. To diminish catastrophic expenses for health problems. 6. Technical training for all workers. The impact of poverty over health can provide valuable elements to establish effective preventive strategies on health workers.
Yoshikawa, Hirokazu; Aber, J. Lawrence; Beardslee, William R.
This article considers the implications for prevention science of recent advances in research on family poverty and children's mental, emotional, and behavioral health. First, we describe definitions of poverty and the conceptual and empirical challenges to estimating the causal effects of poverty on children's mental, emotional, and behavioral…
Kessler, Aad; van Duivenbooden, Niek; van Beek, Christy
Extreme poverty in Burundi's rural area and tensions between families with limited access to arable land hinder development towards a more stable and peaceful society. Due to these tensions and a rapid population growth, agricultural land is currently subject to increased degradation and low agricultural productivity. A whole range of other limiting factors contributes to this, such as: poor seed quality, poor nutrient management combined with low soil fertility, inadequate agronomic practices, pests and crop diseases, poorly developed supply chains, health problems, difficult access to credit, and insecurity. Solving one of these problems will not solve the chain that eventually leads to low food production; it will simply move the emphasis to the next constraining factor. An integrated rural development approach is therefore required to break this vicious circle. The project Fanning the Spark, a Public-Private-Partnership between Achmea Foundation, Alterra of Wageningen University and Research Centre, and HealthNet-TPO in Burundi started in September 2013 with an intervention in several rural villages in Gitega. The project's objective is to increase food production at village level, by means of investments in crop production, a family (income) insurance package that protects rural families against the financial consequences of catastrophic events (natural and health) and making micro-credits available. This will enhance farmers' workability and generate income from agricultural activities in order to break the poverty cycle and enhance food security. The insurance package comprises agricultural and health insurances, and will be jointly implemented with the sustainable agriculture component. The latter component focuses on Integrated Farm Management and the use of innovative soil management practices. Farmer-to-farmer training and scaling-up are crucial components, and in the first phase of the project "innovative farmer groups" have a central role in the
Background Poverty is widely recognized as a major determinant of poor health, and this link has been extensively studied and verified. Despite the strong evidentiary link, little work has been done to determine what primary care health providers can do to address their patients' income as a risk to their health. This qualitative study explores the barriers to primary care responsiveness to poverty as a health issue in a well-resourced jurisdiction with near-universal health care insurance coverage. Methods One to one interviews were conducted with twelve experts on poverty and health in primary care in Ontario, Canada. Participants included family physicians, specialist physicians, nurse practitioners, community workers, advocates, policy experts and researchers. The interviews were analysed for anticipated and emergent themes. Results This study reveals provider- and patient-centred structural, attitudinal, and knowledge-based barriers to addressing poverty as a risk to health. While many of its findings reinforce previous work in this area, this study's findings point to a number of areas front line primary care providers could target to address their patients' poverty. These include a lack of provider understanding of the lived reality of poverty, leading to a failure to collect adequate data about patients' social circumstances, and to the development of inappropriate care plans. Participants also pointed to prejudicial attitudes among providers, a failure of primary care disciplines to incorporate approaches to poverty as a standard of care, and a lack of knowledge of concrete steps providers can take to address patients' poverty. Conclusions While this study reinforces, in a well-resourced jurisdiction such as Ontario, the previously reported existence of significant barriers to addressing income as a health issue within primary care, the findings point to the possibility of front line primary care providers taking direct steps to address the health risks
Kristiansson, Marianne; Sörman, Karolina; Tekwe, Carmen; Calderón-Garcidueñas, Lilian
Rapid rural-urban migration has created overcrowded areas characterized by concentrated poverty and increases in indoor and outdoor air pollutants. These "hotspots" constitute an increased risk of violence and disease outbreaks. We hypothesize that the effects of poverty and associated air pollution-related stress on impaired cognitive skills are mediated by inflammatory cytokines. A research framework is proposed, encompassing (i) an epidemiological investigation of associations between poverty, high concentrations of air pollutants, violence and health, (ii) a longitudinal follow-up of working memory capacities and inflammatory markers, and (iii) intervention programs aiming to strengthen employability and decreased exposures to toxic air pollutants.
Cluver, Lucie; Gardner, Frances; Operario, Don
This study examined associations between AIDS-orphanhood status, poverty indicators, and psychological problems (depression, anxiety, post-traumatic stress, peer problems, delinquency, conduct problems) among children and adolescents in townships surrounding Cape Town, South Africa. One thousand and twenty-five children and adolescents completed standardized and culturally sensitive cross-sectional surveys. Children orphaned by AIDS had more psychological problems including depression, peer problems, post-traumatic stress, and conduct problems. Specific poverty indicators including food security, access to social welfare grants, employment in the household and access to school were associated with better psychological health. Poverty indicators mediated associations of AIDS-orphanhood with psychological problems. Food security showed the most consistent association with reduced psychological problems. Poverty alleviation measures have the potential to improve psychological health for AIDS-orphaned children in South African townships.
Simms, Chris D; Persaud, D David
Poverty is an important determinant of ill health, mortality and suffering across the globe. This commentary asks what we can learn about poverty by looking at the way rich countries respond to the needs of vulnerable populations both within their own societies and those of low-income countries. Taking advantage of recent efforts to redefine child poverty in a way that is consistent with the World Health Organization's Commission on Social Determinants of Health, three sets of data are reviewed: levels of child well-being within 23 Organization of Economic Community Development countries; the amount of official development assistance these countries disburse to poor countries; and, government social transfers targeted at families as a percentage of GDP. Analysis shows that countries in Northern Europe tend to have lower levels of child poverty, and are the most generous with social transfers and providing development assistance to poor countries; in contrast, the non-European countries like Australia, Canada, Japan, and the United States, and generally, the G7 countries, are the least generous towards the vulnerable at home and abroad and tend to have the highest levels of child poverty. The findings suggest that nations' responses tend to be ideologically based rather than evidence or needs based and that poverty is neither inevitable nor intractable.
Barry, M A; Bezek, S; Serpa, J A; Hotez, P J; Woc-Colburn, L
In the poorest regions of the United States, especially along the Gulf Coast and in South Texas, are a group of endemic parasitic and related infections known as the neglected infections of poverty. Such infections are characterized by their chronicity, disabling features, and disproportionate impact on the estimated 46 million people who live below the U.S. poverty line. Today more Americans live in poverty than ever before in the half-century that the Census Bureau has been recording poverty rates. In association with that poverty, a group of major neglected infections of poverty have emerged in the United States. Here we describe the major neglected infections of poverty in the United States, with a brief overview of their significant epidemiological features, their links with poverty, and our approaches to their diagnosis, management, and treatment.
Goodman, Lisa A; Pugach, Meghan; Skolnik, Avy; Smith, Laura
Despite the high and increasing prevalence of poverty in the United States, psychologists and allied professionals have done little to develop mental health interventions that are tailored to the specific sociocultural experiences of low-income families. In this article, we describe the sociocultural stressors that accompany the material deprivations of poverty, and the mental health difficulties to which they often give rise. Next, we outline the psychosocial and class-related issues surrounding low-income adults' access to and use of mental health services and suggest a conceptual framework to guide the modification of mental health practice to better accommodate poor peoples' complex needs. This framework describes opportunities for practice modification at three levels of intervention, beginning at the individual level of traditional individual psychotherapy and subsequently targeting increasingly broad contextual elements of poverty.
While researchers build an evidence that where one lives has an independent effect on their health, the work of translating this research into effective policies is impeded by problematic assumptions about urban poverty. In light of new experimental studies on the health effects of neighbourhoods using housing mobility programs, this paper addresses the politics of poverty deconcentration that implicitly undergirds much of this new research. By raising critiques of these programs that are rarely considered in the health literature, this paper challenges the central treatment of poverty dispersal in the new experimental literature. Poverty dispersal policies, without addressing the competitive urban structure, simply react to symptoms of poverty and ignore the underlying factors that shape the neighbourhood resources that structure health outcomes. These factors include municipal fragmentation, exclusionary land use planning, and municipal competition. Effective social policies aimed at improving neighbourhood influence on health must address the competitive and fragmented municipal structure that produces a patchwork of affluence and deprivation in today's urban America.
Richey Smith, Carriann E; Ryder, Priscilla; Bilodeau, Ann; Schultz, Michele
Objective. To determine baseline attitudes of pharmacy, physician assistant studies, and communication science and disorders students toward people in poverty and to examine the effectiveness of using the online poverty simulation game SPENT to affect these attitudes. Methods. Students completed pre/postassessments using the validated Undergraduate Perceptions of Poverty Tracking Survey (UPPTS). Students played the online, open access, SPENT game alone and/or in pairs in a 50-minute class. Results. Significant improvements in scale scores were seen in students after playing SPENT. Quartile results by prescore indicated that students with the lowest attitudes towards patients in poverty improved the most. Results suggested that most students found the experience worthwhile for themselves and/or for their classmates. Conclusions. The results of this study suggest SPENT may improve perspectives of undergraduate pharmacy and other health professions students.
Ryder, Priscilla; Bilodeau, Ann; Schultz, Michele
Objective. To determine baseline attitudes of pharmacy, physician assistant studies, and communication science and disorders students toward people in poverty and to examine the effectiveness of using the online poverty simulation game SPENT to affect these attitudes. Methods. Students completed pre/postassessments using the validated Undergraduate Perceptions of Poverty Tracking Survey (UPPTS). Students played the online, open access, SPENT game alone and/or in pairs in a 50-minute class. Results. Significant improvements in scale scores were seen in students after playing SPENT. Quartile results by prescore indicated that students with the lowest attitudes towards patients in poverty improved the most. Results suggested that most students found the experience worthwhile for themselves and/or for their classmates. Conclusions. The results of this study suggest SPENT may improve perspectives of undergraduate pharmacy and other health professions students. PMID:27899835
Roy, Abhijit; Roy, Mousumi
Over half of the world's population lives on less than $2 a day, and yet international business education to date has continued to ignore the not so well-off customers. We propose a holistic pedagogical approach to studying this market by considering the historical background of the growth of inequality and poverty in different regions of the…
Muma, John B; Mwacalimba, Kennedy K; Munang'andu, Hetron M; Matope, Gift; Jenkins, Akinbowale; Siamudaala, Victor; Mweene, Aaron S; Marcotty, Tanguy
Few studies have explicitly examined the linkages between human health, animal disease control and poverty alleviation. This paper reviews the contribution that veterinary medicine can make to poverty alleviation in sub-Saharan Africa. Our analysis attempts to explore aspects of this contribution under five themes: food production; food safety; impact and control of zoonotic infections; promotion of ecotourism; and environmental protection. While these areas of human activity have, more or less, fallen under the influence of the veterinary profession to varying degrees, we attempt to unify this mandate using a 'One Health' narrative, for the purpose of providing clarity on the linkages between the veterinary and other professions, livestock production and poverty alleviation. Future opportunities for improving health and reducing poverty in the context of developing African countries are also discussed. We conclude that veterinary science is uniquely positioned to play a key role in both poverty reduction and the promotion of health, a role that can be enhanced through the reorientation of the profession's goals and the creation of synergies with allied and related professions.
Saito, Masashige; Kondo, Katsunori; Kondo, Naoki; Abe, Aya; Ojima, Toshiyuki; Suzuki, Kayo
To evaluate the association between relative deprivation (lacking daily necessities) and subjective health in older Japanese adults, we performed a cross-sectional analysis using data from the Japan Gerontological Evaluation Study (JAGES). The data were obtained from functionally independent residents aged ≥65 years from 24 municipalities in Japan (n = 24,742). Thirteen items in three dimensions were used to evaluate relative deprivation of material conditions. Approximately 28% of older Japanese people indicated that they lacked some daily necessities (non-monetary poverty). A two-level Poisson regression analysis revealed that relative deprivation was associated with poor self-rated health (PR = 1.3-1.5) and depressive symptoms (PR = 1.5-1.8) in both men and women, and these relationships were stronger than those observed in people living in relative poverty (monetary poverty). The interaction effect between relative deprivation and relative poverty was not associated with poor health. As a dimension of the social determinants of health, poverty should be evaluated from a multidimensional approach, capturing not only monetary conditions but also material-based, non-monetary conditions.
Rock, Amelia; Barrington, Clare; Abdoulayi, Sara; Tsoka, Maxton; Mvula, Peter; Handa, Sudhanshu
Extensive research documents that social network characteristics affect health, but knowledge of peer networks of youth in Malawi and sub-Saharan Africa is limited. We examine the networks and social participation of youth living in extreme poverty in rural Malawi, using in-depth interviews with 32 youth and caregivers. We describe youth's peer networks and assess how gender and the context of extreme poverty influence their networks and participation, and how their networks influence health. In-school youth had larger, more interactive, and more supportive networks than out-of-school youth, and girls described less social participation and more isolation than boys. Youth exchanged social support and influence within their networks that helped cope with poverty-induced stress and sadness, and encouraged protective sexual health practices. However, poverty hampered their involvement in school, religious schools, and community organizations, directly by denying them required material means, and indirectly by reducing time and emotional resources and creating shame and stigma. Poverty alleviation policy holds promise for improving youth's social wellbeing and mental and physical health by increasing their opportunities to form networks, receive social support, and experience positive influence.
Collins, Timothy W; Kim, Young-an; Grineski, Sara E; Clark-Reyna, Stephanie
Prior research suggests that economic deprivation has a generally negative influence on residents' health. We employ hierarchical logistic regression modeling to test if economic deprivation presents respiratory health risks or benefits to Hispanic children living in the City of El Paso (Texas, USA) at neighborhood- and individual-levels, and whether individual-level health effects of economic deprivation vary based on neighborhood-level economic deprivation. Data come from the US Census Bureau and a population-based survey of El Paso schoolchildren. The dependent variable is children's current wheezing, an established respiratory morbidity measure, which is appropriate for use with economically-deprived children with an increased likelihood of not receiving a doctor's asthma diagnosis. Results reveal that economic deprivation (measured based on poverty status) at both neighborhood- and individual-levels is associated with reduced odds of wheezing for Hispanic children. A sensitivity analysis revealed similar significant effects of individual- and neighborhood-level poverty on the odds of doctor-diagnosed asthma. Neighborhood-level poverty did not significantly modify the observed association between individual-level poverty and Hispanic children's wheezing; however, greater neighborhood poverty tends to be more protective for poor (as opposed to non-poor) Hispanic children. These findings support a novel, multilevel understanding of seemingly paradoxical effects of economic deprivation on Hispanic health.
Rock, Amelia; Barrington, Clare; Abdoulayi, Sara; Tsoka, Maxton; Mvula, Peter; Handa, Sudhanshu
Extensive research documents that social network characteristics affect health, but knowledge of peer networks of youth in Malawi and sub-Saharan Africa is limited. We examine the networks and social participation of youth living in extreme poverty in rural Malawi, using in-depth interviews with 32 youth and caregivers. We describe youth’s peer networks and assess how gender and the context of extreme poverty influence their networks and participation, and how their networks influence health. In-school youth had larger, more interactive, and more supportive networks than out-of-school youth, and girls described less social participation and more isolation than boys. Youth exchanged social support and influence within their networks that helped cope with poverty-induced stress and sadness, and encouraged protective sexual health practices. However, poverty hampered their involvement in school, religious schools, and community organizations, directly through lack of required material means, and indirectly by reducing time and emotional resources and creating shame and stigma. Poverty alleviation policy holds promise for improving youth’s social wellbeing and mental and physical health by increasing their opportunities to form networks, receive social support, and experience positive influence. PMID:27760393
Victor, Bart; Blevins, Meridith; Green, Ann F.; Ndatimana, Elisée; González-Calvo, Lázaro; Fischer, Edward F.; Vergara, Alfredo E.; Vermund, Sten H.; Olupona, Omo; Moon, Troy D.
Background Poverty is a multidimensional phenomenon and unidimensional measurements have proven inadequate to the challenge of assessing its dynamics. Dynamics between poverty and public health intervention is among the most difficult yet important problems faced in development. We sought to demonstrate how multidimensional poverty measures can be utilized in the evaluation of public health interventions; and to create geospatial maps of poverty deprivation to aid implementers in prioritizing program planning. Methods Survey teams interviewed a representative sample of 3,749 female heads of household in 259 enumeration areas across Zambézia in August-September 2010. We estimated a multidimensional poverty index, which can be disaggregated into context-specific indicators. We produced an MPI comprised of 3 dimensions and 11 weighted indicators selected from the survey. Households were identified as “poor” if were deprived in >33% of indicators. Our MPI is an adjusted headcount, calculated by multiplying the proportion identified as poor (headcount) and the poverty gap (average deprivation). Geospatial visualizations of poverty deprivation were created as a contextual baseline for future evaluation. Results In our rural (96%) and urban (4%) interviewees, the 33% deprivation cut-off suggested 58.2% of households were poor (29.3% of urban vs. 59.5% of rural). Among the poor, households experienced an average deprivation of 46%; thus the MPI/adjusted headcount is 0.27 ( = 0.58×0.46). Of households where a local language was the primary language, 58.6% were considered poor versus Portuguese-speaking households where 73.5% were considered non-poor. Living standard is the dominant deprivation, followed by health, and then education. Conclusions Multidimensional poverty measurement can be integrated into program design for public health interventions, and geospatial visualization helps examine the impact of intervention deployment within the context of distinct
Rosenbloom, Al; Cortes, Juan Alejandro
This article describes the current relationship between management education in Colombia and the efforts of the management program at Universidad Pontificia Bolivariana (UPB) in Medellin to reduce local poverty. The article uses the metaphor of "the bubble" to illustrate how social class, family socialization, and the current UPB…
Neckerman, Kathryn M; Garfinkel, Irwin; Teitler, Julien O; Waldfogel, Jane; Wimer, Christopher
The New York City (NYC) Longitudinal Study of Wellbeing, or "Poverty Tracker," is a survey of approximately 2300 NYC residents. Its purpose is to provide a multidimensional and dynamic understanding of economic disadvantage in NYC. Measures of disadvantage were collected at baseline and a 12-month follow-up, and include 3 types of disadvantage: 1) income poverty, using a measure on the basis of the new Supplemental Poverty Measure; 2) material hardship, including indicators of food insecurity, housing hardship, unmet medical needs, utility cutoffs, and financial insecurity; and 3) adult health problems, which can drain family time and resources. In this article initial results for NYC families with children younger than the age of 18 years are presented. At baseline, 56% of families with children had 1 or more type of disadvantage, including 28% with income poverty, 39% with material hardship, and 17% with an adult health problem. Even among nonpoor families, 33% experienced material hardship and 14% reported an adult health problem. Two-thirds of all families faced disadvantage at either baseline or follow-up, with 46% experiencing some kind of disadvantage at both time points. Respondents with a college education were much less likely to face disadvantage. Even after adjusting for educational attainment and family characteristics, the families of black and Hispanic respondents had increased rates of disadvantage. Considering income poverty alone the extent of disadvantage among families with children in NYC is greatly understated. These results suggest that in addition to addressing income poverty, policymakers should give priority to efforts to reduce material hardship and help families cope with chronic physical or mental illness. The need for these resources extends far above the poverty line.
Neckerman, Kathryn M.; Garfinkel, Irwin; Teitler, Julien O.; Waldfogel, Jane; Wimer, Christopher
The New York City (NYC) Longitudinal Study of Wellbeing, or “Poverty Tracker,” is a survey of about 2,300 New York City residents. Its purpose is to provide a multidimensional and dynamic understanding of economic disadvantage in NYC. Measures of disadvantage were collected at baseline and a 12-month follow-up, and include three types of disadvantage: (1) income poverty, using a measure based on the new Supplemental Poverty Measure; (2) material hardship, including indicators of food insecurity, housing hardship, unmet medical needs, utility cutoffs, and financial insecurity; and (3) adult health problems, which can drain family time and resources. This paper presents initial results for NYC families with children under 18. At baseline, 56% of families with children had one or more type of disadvantage, including 28% with income poverty, 39% with material hardship, and 17% with an adult health problem. Even among nonpoor families, 33% experienced material hardship and 14% reported an adult health problem. Two-thirds of all families faced disadvantage at either baseline or follow-up, with 46% experiencing some kind of disadvantage at both time points. Respondents with a college education were much less likely to face disadvantage. Even after adjusting for educational attainment and family characteristics, the families of black and Hispanic respondents had elevated rates of disadvantage. Considering income poverty alone greatly understates the extent of disadvantage among families with children in New York City. These results suggest that in addition to addressing income poverty, policymakers should give priority to efforts to reduce material hardship and help families cope with chronic physical or mental illness. The need for these resources extends far above the poverty line. PMID:27044702
Hodgetts, Darrin; Chamberlain, Kerry; Tankel, Yadena; Groot, Shiloh
Urban poverty and health inequalities are inextricably intertwined. By working in partnership with service providers and communities to address urban poverty, we can enhance the wellness of people in need. This article reflects on lessons learned from the Family100 project that explores the everyday lives, frustrations and dilemmas faced by 100 families living in poverty in Auckland. Lessons learned support the need to bring the experiences and lived realities of families to the fore in public deliberations about community and societal responses to urban poverty and health inequality.
Beste, Jason; Pfeiffer, James
For nearly 30 years, Mozambique has been facing austerity measures regulated by the IMF. These austerity measures, grounded in macroeconomic policies, were supposed to lift Mozambique out of poverty, and improve its healthcare and education systems. By taking an in-depth look at the major etiologies of Mozambique's debt and the conditions which forced the country to accept austerity measures-despite their protests-prior to receiving IMF funding, this paper examines how IMF policies over the past 30 years have affected poverty, health, and the education system. The results of these policies have contributed to Mozambique's enduring classification as one of the poorest countries in the world. Aside from economic outcomes, Mozambique also has abysmal health and education systems, with one of the lowest life expectancies in Sub-Saharan Africa. It is time to re-evaluate how the current IMF macroeconomic policies negatively affect, health, education and the socioeconomic status of those who live in abject poverty. As short term macroeconomic policies of PARPA have been ineffective at reducing poverty, promoting education and improving health, the IMF should consider using longer term macroeconomic policies which invest in-rather than limit-public services such as health and education.
Lanjouw, Peter; Pradhan, Menno; Saadah, Fadia; Sayed, Haneen; Sparrow, Robert
This paper focuses on two important dimensions of Indonesia's development record: education and health. The paper investigates the extent to which the poor benefit from public and private provisioning of these services. Multiple rounds of annual household surveys document a reversal in the rate of decline in poverty and a slowdown in improvements…
Komro, Kelli A.; Flay, Brian R.; Biglan, Anthony
Living in poverty and living in areas of concentrated poverty pose multiple risks for child development and for overall health and wellbeing. Poverty is a major risk factor for several mental, emotional, and behavioral disorders, as well as for other developmental challenges and physical health problems. In this paper, the Promise Neighborhoods Research Consortium describes a science-based framework for the promotion of child health and development within distressed high-poverty neighborhoods. We lay out a model of child and adolescent developmental outcomes, and integrate knowledge of potent and malleable influences to define a comprehensive intervention framework to bring about a significant increase in the proportion of young people in high-poverty neighborhoods who will develop successfully. Based on a synthesis of research from diverse fields, we designed the Creating Nurturing Environments framework to guide community-wide efforts to improve child outcomes and reduce health and educational inequalities. PMID:21468644
Bendavid, Eran; Mukherji, Arnab; Wagner, Zachary; Nagpal, Somil; Mullen, Patrick
Objectives To evaluate the effects of a government insurance program covering tertiary care for people below the poverty line in Karnataka, India, on out-of-pocket expenditures, hospital use, and mortality. Design Geographic regression discontinuity study. Setting 572 villages in Karnataka, India. Participants 31 476 households (22 796 below poverty line and 8680 above poverty line) in 300 villages where the scheme was implemented and 28 633 households (21 767 below poverty line and 6866 above poverty line) in 272 neighboring matched villages ineligible for the scheme. Intervention A government insurance program (Vajpayee Arogyashree scheme) that provided free tertiary care to households below the poverty line in about half of villages in Karnataka from February 2010 to August 2012. Main outcome measure Out-of-pocket expenditures, hospital use, and mortality. Results Among households below the poverty line, the mortality rate from conditions potentially responsive to services covered by the scheme (mostly cardiac conditions and cancer) was 0.32% in households eligible for the scheme compared with 0.90% among ineligible households just south of the eligibility border (difference of 0.58 percentage points, 95% confidence interval 0.40 to 0.75; P<0.001). We found no difference in mortality rates for households above the poverty line (households above the poverty line were not eligible for the scheme), with a mortality rate from conditions covered by the scheme of 0.56% in eligible villages compared with 0.55% in ineligible villages (difference of 0.01 percentage points, −0.03 to 0.03; P=0.95). Eligible households had significantly reduced out-of-pocket health expenditures for admissions to hospitals with tertiary care facilities likely to be covered by the scheme (64% reduction, 35% to 97%; P<0.001). There was no significant increase in use of covered services, although the point estimate of a 44.2% increase approached significance (−5.1% to 90.5%; P=0.059). Both
Assis, Ana Marlúcia O; Barreto, Maurício L; Santos, Nedja Silva; Oliveira, Lucivalda Pereira Magalhães de; Dos Santos, Sandra Maria Chaves; Pinheiro, Sandra Maria Conceição
This cross-sectional study analyzes the relationship between gradients of social inequalities and the household environment and health and nutritional conditions among 2,001 preschool children in ten counties (municipalities) in the State of Bahia, Brazil. The analysis used multinomial multivariate logistic regression. Children in the middle and lower tertiles on the poverty scale had significant and increasing odds of living in a household headed by a woman, an unemployed father, a mother with = years of schooling, more than one child sharing the same bed, severe stunting, and retinol consumption below the median as compared to those in the upper tertile. More than one child in the home, weight deficit, and lipid consumption below the median were also significantly associated with the poorest tertile. Specific emergency health policies and measures must be implemented to minimize the burden imposed by poverty and social inequalities on childhood health and nutrition.
Santiago, Catherine DeCarlo; Kaltman, Stacey; Miranda, Jeanne
Poverty is associated with an increased risk for psychological problems. Even with this increased risk for mental health problems and need for care, many low-income adults and families do not receive treatment because of logistical, attitudinal, and systemic barriers. Despite significant barriers to obtaining care, research suggests that low-income individuals show significant benefit from evidence-based mental healthcare. In this article, we review the link between poverty and mental health, common barriers to obtaining mental health services, and treatment studies that have been conducted with low-income groups. Finally, we discuss the implications of the research reviewed and offer recommendations for clinicians working with low-income children or adults, highlighting the importance of evidence-based care, extensive outreach, and empathic respect.
Tezoquipa, Isabel Hernández; Monreal, Luz Arenas; Treviño-Siller, Sandra
The objective of this qualitative study was to get to know poor Mexican women's experience of poverty in relation to health care. Forty-nine interviews were carried out with poor adult women in Mexico (between 35 and 65 years old). Three central elements were detected in relation to the women's experience of poverty and health care: their socio-economic dependence on their family; the notion of social belonging in their experience with health care rights, reflected in the idea and acceptance that, due to their poverty, they can only be attended at philanthropic institutions; and the existence of survival mechanisms when facing an illness. In recovering the experience of poor women in relation to their health care, we identified that there is a clear idea that, if women had had economic resources, their health problem would have been solved differently. They are also convinced that, due to being poor, they have to content themselves with bad-quality medical care. This conformity finally makes them resign to the fact of either loosing a part of their own body, or even just waiting for death.
Hong, Seunghye; Zhang, Wei; Walton, Emily
This study examines the associations of neighborhood ethnic density and poverty with social cohesion and self-rated mental health among Asian Americans and Latinos. Path analysis is employed to analyze data from the 2002-2003 National Latino and Asian American Study (NLAAS) and the 2000 U.S. Census (N = 2095 Asian Americans living in N = 259 neighborhoods; N = 2554 Latinos living in N = 317 neighborhoods). Findings reveal that neighborhood ethnic density relates to poor mental health in both groups. Social cohesion partially mediates that structural relationship, but is positively related to ethnic density among Latinos and negatively related to ethnic density among Asian Americans. Although higher neighborhood poverty is negatively associated with mental health for both groups, the relationship does not hold in the path models after accounting for social cohesion and covariates. Furthermore, social cohesion fully mediates the association between neighborhood poverty and mental health among Latinos. This study highlights the necessity of reconceptualizing existing theories of social relationships to reflect complex and nuanced mechanisms linking neighborhood structure and mental health for diverse racial and ethnic groups.
Kang, Ezer; Delzell, Darcie A P; McNamara, Paul E; Cuffey, Joel; Cherian, Anil; Matthew, Saira
Poor mental health functioning among persons living with HIV (PLHIV) has gained considerable attention particularly in low-income countries that disproportionately carry the global HIV/AIDS burden. Fewer studies, however, have examined the relationship between poverty indicators and mental health among PHLIV in India. Based on this cross-sectional study of 196 HIV-seropositive adults who received medical services at Shalom AIDS Project in Delhi, India, structural equation modeling and mediation analysis were employed to estimate the associations between poverty indices (household asset index, food security, unemployment, water treatment, sanitation), HIV-health factors (illness in the past 3 months, co-morbid medical conditions), and psychological distress. In the final model, ownership of fewer household assets was associated with higher levels of food insecurity, which in turn was associated with higher psychological distress. Also, the household asset index, food insecurity, and unemployment had a larger effect on psychological distress than new opportunistic infections. These findings build on increasing evidence that support concerted efforts to design, evaluate, and refine HIV mental health interventions that are mainstreamed with livelihood programming in high poverty regions in India.
Rauh, Virginia A; Landrigan, Philip J; Claudio, Luz
The importance of adequate housing for the maintenance of health and well-being has long been a topic of scientific and public health policy discussion, but the links remain elusive. Here we explore the role of the residential environment in the etiology of illness (specifically asthma) and the persistence of socioeconomic health disparities. Housing conditions, shaped by social forces, affect exposure to physical and chemical "toxicants," thereby translating social adversities into individual illness and population health disparities. We discuss the mediating role of housing in determining health outcomes at multiple levels (social-structural, neighborhood, and individual family). To date, little attention has been paid by most environmental health scientists to the social-structural conditions underlying gross inequities in the distribution of toxic exposures, with even less attention to the processes whereby these social conditions may directly affect susceptibility to the toxic exposures themselves. This chapter goes beyond traditional medical and environmental science models to incorporate a range of social and physical determinants of environmental pollutions, illustrating how these conditions result in health and illness. We focus here on childhood asthma as an example of a serious public health problem that has been associated with low income, minority status, and characteristics of the home environment. We end the chapter with a discussion of the environmental justice movement and the role of housing as a potential agent of change and focus of interventions aimed to reduce the harmful effects of environmental pollutants.
Hossain, Mohammed P; Goyder, Elizabeth C; Rigby, Jan E; El Nahas, Meguid
Approximately 1.2 billion individuals worldwide live in extreme poverty (< $1/d), and 2.7 billion live in moderate poverty (< $2/d). Poverty is most prevalent in developing countries, but does not spare richer economies, where huge income discrepancies have been reported. Poverty is a major health care marker affecting a number of chronic, communicable, and noncommunicable diseases. Poverty and social deprivation are known to affect the predisposition, diagnosis, and management of chronic diseases; they directly impact on the prevalence of such conditions as obesity, diabetes, and hypertension. Also, growing evidence links poverty to chronic kidney disease (CKD). This may be caused by a direct impact of poverty on CKD or indirectly through the increased health care burden linked to poverty-associated diabetes and hypertension. Furthermore, data have shown that the poor and socially deprived have a greater prevalence of end-stage renal disease. Access to renal care, dialysis, and transplantation may also be affected by social deprivation. Overall, poverty and social deprivation are emerging as major risk markers for CKD in both developing and developed countries. Their impact on CKD warrants careful analysis because it may confound the interpretation of CKD risk factors within communities. This review therefore aims to look at the evidence linking poverty to CKD and its major risk factors, namely, diabetes and hypertension.
Shortt, Niamh; Rugkåsa, Jorun
This article reports the findings from an evaluation of a fuel poverty programme in the Armagh and Dungannon Health Action Zone in Northern Ireland. Focusing on a rural community, it adds to the debate surrounding the hidden nature of rural fuel poverty. As part of the programme, energy efficiency measures, including some central heating systems, were installed in 54 homes. Surveys were conducted both pre and post intervention and analysed to assess any changes. The programme demonstrated that energy efficiency intervention can lead to improvements in health and well being, increased comfort levels in the home and a reduction in the use of health services, therefore having potential cost savings for the NHS. Some households, however, remain in fuel poverty after having full central heating installed, reflecting the significant contribution of low income on the production of fuel poverty. The article concludes by suggesting that interventions in this area require commitment from multiple sectors of society, including health professionals and local communities.
Delavega, Elena; Lennon-Dearing, Robin
The social context of living in poverty has a direct and indirect impact on a woman's health and well-being. This cross-sectional study investigates the relationship between housing and adherence to treatment, emotional wellness, environmental safety, physical health status, and risk behaviors among HIV-positive women receiving services from an AIDS service organization in the mid-South. Significant differences were found between stably housed and unstably housed women on the dependent outcome variables. Results suggest that housing services for HIV-positive women may be an effective way to increase their health and well-being as well as prevent transmission to others.
Chung, Esther K; Siegel, Benjamin S; Garg, Arvin; Conroy, Kathleen; Gross, Rachel S; Long, Dayna A; Lewis, Gena; Osman, Cynthia J; Jo Messito, Mary; Wade, Roy; Shonna Yin, H; Cox, Joanne; Fierman, Arthur H
Approximately 20% of all children in the United States live in poverty, which exists in rural, urban, and suburban areas. Thus, all child health clinicians need to be familiar with the effects of poverty on health and to understand associated, preventable, and modifiable social factors that impact health. Social determinants of health are identifiable root causes of medical problems. For children living in poverty, social determinants of health for which clinicians may play a role include the following: child maltreatment, child care and education, family financial support, physical environment, family social support, intimate partner violence, maternal depression and family mental illness, household substance abuse, firearm exposure, and parental health literacy. Children, particularly those living in poverty, exposed to adverse childhood experiences are susceptible to toxic stress and a variety of child and adult health problems, including developmental delay, asthma and heart disease. Despite the detrimental effects of social determinants on health, few child health clinicians routinely address the unmet social and psychosocial factors impacting children and their families during routine primary care visits. Clinicians need tools to screen for social determinants of health and to be familiar with available local and national resources to address these issues. These guidelines provide an overview of social determinants of health impacting children living in poverty and provide clinicians with practical screening tools and resources.
Molnar, Agnes; O'Campo, Patricia; Ng, Edwin; Mitchell, Christiane; Muntaner, Carles; Renahy, Emilie; St John, Alexander; Shankardass, Ketan
Unemployment insurance is an important social protection policy that buffers unemployed workers against poverty and poor health. Most unemployment insurance studies focus on whether increases in unemployment insurance generosity are predictive of poverty and health outcomes. Less work has used theory-driven approaches to understand and explain how and why unemployment insurance works, for whom, and under what circumstances. Given this, we present a realist synthesis protocol that seeks to unpack how contextual influences trigger relevant mechanisms to generate poverty and health outcomes. In this protocol, we conceptualize unemployment insurance as a key social protection policy; provide a supporting rationale on the need for a realist synthesis; and describe our process on identifying context-mechanism-outcome pattern configurations. Six methodological steps are described: initial theory development, search strategy; selection and appraisal of documents; data extraction; analysis and synthesis process; and presentation and dissemination of revised theory. Our forthcoming realist synthesis will be the first to build and test theory on the intended and unintended outcomes of unemployment insurance policies. Anticipated findings will allow policymakers to move beyond 'black box' approaches to consider 'mechanism-based' explanations that explicate the logic on how and why unemployment insurance matters.
First of all a definition is given of "poverty" and "precaution". A short, by no means comprehensive, presentation of some especially relevant recent publications on both topics is included, with a view to offering also readers who are not familiar with these issues a broad overview of the specialised literature available. This is followed by a description of the solidarity concept, following various philosophical, cultural and religious trends, analysing their relationship with precaution. An attempt is then made to show how solidarity and precaution could help counteract poverty, the risks for the environment and health, with the ensuing social and health damage. Reasons are outlined which support the adoption of the precaution principle in economics, as well as some arguments which could be put forward to oppose these views. The final remarks are a reply to such criticisms with a view to showing how precaution could be an effective economic tool, as well as a way to tackle those health-related and environmental problems that are also associated with poverty.
Biggs, Brian; King, Lawrence; Basu, Sanjay; Stuckler, David
Despite findings indicating that both national income level and income inequality are each determinants of public health, few have studied how national income level, poverty and inequality interact with each other to influence public health outcomes. We analyzed the relationship between gross domestic product (GDP) per capita in purchasing power parity, extreme poverty rates, the gini coefficient for personal income and three common measures of public health: life expectancy, infant mortality rates, and tuberculosis (TB) mortality rates. Introducing poverty and inequality as modifying factors, we then assessed whether the relationship between GDP and health differed during times of increasing, decreasing, and decreasing or constant poverty and inequality. Data were taken from twenty-two Latin American countries from 1960 to 2007 from the December 2008 World Bank World Development Indicators, World Health Organization Global Tuberculosis Database 2008, and the Socio-Economic Database for Latin America and the Caribbean. Consistent with previous studies, we found increases in GDP have a sizable positive impact on population health. However, the strength of the relationship is powerfully influenced by changing levels of poverty and inequality. When poverty was increasing, greater GDP had no significant effect on life expectancy or TB mortality, and only led to a small reduction in infant mortality rates. When inequality was rising, greater GDP had only a modest effect on life expectancy and infant mortality rates, and no effect on TB mortality rates. In sharp contrast, during times of decreasing or constant poverty and inequality, there was a very strong relationship between increasing GDP and higher life expectancy and lower TB and infant mortality rates. Finally, inequality and poverty were found to exert independent, substantial effects on the relationship between national income level and health. Wealthier is indeed healthier, but how much healthier depends on how
Zimmerman, Rolf; Gallagher, Pat
This chapter gives an educational overview of: * The actual application of supply chain practice and disciplines required for service delivery improvement within the current health environment. * A rationale for the application of Supply Chain Management (SCM) approaches to the Health sector. * The tools and methods available for supply chain analysis and benchmarking. * Key supply chain success factors.
Harrison, S; Hunter, D; Fairfield, G; Cole, A
Disease management has been described as a comprehensive, integrated approach to care and reimbursement based on the natural course of a disease. It requires a management approach which brings together research evidence, best practice and inter-professional and inter-agency working. Starting with the ideal of continuity of care for individual patients, it implies structured co-ordination of care over time and across primary, secondary and tertiary settings. The appeal of disease management is that it promises reduced costs, combined with increased quality of care and patient satisfaction. But the concept is open to different definitions and interpretations and its effectiveness in improving UK healthcare is still largely untested. This Health Management Guide removes the mystique behind disease management and puts it in the context of existing knowledge and practice. Treating it as a concept, rather than a specific technique, it distinguishes between its different potential applications, offers practical guidance on implementation, and reports on how NHS organisations are taking it forward.
Gao, Jianmin; Zhou, Zhongliang; Yan, Jue; Lai, Sha; Xu, Yongjian; Chen, Gang
Background Disease has become one of the key causes of falling into poverty in rural China. The poor households are even more likely to suffer. The New Cooperative Medical Scheme (NCMS) has been implemented to provide rural residents financial protection against health risks. This study aims to assess the effect of the NCMS on alleviating health payment-induced poverty in the Shaanxi Province of China. Methods The data was drawn from the 5th National Health Service Survey of Shaanxi Province, conducted in 2013. In total, 41,037 individuals covered by NCMS were selected. Poverty headcount ratio (HCR), poverty gap and mean positive poverty gap were used for measuring the incidence, depth and intensity of poverty, respectively. The differences on poverty measures pre- and post- insurance reimbursement indicate the effectiveness of alleviating health payment-induced poverty under NCMS. Results For the general insured, 5.81% of households fell below the national poverty line owing to the health payment; this HCR dropped to 4.84% after insurance reimbursement. The poverty HCRs for the insured that had hospitalization in the past year dropped from 7.50% to 2.09% after reimbursement. With the NCMS compensation, the poverty gap declined from 42.90 Yuan to 34.49 Yuan (19.60% decreased) for the general insured and from 57.48 Yuan to 10.01 Yuan (82.59% decreased) for the hospital admission insured. The mean positive poverty gap declined 3.56% and 37.40% for two samples, respectively. Conclusion The NCMS could alleviate the health payment-induced poverty. The effectiveness of alleviating health payment-induced poverty is greater for hospital admission insured than for general insured, mainly because NCMS compensates for serious diseases. Our study suggests that a more comprehensive insurance benefit package design could further improve the effectiveness of poverty alleviation. PMID:27380417
Randolph, T F; Schelling, E; Grace, D; Nicholson, C F; Leroy, J L; Cole, D C; Demment, M W; Omore, A; Zinsstag, J; Ruel, M
Livestock keeping is critical for many of the poor in the developing world, often contributing to multiple livelihood objectives and offering pathways out of poverty. Livestock keeping also affects an indispensable asset of the poor, their human capital, through its impact on their own nutrition and health. This paper outlines the linkages between livestock keeping and the physical well-being of the poor, and examines a number of commonly held beliefs that misrepresent livestock development issues related to these linkages. These beliefs limit the scope of intervention programs to promote livestock and limit their potential contribution to poverty reduction. Recognition of the complexity of the role livestock play in household decision-making and of the opportunities foregone due to these misconceptions can enhance the ability of livestock to contribute to human well-being in the developing world.
Eamon, Mary Keegan; Venkataraman, Meenakshi
Parent management training (PMT) is a well-investigated, effective, and preferred treatment for children's externalizing behaviors and related disorders. This article explores why, unfortunately, PMT is not as effective for children living in poor families, who disproportionately exhibit the behaviors that PMT is designed to correct. (Contains 40…
Rajan, Keertichandra; Kennedy, Jonathan; King, Lawrence
Standard policy prescriptions for improving public health in less developed countries (LDCs) prioritise raising average income levels over redistributive policies since it is widely accepted that 'wealthier is healthier'. It is argued that income inequality becomes a significant predictor of public health only after the 'epidemiological transition'. This paper tests this theory in India, where rising income levels have not been matched by improvements in public health. We use state-, district-, and individual-level data to investigate the relationship between infant and under-five mortality, and average income, poverty, income inequality, and literacy. Our analysis shows that at both state- and district-level public health is negatively associated with average income and positively associated with poverty. But, at both levels, controlling for poverty and literacy renders average income statistically insignificant. At state-level, only literacy remains a significant and negative predictor. At the less aggregated district-level, both poverty and literacy predict public health but literacy has a stronger effect than poverty. Inequality does not predict public health at state- or district-levels. At the individual-level, however, it is a strong predictor of self-reported ailment, even after we control for district average income, individual income, and individual education. Our analysis suggests that wealthier is indeed healthier in India - but only to the extent that high average incomes reflect low poverty and high literacy. Furthermore, inequality has a strong effect on self-reported health. Standard policy prescriptions, then, need revision: first, alleviating poverty may be more effective than raising average income levels; second, non-income goods like literacy may make an important contribution to public health; and third, policy should be based on a broader understanding of societal well-being and the factors that promote it.
Goodman, Lisa A; Smyth, Katya Fels; Borges, Angela M; Singer, Rachel
Until recently, the connection between intimate partner violence (IPV) and persistent poverty had been largely ignored. Recent research indicates, however, that the two phenomena cooccur at high rates; produce parallel effects; and, in each other's presence, constrain coping options. Therefore, both external situational, and internal psychological difficulties are missed when women contending with both poverty and IPV are viewed through the lens of just one or just the other. This article describes mental health consequences for women who contend with both partner violence and poverty. It proposes that the stress, powerlessness, and social isolation at the heart of both phenomena combine to produce posttraumatic stress disorder, depression, and other emotional difficulties. The article also introduces the term ''survival-focused coping'' to describe women's methods of coping with IPV in the context of poverty and highlights the role that domestic violence advocates, mental health providers, and researchers can play in addressing these tightly intertwined phenomena.
Prakash, Ravi; Kumar, Abhishek
Drawing upon data from the third round of the National Family Health Survey (NFHS-3) conducted in India during 2005-06, this study compares the utilization of selected maternal and child health care services between the urban poor and non-poor in India and across selected Indian states. A wealth index was created, separately for urban areas, using Principal Component Analysis to identify the urban poor. The findings suggest that the indicators of maternal and child health care are worse among the urban poor than in their non-poor counterparts. For instance, the levels of antenatal care, safe delivery and childhood vaccinations are much lower among the urban poor than non-poor, especially in socioeconomically disadvantageous states. Among all the maternal and child health care indicators, the non-poor/poor difference is most pronounced for delivery care in the country and across the states. Other than poverty status, utilization of antenatal services by mothers increases the chances of safe delivery and child immunization at both national and sub-national levels. The poverty status of the household emerged as a significant barrier to utilization of health care services in urban India.
Ponic, Pamela; Frisby, Wendy
Community-based health promoters often aim to facilitate "inclusion" when working with marginalized women to address their exclusion and related health issues. Yet the notion of inclusion has not been critically interrogated within this field, resulting in the perpetuation of assumptions that oversimplify it. We provide qualitative evidence on inclusion as a health-promotion strategy from the perspectives of women living in poverty. We collected data with women engaged in a 6-year community-based health promotion and feminist participatory action research project. Participants' experiences illustrated that inclusion was a multidimensional process that involved a dynamic interplay between structural determinants and individual agency. The women named multiple elements of inclusion across psychosocial, relational, organizational, and participatory dimensions. This knowledge interrupts assumptions that inclusion is achievable and desirable for so-called recipients of such initiatives. We thus call for critical consideration of the complexities, limitations, and possibilities of facilitating inclusion as a health-promotion strategy.
Frazier, Stacy L; Cappella, Elise; Atkins, Marc S
The current mental health system is failing to meet the extensive needs of children living in urban poverty. After school programs, whose mission includes children's socialization, peer relations, and adaptive functioning, are uniquely positioned to support and promote children's healthy development. We propose that public sector mental health resources can be reallocated to support after school settings, and we offer specific examples and recommendations from an ongoing federally funded program of research to illustrate how mental health consultation can support publicly funded after school programs. In light of the increasing needs and depleting [corrected] resources of urban, poor communities, consultation to publicly funded after school programs can contribute to the mental health goals of keeping children safe and supervised, promoting their healthy development through academically and socially enriching activities, and identifying children in need of more intensive mental health services.
Rommelmann, Vanessa; Setel, Philip W.; Hemed, Yusuf; Angeles, Gustavo; Mponezya, Hamisi; Whiting, David; Boerma, Ties
OBJECTIVE: To examine the costs of complementary information generation activities in a resource-constrained setting and compare the costs and outputs of information subsystems that generate the statistics on poverty, health and survival required for monitoring, evaluation and reporting on health programmes in the United Republic of Tanzania. METHODS: Nine systems used by four government agencies or ministries were assessed. Costs were calculated from budgets and expenditure data made available by information system managers. System coverage, quality assurance and information production were reviewed using questionnaires and interviews. Information production was characterized in terms of 38 key sociodemographic indicators required for national programme monitoring. FINDINGS: In 2002-03 approximately US$ 0.53 was spent per Tanzanian citizen on the nine information subsystems that generated information on 37 of the 38 selected indicators. The census and reporting system for routine health service statistics had the largest participating populations and highest total costs. Nationally representative household surveys and demographic surveillance systems (which are not based on nationally representative samples) produced more than half the indicators and used the most rigorous quality assurance. Five systems produced fewer than 13 indicators and had comparatively high costs per participant. CONCLUSION: Policy-makers and programme planners should be aware of the many trade-offs with respect to system costs, coverage, production, representativeness and quality control when making investment choices for monitoring and evaluation. In future, formal cost-effectiveness studies of complementary information systems would help guide investments in the monitoring, evaluation and planning needed to demonstrate the impact of poverty-reduction and health programmes. PMID:16184275
... of Health Care Office Management American Health Information Management Association American College of Health Care Administrators For more information about academic programs in this field, visit Association of University ...
Cone, Pamela M. H.
Throughout history, the issue of poverty has been a problem in society. In this article, examination of Hebrew and Greek words related to poverty throughout the Bible revealed descriptions of the various types and causes of poverty. Historical research uncovered writings on poverty by several early Church Fathers and influential Christian scholars…
Langlois, J; Fortin, D
The goal of this article is to discuss an overview of literature published from 1968 to 1993 and dealing with links between single-parenting, poverty and mental health. A total of 56 articles were selected based on the most current data banks. Results show that the population of single-parent mothers is growing and that they are becoming increasingly poor. Of the six mental health variables listed by the author, four (psychological distress, self-esteem, perception of one's own skills and psychological isolation) clearly demonstrate that single-parent mothers are in a less healthy mental state than are mothers in two-parent families. Results also indicate that self-esteem, distress and psychological well-being are affected by economic variables. Results therefore vary according to the variable being measured. Although single-parent mothers experience more psychological discomfort than mothers in two-parent families, they do not seem to experience more serious mental health problems. The authors argue that future research on the subject should take into consideration a certain number of aspects, discussed in the conclusion of this article, which account for links between single-parenting, poverty and mental health.
The publication of The Spirit Level (Wilkinson and Pickett, 2009) marked a paramount moment in the analysis of health and inequality, quickly attracting a remarkable degree of attention, both positive and negative, both in academic and in public discourse. Following at least 20 years of research, the book proposes a simple and powerful argument: inequality per se, more specifically income inequality, is harmful to every aspect of social life. In order to confirm this idea, the authors present a series of bivariate, cross-sectional associations showing comparisons across countries and within the United States. Despite the methodological limitations of this approach, the authors advance causal claims concerning the detrimental effects of income inequality. They also rule out poverty as a plausible alternative explanation, without directly measuring it. Meanwhile, over the last decade stratification scholars have demonstrated the nonlinear effect of economic factors, especially income, on health. The results suggest that a relative approach is best for analyzing dynamics at the top of the income distribution, whereas an absolute approach seems most appropriate for studying the bottom of the distribution. Consistent with this perspective, here I reanalyze data from The Spirit Level, adding a measure of poverty, in order to control the effect of inequality and explore its interaction with poverty. The findings show that inequality and poverty-which I contend are two interdependent but nonetheless distinct phenomena-interact across countries, such that the detrimental effects of inequality are present or stronger in countries with high poverty, and absent or weaker in countries with low poverty; poverty replaces inequality as the favored explanation of health and social ills across states. The new evidence suggests that income distributions are characterized by a complex interplay between inequality and poverty, whose interaction deserves further analysis.
Ostlin, Piroska; Sen, Gita; George, Asha
Despite the magnitude of the problem of health inequity within and between countries, little systematic research has been done on the social causes of ill-health. Health researchers have overwhelmingly focused on biomedical research at the level of individuals. Investigations into the health of groups and the determinants of health inequities that lie outside the control of the individual have received a much smaller share of research resources. Ignoring factors such as socioeconomic class, race and gender leads to biases in both the content and process of research. We use two such factors--poverty and gender--to illustrate how this occurs. There is a systematic imbalance in medical journals: research into diseases that predominate in the poorest regions of the world is less likely to be published. In addition, the slow recognition of women's health problems, misdirected and partial approaches to understanding women's and men's health, and the dearth of information on how gender interacts with other social determinants continue to limit the content of health research. In the research community these imbalances in content are linked to biases against researchers from poorer regions and women. Researchers from high-income countries benefit from better funding and infrastructure. Their publications dominate journals and citations, and these researchers also dominate advisory boards. The way to move forward is to correct biases against poverty and gender in research content and processes and provide increased funding and better career incentives to support equity-linked research. Journals need to address equity concerns in their published content and in the publishing process. Efforts to broaden access to research information need to be well resourced, publicized and expanded. PMID:15643794
Zulu, Eliya M; Beguy, Donatien; Ezeh, Alex C; Bocquier, Philippe; Madise, Nyovani J; Cleland, John; Falkingham, Jane
The Urbanization, Poverty, and Health Dynamics research program was designed to generate and provide the evidence base that would help governments, development partners, and other stakeholders understand how the urban slum context affects health outcomes in order to stimulate policy and action for uplifting the wellbeing of slum residents. The program was nested into the Nairobi Urban Health and Demographic Surveillance System, a uniquely rich longitudinal research platform, set up in Korogocho and Viwandani slum settlements in Nairobi city, Kenya. Findings provide rich insights on the context in which slum dwellers live and how poverty and migration status interacts with health issues over the life course. Contrary to popular opinions and beliefs that see slums as homogenous residential entities, the findings paint a picture of a highly dynamic and heterogeneous setting. While slum populations are highly mobile, about half of the population comprises relatively well doing long-term dwellers who have lived in slum settlements for over 10 years. The poor health outcomes that slum residents exhibit at all stages of the life course are rooted in three key characteristics of slum settlements: poor environmental conditions and infrastructure; limited access to services due to lack of income to pay for treatment and preventive services; and reliance on poor quality and mostly informal and unregulated health services that are not well suited to meeting the unique realities and health needs of slum dwellers. Consequently, policies and programs aimed at improving the wellbeing of slum dwellers should address comprehensively the underlying structural, economic, behavioral, and service-oriented barriers to good health and productive lives among slum residents.
Emerson, E.; Hatton, C.
Background: When compared with their nonintellectually disabled peers, people with intellectual disabilities (IDs) have poorer health and are more likely to be exposed to poverty during childhood. Given that exposure to child poverty has been linked to poorer health outcomes, we attempted to estimate the extent to which the health inequalities…
Poverty Reduction Strategy Papers (PRSPs) represent the World Bank and the International Monetary Fund's (IMF) most recent initiative for reducing the plight of the poor. This paper examines whether the PRSPs for Liberia, Afghanistan and Haiti follow World Bank guidance on health. The health data, analysis and strategy content of the three PRSPs are assessed with respect to the 'Health, Nutrition and Population' chapter of the World Bank's PRSP Sourcebook. This guidance states that PRSPs should include: health data on the poor and a clear analysis showing the determinants of ill health and pro-poor health strategies. Unfortunately, none of the PRSPs analysed comply with the guidance and, consequently, do not adequately portray the health situation within their countries. Thus health is not given a high priority in the PRSP process and is seemingly low on the agenda of both poor country governments and the International Financial Institutions (IFIs). If the situation for the world's poorest people is to improve, health and the right to health need to be promoted within PRSPs. PMID:22690131
O'Campo, Patricia; Molnar, Agnes; Ng, Edwin; Renahy, Emilie; Mitchell, Christiane; Shankardass, Ketan; St John, Alexander; Bambra, Clare; Muntaner, Carles
The recent global recession and concurrent rise in job loss makes unemployment insurance (UI) increasingly important to smooth patterns of consumption and keep households from experiencing extreme material poverty. In this paper, we undertake a realist review to produce a critical understanding of how and why UI policies impact on poverty and health in different welfare state contexts between 2000 and 2013. We relied on literature and expert interviews to generate an initial theory and set of propositions about how UI might alleviate poverty and mental distress. We then systematically located and synthesized peer-review studies to glean supportive or contradictory evidence for our initial propositions. Poverty and psychological distress, among unemployed and even the employed, are impacted by generosity of UI in terms of eligibility, duration and wage replacement levels. Though unemployment benefits are not intended to compensate fully for a loss of earnings, generous UI programs can moderate harmful consequences of unemployment.
Sarti, Simone; Terraneo, Marco; Tognetti Bordogna, Mara
The global financial crisis that began in 2008 had an overall effect on the health behaviours of Italian households. Aggregate private health expenditures have decreased while the citizens have increasingly been asked to share health costs. The reduction of households' health expenditure could have serious consequences for health, especially if it concerns the most vulnerable people. The aim of this paper is to analyse the relation between poverty and household health expenditure, considering regional and social group variations. The data used stem from the "Family Expenditure Survey" collected by the Italian Statistical Institute (ISTAT) from 1997 to 2013. Results of multivariate analysis controlling for potential socio-demographic confounders show that the propensity to spend for poor families is decreased in the last years compared to not poor households. Meanwhile, among the households who spend, the average expenditure in euro seems to have been more stable over time. This is an alarming signal for the health of the most vulnerable households. These conditions could result in a gradual deterioration of health in poor families, which is likely to increase the burden on health systems in future. Hence, at this moment public intervention does not seem able to alleviate this situation.
Stewart, Jill; Habgood, Veronica
The links between fuel poverty and poor health are well documented, yet there is no statutory requirement on local authorities to develop fuel poverty strategies, which tend to be patchy nationally and differ substantially in quality. Fuel poverty starts from the perspective of income, even though interventions can improve health. The current public health agenda calls for more partnership-based, cost-effective strategies based on sound evidence. Fuel poverty represents a key area where there is currently little local evidence quantifying and qualifying health gain arising from strategic interventions. As a result, this initial study sought to apply the principles of a health impact assessment to Luton's Affordable Warmth Strategy, exploring the potential to identify health impact arising--as a baseline for future research--in the context of the public health agenda. A national strategy would help ensure the promotion of targeted fuel poverty strategies.
Weeks, John R.; Getis, Arthur; Stow, Douglas A.; Hill, Allan G.; Rain, David; Engstrom, Ryan; Stoler, Justin; Lippitt, Christopher; Jankowska, Marta; Lopez-Carr, Anna Carla; Coulter, Lloyd; Ofiesh, Caetlin
West Africa has a rapidly growing population, an increasing fraction of which lives in urban informal settlements characterized by inadequate infrastructure and relatively high health risks. Little is known, however, about the spatial or health characteristics of cities in this region or about the spatial inequalities in health within them. In this article we show how we have been creating a data-rich field laboratory in Accra, Ghana, to connect the dots between health, poverty, and place in a large city in West Africa. Our overarching goal is to test the hypothesis that satellite imagery, in combination with census and limited survey data, such as that found in demographic and health surveys (DHSs), can provide clues to the spatial distribution of health inequalities in cities where fewer data exist than those we have collected for Accra. To this end, we have created the first digital boundary file of the city, obtained high spatial resolution satellite imagery for two dates, collected data from a longitudinal panel of 3,200 women spatially distributed throughout Accra, and obtained microlevel data from the census. We have also acquired water, sewerage, and elevation layers and then coupled all of these data with extensive field research on the neighborhood structure of Accra. We show that the proportional abundance of vegetation in a neighborhood serves as a key indicator of local levels of health and well-being and that local perceptions of health risk are not always consistent with objective measures. PMID:24532846
Background Poverty is multi dimensional. Beyond the quantitative and tangible issues related to inadequate income it also has equally important social, more intangible and difficult if not impossible to quantify dimensions. In 2009, we explored these social and relativist dimension of poverty in five communities in the South of Ghana with differing socio economic characteristics to inform the development and implementation of policies and programs to identify and target the poor for premium exemptions under Ghana’s National Health Insurance Scheme. Methods We employed participatory wealth ranking (PWR) a qualitative tool for the exploration of community concepts, identification and ranking of households into socioeconomic groups. Key informants within the community ranked households into wealth categories after discussing in detail concepts and indicators of poverty. Results Community defined indicators of poverty covered themes related to type of employment, educational attainment of children, food availability, physical appearance, housing conditions, asset ownership, health seeking behavior, social exclusion and marginalization. The poverty indicators discussed shared commonalities but contrasted in the patterns of ranking per community. Conclusion The in-depth nature of the PWR process precludes it from being used for identification of the poor on a large national scale in a program such as the NHIS. However, PWR can provide valuable qualitative input to enrich discussions, development and implementation of policies, programs and tools for large scale interventions and targeting of the poor for social welfare programs such as premium exemption for health care. PMID:23497484
Kalichman, Seth C; Hernandez, Dominica; Kegler, Christopher; Cherry, Chauncey; Kalichman, Moira O; Grebler, Tamar
HIV infection is concentrated in populations living in poverty. We examined the overlapping and independent effects of multiple poverty indicators on HIV-related health status. Because substance use can create competing survival needs when resources are limited, we also sought to objectively measure expenditures on food relative to alcohol and tobacco products. To achieve these aims, 459 men and 212 women living with HIV infection in Atlanta, GA completed measures of socio-demographic and heath characteristics as well as multiple indicators of poverty including housing stability, transportation, food insecurity, and substance use. Participants were given a $30 grocery gift card for their participation and we collected receipts which were coded for alcohol (beer, wine, liquors) and tobacco purchases. Results showed that participants with unsuppressed HIV replication were significantly more likely to experience multiple indicators of poverty. In addition, one in four participants purchased alcohol or tobacco products with their gift cards, with as much as one-fourth of money spent on these products. A multivariable logistic regression model showed that food insecurity was independently associated with unsuppressed HIV, and purchasing alcohol or tobacco products did not moderate this association. Results confirm previous research to show the primacy of food insecurity in relation to HIV-related health outcomes. Competing survival needs, including addictive substances, should be addressed in programs that aim to alleviate poverty to enhance the health and well-being of people with HIV infection.
Gallo, Edmundo; Setti, Andréia Faraoni Freitas; Magalhães, Danielly de Paiva; Machado, Jorge Mesquita Huet; Buss, Daniel Forsin; Franco Netto, Francisco de Abreu; Buss, Paulo Marchiori
In a scenario where ecosystemic services are being eroded and there is high social inequity, a new model of development is necessary, namely one capable of promoting social development with a reduction of its ecological footprint. The 'Green Economy' model is one of the proposed models. This paper seeks to analyze the environmental, social and individual impacts on human health in the context of a 'brown economy', and discusses the contributions of a green economy on the promotion of equity and health. The assumption is that economic development and environmental sustainability are not incompatible and both contribute to the eradication of poverty. The transition to a sustainable economy depends on political decisions, and transcends technological developments. Above all, it should instigate new models of production, consumption and social organization, which promote socio-environmental justice, encouraging social participation and democratic forms of governance to define a solid agenda for the implementation of sustainable development and mechanisms to implement them at all levels.
Bellin, Melissa H.; Land, Cassie; Newsome, Angelica; Kub, Joan; Mudd, Shawna S.; Bollinger, Mary Elizabeth; Butz, Arlene M.
Objective Low-income caregivers of young children with high-risk asthma experience social stressors and illness-related demands that may impede effective home asthma management. Knowledge of the caregiving experience in the context of poverty is limited. Methods Convenience sampling methods were used to recruit low-income caregivers of children aged 7–12 years, who are frequently in the Emergency Room (ED) for uncontrolled asthma. Thirteen caregivers participated in focus groups that were designed to elicit reflections on asthma home and community management from the caregiver perspective. A grounded theory approach was used in the open coding of transcript data from three focus groups, as well as to revise and reorganize emerging themes and sub-themes. Results Participants (Mean age = 33.9 years) were predominantly the biological mother (92.3%), single (84.6%), and impoverished (69.2% reported annual household income ≤ $30,000). Their children (Mean age = 7.8 years) were African-American (100%), enrolled in Medicaid (92.3%), averaged 1.38 (SD = 0.7) ED visits over the prior 3 months, resided in homes with at least one smoker (61.5%), and nearly all (84.6%) experienced activity limitations due to asthma. Five themes emerged in the analysis: intensive caregiving role, complex and shared asthma management responsibility, parental beliefs and structural barriers to guideline-based care, lack of control over environmental triggers, and parent advocacy to improve child asthma care and outcomes. Conclusions Caregivers managing a child with high-risk asthma in the context of poverty indicate the need for ongoing asthma education, increased sensitivity to the complexity of home asthma management, and family-centered interventions that enhance communication and collaboration between caregivers and providers. PMID:27304455
Klebanov, Pamela Kato; And Others
Estimated effects of neighborhood and family poverty on maternal psychological and behavioral characteristics using data from 895 mothers. Neighborhood poverty was associated with poorer home physical environment and with less maternal warmth, controlling for family conditions. Home environment was adversely affected by family poverty, large…
O'Neill, Marie S; McMichael, Anthony J; Schwartz, Joel; Wartenberg, Daniel
International attention is focusing increasingly on environmental concerns, from global warming and extreme weather to persistent chemical pollutants that affect our food supplies, health and well-being. These environmental exposures disproportionately affect the poor and those residing in developing countries, and may partly explain the persistent social gradients in health that exist within and between nations. We support recent calls for environmental epidemiologists to play a more active role in furthering the global agenda for sustainability, environmental health and equity. We further suggest that the discipline of environmental epidemiology, as well as relevant funding agencies, broaden their focus to include rigorous research on the upstream, larger-scale societal factors that contribute to inequitable patterns of exposure and health outcomes. By widening the scope of our vision and increasing the strength and breadth of the evidence base about how poverty and environment together affect health, we can better participate in efforts to promote social justice and responsible use and protection of the environment, and thus reduce health inequities. That is both a primary mode and rationale for achieving sustainability.
In this study, state-level US data for the years 2000 and 1990 are used to provide additional evidence on the roles of income inequality and poverty in population health. Five main points are noted. First, contrary to the suggestion made in several recent studies, the income inequality parameter is observed to be quite robust and carries statistical significance in mortality equations estimated from several observation sets and a fairly wide variety of specificational choices. Second, the evidence does not indicate that significance of income inequality is lost when education variables are included. Third, similarly, the income inequality parameter shows significance when a race variable is added, and also when both race and urbanization terms are entered. Fourth, while poverty is seen to have some mortality-increasing consequence, the role of income inequality appears stronger. Fifth, income inequality retains statistical significance when a quadratic income term is added and also if the log-log version of a fairly inclusive model is estimated. I therefore suggest that the recent skepticism articulated by several scholars in regard to the robustness of the income inequality parameters in mortality equations estimated from the US data should be reconsidered.
Seponski, Desiree M; Lewis, Denise C; Megginson, Maegan C
Mental health issues are significant contributors to the global burden of disease with the highest incidence in resource poor countries; 90% of those in need of mental health treatment reside in low resource countries but receive only 10% of the world's resources. Cambodia, the eighth least developed country in the world, serves as one example of the need to address mental health concerns in low-income, resource poor countries. The current study utilises responsive evaluation methodology to explore how poverty-stricken Cambodian clients, therapists and supervisors experience Western models of therapy as culturally responsive to their unique needs. Quantitative and qualitative data were triangulated across multiple stakeholders using numerous methods including a focus group, interviews, surveys, case illustrations and live supervision observation and analysed using constant comparative analysis. Emerging findings suggest that poverty, material needs, therapy location and financial situations greatly impact the daily lives and mental health conditions of Cambodians and hinder clients' therapeutic progress. The local community needs and context of poverty greatly hinder clients' therapeutic progress in therapy treatment and when therapy does not directly address the culture of poverty, clients did not experience therapy as valuable despite some temporary decreases in mental health symptoms.
Schickedanz, Adam; Dreyer, Benard P; Halfon, Neal
Poor children are at greater risk for worse health, less productivity, and harms to well-being that extend into adulthood and subsequent generations. Timing and duration of poverty matter and influence life course outcomes, especially for education, health, and lifetime productivity. This article focuses on interventions by policy advocacy and the pediatric health system, and protection of the health and well-being of families in economic hardship from disadvantages and trauma wrought by poverty. A framework is presented for child poverty prevention and its consequences for lifelong health and success on a national scale.
Paris, Deidre E.; Trevino, Luis; Watson, Michael D.
As a part of the overall goal of developing Integrated Vehicle Health Management systems for aerospace vehicles, the NASA Faculty Fellowship Program (NFFP) at Marshall Space Flight Center has performed a pilot study on IVHM principals which integrates researched IVHM technologies in support of Integrated Intelligent Vehicle Management (IIVM). IVHM is the process of assessing, preserving, and restoring system functionality across flight and ground systems (NASA NGLT 2004). The framework presented in this paper integrates advanced computational techniques with sensor and communication technologies for spacecraft that can generate responses through detection, diagnosis, reasoning, and adapt to system faults in support of INM. These real-time responses allow the IIVM to modify the affected vehicle subsystem(s) prior to a catastrophic event. Furthermore, the objective of this pilot program is to develop and integrate technologies which can provide a continuous, intelligent, and adaptive health state of a vehicle and use this information to improve safety and reduce costs of operations. Recent investments in avionics, health management, and controls have been directed towards IIVM. As this concept has matured, it has become clear the INM requires the same sensors and processing capabilities as the real-time avionics functions to support diagnosis of subsystem problems. New sensors have been proposed, in addition, to augment the avionics sensors to support better system monitoring and diagnostics. As the designs have been considered, a synergy has been realized where the real-time avionics can utilize sensors proposed for diagnostics and prognostics to make better real-time decisions in response to detected failures. IIVM provides for a single system allowing modularity of functions and hardware across the vehicle. The framework that supports IIVM consists of 11 major on-board functions necessary to fully manage a space vehicle maintaining crew safety and mission
This study examined the perceptions of principals and teachers regarding mental health provider's impact on student achievement and behavior in high poverty schools using descriptive statistics, t-test, and two-way ANOVA. Respondents in this study shared similar views concerning principal and teacher satisfaction and levels of support for the…
Despite important recent initiatives to improve the health of the most disadvantaged in the world (the Millennium Development Goals, debt cancellation campaigns), poverty and preventable diseases still plague many parts of the globe. Sub-Saharan Africa remains one of the most severely affected. It is the only region in the world where life expectancy has not seen much improvement. Some countries have employed strategies of investment in public services, such as education, with positive results (e.g. the 'tiger economies'). Others have tried to follow prescribed strategies from global institutions such as the International Monetary Fund and World Bank with varying degrees of success. Sustainable development will require continuous commitment from donors and recipients to long-term strategies. Oxfam believes investment in public services and education is key to sustainability, in combination with more effective debt cancellation. These concepts are explored in the 2006 Harben Lecture given by Barbara Stocking, Director of Oxfam.
Maier, Raina M.; Díaz-Barriga, Fernando; Field, James A.; Hopkins, James; Klein, Bern; Poulton, Mary M.
Increasing global demand for metals is straining the ability of the mining industry to physically keep up with demand (physical scarcity). On the other hand, social issues including the environmental and human health consequences of mining as well as the disparity in income distribution from mining revenues are disproportionately felt at the local community level. This has created social rifts, particularly in the developing world, between affected communities and both industry and governments. Such rifts can result in a disruption of the steady supply of metals (situational scarcity). Here we discuss the importance of mining in relationship to poverty, identify steps that have been taken to create a framework for socially responsible mining, and then discuss the need for academia to work in partnership with communities, government, and industry to develop trans-disciplinary research-based step change solutions to the intertwined problems of physical and situational scarcity. PMID:24552962
Maier, Raina M; Díaz-Barriga, Fernando; Field, James A; Hopkins, James; Klein, Bern; Poulton, Mary M
Increasing global demand for metals is putting strain on the ability of the mining industry to physically keep up with demand (physical scarcity). Conversely, social issues including the environmental and human health consequences of mining as well as the disparity in income distribution from mining revenues are disproportionately felt at the local community level. This has created social rifts, particularly in the developing world, between affected communities and both industry and governments. Such rifts can result in a disruption of the steady supply of metals (situational scarcity). Here we discuss the importance of mining in relationship to poverty, identify steps that have been taken to create a framework for socially responsible mining, and then discuss the need for academia to work in partnership with communities, government, and industry to develop transdisciplinary research-based step change solutions to the intertwined problems of physical and situational scarcity.
Morris, Amanda Sheffield; Robinson, Lara R; Hays-Grudo, Jennifer; Claussen, Angelika H; Hartwig, Sophie A; Treat, Amy E
In this article, the authors posit that programs promoting nurturing parent-child relationships influence outcomes of parents and young children living in poverty through two primary mechanisms: (a) strengthening parents' social support and (b) increasing positive parent-child interactions. The authors discuss evidence for these mechanisms as catalysts for change and provide examples from selected parenting programs that support the influence of nurturing relationships on child and parenting outcomes. The article focuses on prevention programs targeted at children and families living in poverty and closes with a discussion of the potential for widespread implementation and scalability for public health impact.
Morris, Amanda Sheffield; Robinson, Lara R.; Hays-Grudo, Jennifer; Claussen, Angelika H.; Hartwig, Sophie A.; Treat, Amy E.
In this article, the authors posit that programs promoting nurturing parent–child relationships influence outcomes of parents and young children living in poverty through two primary mechanisms: (a) strengthening parents’ social support and (b) increasing positive parent–child interactions. The authors discuss evidence for these mechanisms as catalysts for change and provide examples from selected parenting programs that support the influence of nurturing relationships on child and parenting outcomes. The article focuses on prevention programs targeted at children and families living in poverty and closes with a discussion of the potential for widespread implementation and scalability for public health impact. PMID:28138978
Shrime, Mark G.; Sekidde, Serufusa; Linden, Allison; Cohen, Jessica L.; Weinstein, Milton C.; Salomon, Joshua A.
Background The recently adopted Sustainable Development Goals call for the end of poverty and the equitable provision of healthcare. These goals are often at odds, however: health seeking can lead to catastrophic spending, an outcome for which cancer patients and the poor in resource-limited settings are at particularly high risk. How various health policies affect the additional aims of financial wellbeing and equity is poorly understood. This paper evaluates the health, financial, and equity impacts of governmental and charitable policies for surgical oncology in a resource-limited setting. Methods Three charitable platforms for surgical oncology delivery in Uganda were compared to six governmental policies aimed at improving healthcare access. An extended cost-effectiveness analysis using an agent-based simulation model examined the numbers of lives saved, catastrophic expenditure averted, impoverishment averted, costs, and the distribution of benefits across the wealth spectrum. Findings Of the nine policies and platforms evaluated, two were able to provide simultaneous health and financial benefits efficiently and equitably: mobile surgical units and governmental policies that simultaneously address surgical scaleup, the cost of surgery, and the cost of transportation. Policies that only remove user fees are dominated, as is the commonly employed short-term “surgical mission trip”. These results are robust to scenario and sensitivity analyses. Interpretation The most common platforms for increasing access to surgical care appear unable to provide health and financial risk protection equitably. On the other hand, mobile surgical units, to date an underutilized delivery platform, are able to deliver surgical oncology in a manner that meets sustainable development goals by improving health, financial solvency, and equity. These platforms compare favorably with policies that holistically address surgical delivery and should be considered as countries
Holt, James B
Socioeconomic and health-related data at the county level are now available through the Community Health Status Indicators (CHSI) database. These data are useful for assessing the health of communities and regions. Users of the CHSI data can access online reports and an online mapping application for visualizing patterns in various community-related measures. It also is possible to download these data to conduct local analyses. This paper describes a spatial analysis of poverty in the United States at the county level for 2000. Spatial statistical techniques in a geographic information system were used to quantify significant spatial patterns, such as concentrated poverty rates and spatial outliers. The analysis revealed significant and stark patterns of poverty. A distinctive north-south demarcation of low versus high poverty concentrations was found, along with isolated pockets of high and low poverty within areas in which the predominant poverty rates were opposite. This pattern can be described as following a continental poverty divide. These insights can be useful in explicating the underlying processes involved in forming such spatial patterns that result in concentrated wealth and poverty. The spatial analytic techniques are broadly applicable to socioeconomic and health-related data and can provide important information about the spatial structure of datasets, which is important for choosing appropriate analysis methods.
Pförtner, Timo-Kolja; Schmidt-Catran, Alexander W
In this study, we investigated whether self-rated health (SRH) can be predicted by in-work poverty and how between-persons and within-person differences in the poverty status of people who are working contribute to this relationship. We used a logistic random-effects model designed to test within-person and between-persons differences with data from a nationally representative German sample with 19 waves of data collection (1995-2013) to estimate effects of between-persons and within-person differences in working poverty status on poor SRH. Interactions by age and sex were tested, and models controlled for sociodemographic, socioeconomic, and work-related characteristics. We found significant differences in SRH between individuals with different working poverty status but no evidence that within-person differences in working poverty status are associated with poor SRH. The association between in-work poverty and SRH was significantly stronger for women but did not differ significantly by age. All findings were robust when including sociodemographic, socioeconomic, and working characteristics. In this sample of German adults, we found a polarization of poor SRH between the working nonpoor and the working poor but no causal association of within-person differences in working poverty status with SRH.
del Rey Calero, Juan
The Global and economic crisis and Health Management The Health care process discussed are 4 steps: assessment, planing, intervention and evaluation. The identify association between social factors linked to social vulnerability (socio economic status, unemployed, poverty) and objective health relate quality of life. The poverty rate is 24.2%, unemployed 26.26%, youth unemployed 56.13%.ratio worker/retired 2.29. Debts 100% GDP The health inequality influence on health related quality of life. The Health System efficiency index. according Bloomber rate (2,013) Spain is 5 degrees in the world, points 68.3 on 100, for the life expectancy 82.3 years, the personal cost of health care 2,271€. Health care 10% GDP (public 7%,private 3%), SS protected population 92.4%, retired person cost 9.2% GDP, p. capita GDP 23,737€. Cost of Care: Hospital/specialist 54%, P. Care 15%, Pharmaceutical 19.8%, P. Health 3.1%.
Background In India, indigenous populations, known as Adivasi or Scheduled Tribes (STs), are among the poorest and most marginalized groups. 'Deprived' ST groups tend to display high levels of resignation and to lack the capacity to aspire; consequently their health perceptions often do not adequately correspond to their real health needs. Moreover, similar to indigenous populations elsewhere, STs often have little opportunity to voice perspectives framed within their own cultural worldviews. We undertook a study to gather policy-relevant data on the views, experiences, and priorities of a marginalized and previously enslaved tribal group in South India, the Paniyas, who have little 'voice' or power over their own situation. Methods/design We implemented a Participatory Poverty and Health Assessment (PPHA). We adopted guiding principles and an ethical code that promote respect for Paniya culture and values. The PPHA, informed by a vulnerability framework, addressed five key themes (health and illness, well-being, institutions, education, gender) using participatory approaches and qualitative methods. We implemented the PPHA in five Paniya colonies (clusters of houses in a small geographical area) in a gram panchayat (lowest level decentralized territorial unit) to generate data that can be quickly disseminated to decision-makers through interactive workshops and public forums. Preliminary findings Findings indicated that the Paniyas are caught in multiple 'vulnerability traps', that is, they view their situation as vicious cycles from which it is difficult to break free. Conclusion The PPHA is a potentially useful approach for global health researchers working with marginalized communities to implement research initiatives that will address those communities' health needs in an ethical and culturally appropriate manner. PMID:20307290
Ziegenhagen, D J; Schilling, M K
German private health insurance faces new challenges. The classical tools of cost containment are no longer sufficient to keep up with ever increasing expenses for health care, and international competitors with managed care experience from their home markets are on the point of entering business in Germany. Although the American example of managed care is not fully compatible with customer demands and state regulations, some elements of this approach will gradually be introduced. First agreements were signed with networks or individual preferred providers in outpatient care and rehabilitation medicine. Insurance companies become more and more interested in supporting evidence based guidelines and programmes for disease and case management. The pros and cons of various other health management tools are discussed against the specific background of the quite unique German health care system.
Dione, Michel M; Ouma, Emily A; Roesel, Kristina; Kungu, Joseph; Lule, Peter; Pezo, Danilo
While animal health constraints have been identified as a major limiting factor in smallholder pig production in Uganda, researchers and policy makers lack information on the relative incidence of diseases and their impacts on pig production. This study aimed to assess animal health and management practices, constraints and opportunities for intervention in smallholder pig value chains in three high poverty districts of Uganda. Semi-qualitative interview checklists through Focus Group Discussions (FGDs) were administered to 340 pig farmers in 35 villages in Masaka, Kamuli and Mukono districts. Quantitative data was obtained during the exercise through group consensus. Results of FGDs were further triangulated with secondary data and information obtained from key informant interviews. Findings show that pig keeping systems are dominated by tethering and scavenging in rural areas. In peri-urban and urban areas, intensive production systems are more practiced, with pigs confined in pens. The main constraints identified by farmers include high disease burden such as African swine fever (ASF) and parasites, poor housing and feeding practices, poor veterinary services, ineffective drugs and a general lack of knowledge on piggery management. According to farmers, ASF is the primary cause of pig mortality with epidemics occurring mainly during the dry season. Worms and ectoparasites namely; mange, lice and flies are endemic leading to stunted growth which reduces the market value of pigs. Diarrhoea and malnutrition are common in piglets. Ninety-three percent of farmers say they practice deworming, 37% practice ectoparasite spraying and 77% castrate their boars. Indigenous curative treatments include the application of human urine and concoctions of local herbs for ASF control and use of old engine oil or tobacco extracts to control ectoparasites. There is a need for better technical services to assist farmers with these problems.
Oshio, Takashi; Kobayashi, Miki
In this study we conduct a multilevel analysis to investigate the association between regional income inequality and self-rated health in Japan, based on two nationwide surveys. We confirm that there is a significant association between area-level income inequality and individual-level health assessment. We also find that health assessment tends to be more sensitive to income inequality among lower income individuals, and to degree of area-level poverty, than income inequality for the society as a whole. In addition, we examine how individuals are averse to inequality, based on the observed association between inequality and self-rated health.
Kim, Jinhyun; Richardson, Virginia
This study aims to examine poverty, chronic illnesses, health insurance, and health care expenditures, within the context of a political economy of aging perspective. Subsamples of 1,773 older adults from the Medical Expenditure Panel Survey were selected for analyses. The results showed that chronic illnesses influenced out-of-pocket health care costs. Older persons with more than one health insurance spent less on out-of-pocket health care costs. The results have implications for health care social workers concerned with the growing costs of chronic illnesses, implementing integrated care, and advocating for extending public health insurance coverage especially for our most impoverished older adults.
Bhui, Kamaldeep; Warfa, Nasir; Jones, Edgar
Background Doctors, lawyers and criminal justice agencies need methods to assess vulnerability to violent radicalization. In synergy, public health interventions aim to prevent the emergence of risk behaviours as well as prevent and treat new illness events. This paper describes a new method of assessing vulnerability to violent radicalization, and then investigates the role of previously reported causes, including poor self-reported health, anxiety and depression, adverse life events, poverty, and migration and socio-political factors. The aim is to identify foci for preventive intervention. Methods A cross-sectional survey of a representative population sample of men and women aged 18–45, of Muslim heritage and recruited by quota sampling by age, gender, working status, in two English cities. The main outcomes include self-reported health, symptoms of anxiety and depression (common mental disorders), and vulnerability to violent radicalization assessed by sympathies for violent protest and terrorist acts. Results 2.4% of people showed some sympathy for violent protest and terrorist acts. Sympathy was more likely to be articulated by the under 20s, those in full time education rather than employment, those born in the UK, those speaking English at home, and high earners (>£75,000 a year). People with poor self-reported health were less likely to show sympathies for violent protest and terrorism. Anxiety and depressive symptoms, adverse life events and socio-political attitudes showed no associations. Conclusions Sympathies for violent protest and terrorism were uncommon among men and women, aged 18–45, of Muslim heritage living in two English cities. Youth, wealth, and being in education rather than employment were risk factors. PMID:24599058
Frazier, Stacy L.; Atkins, Marc S.; Schoenwald, Sonja K.; Glisson, Charles
School based mental health services for children in poverty can capitalize on schools’ inherent capacity to support development and bridge home and neighborhood ecologies. We propose an ecological model informed by public health and organizational theories to refocus school based services in poor communities on the core function of schools to promote learning. We describe how coalescing mental health resources around school goals includes a focus on universal programming, mobilizing indigenous school and community resources, and supporting core teaching technologies. We suggest an iterative research–practice approach to program adaptation and implementation as a means toward advancing science and developing healthy children. PMID:18581225
The poverty affecting 14.5 million U.S. children living below the poverty line poses long-term effects, including risks to health, educational achievement, family stability, and employment prospects. This report provides compelling evidence of the substantial costs of poverty among children to our nation's economic well-being, and shows that…
Stepanikova, Irena; Cook, Karen S
Objective To investigate whether poverty and lack of insurance are associated with perceived racial and ethnic bias in health care. Data Source 2001 Survey on Disparities in Quality of Health Care, a nationally representative telephone survey. We use data on black, Hispanic, and white adults who have a regular physician (N=4,556). Study Design We estimate multivariate logistic regression models to examine the effects of poverty and lack of health insurance on perceived racial and ethnic bias in health care for all respondents and by racial, ethnic, and language groups. Principal Findings Controlling for sociodemographic and other factors, uninsured blacks and Hispanics interviewed in English are more likely to report racial and ethnic bias in health care compared with their privately insured counterparts. Poor whites are more likely to report racial and ethnic bias in health care compared with other whites. Good physician–patient communication is negatively associated with perceived racial and ethnic bias. Conclusions Compared with their more socioeconomically advantaged counterparts, poor whites, uninsured blacks, and some uninsured Hispanics are more likely to perceive that racial and ethnic bias operates in the health care they receive. Providing health insurance for the uninsured may help reduce this perceived bias among some minority groups. PMID:18546546
Ferriss, Abbott L.
Child poverty, as a critical indicator of the QOL, is intricately related to the social structure of the community. This hypothesis is explored for the 159 counties of Georgia for the year 2000. The influence of demographic, economic, family and health factors upon child poverty are explored through models of total, black and white child poverty.…
Weil, Thomas P
The past several decades have witnessed a significant increase in the number of graduate programs in health management, either on campus or online. The alternative for a health professional to attending a graduate program on campus is to receive an MBA or MHA degree online. The current cost ranges from $13,600 to $78,000, with the more expensive online programs tied to graduate programs that are accredited by the Commission on the Accreditation of Healthcare Management Education and provide the names and qualifications of their faculty. The for-profit online programs have not been forthcoming to this author concerning their health management faculty or their curriculum. For the individual desiring more health management education who is unable to enroll, for family or financial reasons, in an on-campus program, the top-tier online programs seem like a worthwhile but is a relatively expensive option.
Honoré, Peggy A; Costich, Julia F
The absence of appropriate financial management competencies has impeded progress in advancing the field of public health finance. It also inhibits the ability to professionalize this sector of the workforce. Financial managers should play a critical role by providing information relevant to decision making. The lack of fundamental financial management knowledge and skills is a barrier to fulfilling this role. A national expert committee was convened to examine this issue. The committee reviewed standards related to financial and business management practices within public health and closely related areas. Alignments were made with national standards such as those established for government chief financial officers. On the basis of this analysis, a comprehensive set of public health financial management competencies was identified and examined further by a review panel. At a minimum, the competencies can be used to define job descriptions, assess job performance, identify critical gaps in financial analysis, create career paths, and design educational programs.
Vanier Inst. of the Family, Ottawa (Ontario).
Children comprise the largest group of poor Canadians. While childhood poverty is closely related to a number of factors pertaining to the structure and functioning of families, such as parental marital status and wage-earning patterns, the poverty of children is a consequence of the poverty of families. As such, childhood poverty can be reduced…
Petersen, Inge; Swartz, Leslie; Bhana, Arvin; Flisher, Alan J
In order to achieve sustainable development and a consequent reduction in levels of poverty, a multisectoral response to development incorporating pro-poor economic policies in low- to middle-income countries (LMICs) is required. An important aspect is strengthening the human capital asset base of vulnerable populations. This should include the promotion of mental health, which can play an important role in breaking the intergenerational cycle of poverty and mental ill-health through promoting positive mental health outcomes within the context of risk. For each developmental phase of early childhood, middle childhood and adolescence, this article provides: (i) an overview of the critical risk influences and evidence of the role of mental health promotion initiatives in mediating these influences; (ii) a background to these risk influences in South Africa; and (iii) a review of mental health promotion initiatives addressing distal upstream influences at a macro-policy level in South Africa, as well as evidence-based micro- and community-level interventions that have the potential to be scaled up. From this review, strengths and gaps in existing micro- and community-level evidence-based mental health promotion interventions as well as macro-policy-level initiatives are identified, and recommendations made for South Africa that may also have applicability for other LMICs.
Two percent of women in the United States suffer from intimate partner violence annually, with poor and minority women disproportionately affected. I provide evidence of an important negative externality associated with domestic violence by estimating a negative and causal relationship between violence during pregnancy and newborn health,…
Math, Suresh Bada; Nirmala, Maria Christine; Moirangthem, Sydney; Kumar, Naveen C.
Disaster mental health is based on the principles of ‘preventive medicine’ This principle has necessitated a paradigm shift from relief centered post-disaster management to a holistic, multi-dimensional integrated community approach of health promotion, disaster prevention, preparedness and mitigation. This has ignited the paradigm shift from curative to preventive aspects of disaster management. This can be understood on the basis of six ‘R’s such as Readiness (Preparedness), Response (Immediate action), Relief (Sustained rescue work), Rehabilitation (Long term remedial measures using community resources), Recovery (Returning to normalcy) and Resilience (Fostering). Prevalence of mental health problems in disaster affected population is found to be higher by two to three times than that of the general population. Along with the diagnosable mental disorders, affected community also harbours large number of sub-syndromal symptoms. Majority of the acute phase reactions and disorders are self-limiting, whereas long-term phase disorders require assistance from mental health professionals. Role of psychotropic medication is very limited in preventing mental health morbidity. The role of cognitive behaviour therapy (CBT) in mitigating the mental health morbidity appears to be promising. Role of Psychological First Aid (PFA) and debriefing is not well-established. Disaster management is a continuous and integrated cyclical process of planning, organising, coordinating and implementing measures to prevent and to manage disaster effectively. Thus, now it is time to integrate public health principles into disaster mental health. PMID:26664073
Intelligent Integrated System Health Management (ISHM) is the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system (Management: storage, distribution, sharing, maintenance, processing, reasoning, and presentation). Presentation discusses: (1) ISHM Capability Development. (1a) ISHM Knowledge Model. (1b) Standards for ISHM Implementation. (1c) ISHM Domain Models (ISHM-DM's). (1d) Intelligent Sensors and Components. (2) ISHM in Systems Design, Engineering, and Integration. (3) Intelligent Control for ISHM-Enabled Systems
Robinson, James C
The future of market-oriented health policy and practice lies in "managed consumerism," a blend of the patient-centric focus of consumer-driven health care and the provider-centric focus of managed competition. The optimal locus of incentives will vary among health services according to the nature of the illness, the clinical technology, and the extent of discretion in utilization. A competitive market will manifest a variety of comprehensive and limited benefit designs, broad and narrow contractual networks, and single-and multispecialty provider organizations.
Short, Kathleen S
This article provides a discussion of what we mean when we refer to 'child poverty.' Many images come to mind when we discuss child poverty, but when we try to measure and quantify the extent of child poverty, we often use a very narrow concept. In this article a variety of poverty measures that are used in the United States are described and some of the differences between those measures are illustrated. In this article 3 measures are explored in detail: a relative measure of poverty that is used more often in an international context, the official US poverty measure, and a new supplemental poverty measure (SPM). The new measure differs from the other 2 because it takes into account noncash benefits that are provided to poor families. These include nutrition assistance such as food stamps, subsidized housing, and home energy assistance. The SPM also takes account of necessary expenses that families face, such as taxes and expenses related to work and health care. Comparing estimates for 2012, the SPM showed lower poverty rates for children than the other 2 measures. Because noncash benefits help those in extreme poverty, there were also lower percentages of children in extreme poverty with resources below half the SPM threshold. These results suggest that 2 important measures of poverty, the relative measure used in international comparisons, and the official poverty measure, are not able to gauge the effect of government programs on the alleviation of poverty, and the SPM illustrates that noncash benefits do help families meet their basic needs.
Kalichman, Seth C; Hernandez, Dominica; Cherry, Chauncey; Kalichman, Moira O; Washington, Christopher; Grebler, Tamar
Health disparities in access to antiretroviral therapy (ART) as well as the demands of long-term medication adherence have meant the full benefits of HIV treatment are often not realized. In particular, food insecurity has emerged as a robust predictor of ART non-adherence. However, research is limited in determining whether food insecurity uniquely impedes HIV treatment or if food insecurity is merely a marker for poverty that interferes more broadly with treatment. This study examined indicators of poverty at multiple levels in a sample of 364 men and 157 women living with HIV recruited through an offering of a free holiday food basket. Results showed that 61 % (N = 321) of participants had experienced at least one indicator of food insecurity in the previous month. Multivariate analyses showed that food insecurity was closely tied to lack of transportation. In addition, food insecurity was associated with lacking access to ART and poor ART adherence after adjusting for neighbourhood poverty, living in an area without a supermarket (food desert), education, stable housing, and reliable transportation. Results therefore affirm previous research that has suggested food insecurity is uniquely associated with poor ART adherence and calls for structural interventions that address basic survival needs among people living with HIV, especially food security.
Sensor and Measurement technologies are rapidly developing for many consumer applications which have the potential to make a major impact on business and society. One of the most important areas for building a sustainable future is in health management. This opportunity arises because of the growing popularity of lifestyle monitoring devices such as the Jawbone UP bracelet, Nike Fuelband and Samsung Galaxy GEAR. These devices measure physical activity and calorie consumption and, when visualised on mobile and portable devices, enable users to take more responsibility for their personal health. This presentation looks at how the process of gamification can be applied to develop important geospatial health management applications that could not only improve the health of nations but also significantly address some of the issues in global health such as the ageing society and obesity.
This paper explores the changing institutional context of health service delivery in rural Tanzania through an anthropological analysis of the kinds of healing strategies pursued by men and women when they are ill. In some rural districts popular dissatisfaction with state medical provision is not manifested in a rejection of the allopathic medicine with which it is associated, but in increased reliance on an emerging informal sector of private medical provision. Although this sector provides a valued and accessible service to certain categories of clients it delivers poor quality treatment, serving to reinforce the cyclical relationship between poverty and ill health. Despite the best intentions of major public sector reforms neither government nor other agencies are able to meet rural demand for health services. Reliance on the parallel market for medical provision is likely to continue, at least in the short term, with negative consequences for health.
Makelarski, Jennifer A; Garibay, Lori B; Escamilla, Veronica; Merchant, Raina M; Wolfe Sr, Marcus B; Holbrook, Rebecca; Lindau, Stacy Tessler
Background More than 35% of American adults are obese. For African American and Hispanic adults, as well as individuals residing in poorer or more racially segregated urban neighborhoods, the likelihood of obesity is even higher. Information and communication technologies (ICTs) may substitute for or complement community-based resources for weight management. However, little is currently known about health-specific ICT use among urban-dwelling people with obesity. Objective We describe health-specific ICT use and its relationship to measured obesity among adults in high-poverty urban communities. Methods Using data collected between November 2012 and July 2013 from a population-based probability sample of urban-dwelling African American and Hispanic adults residing on the South Side of Chicago, we described patterns of ICT use in relation to measured obesity defined by a body mass index (BMI) of ≥30 kg/m2. Among those with BMI≥30 kg/m2, we also assessed the association between health-specific ICT use and diagnosed versus undiagnosed obesity as well as differences in health-specific ICT use by self-reported comorbidities, including diabetes and hypertension. Results The survey response rate was 44.6% (267 completed surveys/598.4 eligible or likely eligible individuals); 53.2% were African American and 34.6% were Hispanic. More than 35% of the population reported an annual income of less than US $25,000. The population prevalence of measured obesity was 50.2%. People with measured obesity (BMI≥30 kg/m2) were more likely to report both general (81.5% vs 67.0%, P=.04) and health-specific (61.1% vs 41.2%, P=.01) ICT use. In contrast, among those with measured obesity, being told of this diagnosis by a physician was not associated with increased health-specific ICT use. People with measured obesity alone had higher rates of health-specific use than those with comorbid hypertension and/or diabetes diagnoses (77.1% vs 60.7% vs 47.4%, P=.04). Conclusions In conclusion
Nkansah-Amankra, Stephen; Agbanu, Samuel Kwami; Miller, Reuben Jonathan
Problems of poverty, poor health, and incarceration are unevenly distributed among racial and ethnic minorities in the United States. We argue that this is due, in part, to the ascendance of United States-style neoliberalism, a prevailing political and economic doctrine that shapes social policy, including public health and anti-poverty intervention strategies. Public health research most often associates inequalities in health outcomes, poverty, and incarceration with individual and cultural risk factors. Contextual links to structural inequality and the neoliberal doctrine animating state-sanctioned interventions are given less attention. The interrelationships among these are not clear in the extant literature. Less is known about public health and incarceration. Thus, the authors describe the linkages between neoliberalism, public health, and criminal justice outcomes. We suggest that neoliberalism exacerbates racial disparities in health, poverty, and incarceration in the United States. We conclude by calling for a new direction in public health research that advances a pro-poor public health agenda to improve the general well-being of disadvantaged groups.
Jeon, Boyoung; Noguchi, Haruko; Kwon, Soonman; Ito, Tomoko; Tamiya, Nanako
With rapid aging, many of the elderly suffer from poverty and high healthcare needs. In Korea, there is a means-tested and non-contributory public assistance, the National Basic Livelihood Security System (NBLSS). The purpose of this study is to show older population's condition of disability and poverty, to evaluate the impact of NBLSS on health services utilization, and to examine the differential effect of the NBLSS by disability status among the elderly. This study used the Korea Welfare Panel Study data 2005-2014 with the final sample of 40,365, who were 65 years and older. The participants were divided into people with mild disability, severe disability, and without disability according to the Korean disability registration system. The income-level was defined to the low-income with NBLSS, the low-income without NBLSS, and the middle and high income, using the relative poverty line as a proxy of the low-income. The dependent variables were the number of outpatient visits and inpatient days, experience of home care services, total healthcare expenditure, and financial burden of healthcare expenditure. We performed Generalized Estimating Equations population-averaged model using the ten years of panel data. The result showed that within the same disability status, the low-income without NBLSS group used the least amount of inpatient care, but their financial burden of health expenditure was the highest among the three income groups. The regression model showed that if the elderly with severe disability were in the low-income without NBLSS, they reduced the outpatient and inpatient days; but their financial burden of healthcare became intensified. This study shows that the low-income elderly with disability but without adequate social protection are the most disadvantaged group. Policy is called for to mitigate the difficulties of this vulnerable population.
Healthy soils are critical for meeting current and future societal demands. Management strategies that protect the soil against erosion, build soil organic matter and promote nutrient cycling are ways to enhance soil health. Keeping soils covered and judicious use of agrochemicals are akin to us “hu...
Garbos, Raymond J.; Mouyos, William
To reduce operations cost, the RLV must include the following elements: highly reliable, robust subsystems designed for simple repair access with a simplified servicing infrastructure and incorporating expedited decision making about faults and anomalies. A key component for the Single Stage to Orbit (SSTO) RLV System used to meet these objectives is System Health Management (SHM). SHM deals with the vehicle component- Vehicle Health Management (VHM), the ground processing associated with the fleet (GVHM) and the Ground Infrastructure Health Management (GIHM). The objective is to provide an automated collection and paperless health decision, maintenance and logistics system. Many critical technologies are necessary to make the SHM (and more specifically VHM) practical, reliable and cost effective. Sanders is leading the design, development and integration of the SHM system for RLV and X-33 SHM (a sub-scale, sub-orbit Advanced Technology Demonstrator). This paper will present the X-33 SHM design which forms the baseline for RLV SHM. This paper will also discuss other applications of these technologies.
There are 16.4 million women over age 65 in this country, compared to 11 million men. The 41 percent of this population who live alone are the poorest of the poor in this country, with an annual median income of just over $3,000 for white women and little more than $2,000 for black women. This abject poverty affects the ability of these women to…
Sundari Ravindran, T K
Universal access to sexual and reproductive health services is one of the goals of the International Conference on Population and Development of 1994. The Millennium Development Goals were intended above all to end poverty. Universal access to health and health services are among the goals being considered for the post-2015 agenda, replacing or augmenting the MDGs. Yet we are not only far from reaching any of these goals but also appear to have lost our way somewhere along the line. Poverty and lack of food security have, through their multiple linkages to health and access to health care, deterred progress towards universal access to health services, including for sexual and reproductive health needs. A more insidious influence is neoliberal globalisation. This paper describes neoliberal globalisation and the economic policies it has engendered, the ways in which it influences poverty and food security, and the often unequal impact it has had on women as compared to men. It explores the effects of neoliberal economic policies on health, health systems, and universal access to health care services, and the implications for access to sexual and reproductive health. To be an advocate for universal access to health and health care is to become an advocate against neoliberal globalisation.
McManus, Marilyn C., Ed.
This theme issue of a bulletin on family support and children's mental health focuses on managed care and the impact on children who are in need of mental health services. Articles include: "Private Sector Managed Care and Children's Mental Health" (Ira S. Lourie and others); "Just What Is Managed Care?" (Chris Koyanagi); "Managed Behavioral…
Wachira, Catherine; Ruger, Jennifer Prah
The public health and development communities understand clearly the need to integrate anti-poverty efforts with HIV/AIDS programs. This article reports findings about the impact of the Poverty Reduction Strategy Paper (PRSP) process on Malawi's National HIV/AIDS Strategic Framework (NSF). In this article we ask, how does the PRSP process support NSF accountability, participation, access to information, funding, resource planning and allocation, monitoring, and evaluation? In 2007, we developed and conducted a survey of Malawian government ministries, United Nations agencies, members of the Country Coordination Mechanism, the Malawi National AIDS Commission (NAC), and NAC grantees (N = 125, 90% response rate), seeking survey respondents' retrospective perceptions of NSF resource levels, participation, inclusion, and governance before, during, and after Malawi's PRSP process (2000-2004). We also assessed principle health sector and economic indicators and budget allocations for HIV/AIDS. These indicators are part of a new conceptual framework called shared health governance (SHG), which seeks congruence among the values and goals of different groups and actors to reflect a common purpose. Under this framework, global health policy should encompass: (i) consensus among global, national, and sub-national actors on goals and measurable outcomes; (ii) mutual collective accountability; and (iii) enhancement of individual and group health agency. Indicators to assess these elements included: (i) goal alignment; (ii) adequate resource levels; (iii) agreement on key outcomes and indicators for evaluating those outcomes; (iv) meaningful inclusion and participation of groups and institutions; (v) special efforts to ensure participation of vulnerable groups; and (vi) effectiveness and efficiency measures. Results suggest that the PRSP process supported accountability for NSF resources. However, the process may have marginalized key stakeholders, potentially undercutting the
Mouyos, William; Wangu, Srimal
To reduce operations costs, Reusable Launch Vehicles (RLVS) must include highly reliable robust subsystems which are designed for simple repair access with a simplified servicing infrastructure, and which incorporate expedited decision-making about faults and anomalies. A key component for the Single Stage To Orbit (SSTO) RLV system used to meet these objectives is System Health Management (SHM). SHM incorporates Vehicle Health Management (VHM), ground processing associated with the vehicle fleet (GVHM), and Ground Infrastructure Health Management (GIHM). The primary objective of SHM is to provide an automated and paperless health decision, maintenance, and logistics system. Sanders, a Lockheed Martin Company, is leading the design, development, and integration of the SHM system for RLV and for X-33 (a sub-scale, sub-orbit Advanced Technology Demonstrator). Many critical technologies are necessary to make SHM (and more specifically VHM) practical, reliable, and cost effective. This paper will present the X-33 SHM design which forms the baseline for the RLV SHM, and it will discuss applications of advanced technologies to future RLVs. In addition, this paper will describe a Virtual Design Environment (VDE) which is being developed for RLV. This VDE will allow for system design engineering, as well as program management teams, to accurately and efficiently evaluate system designs, analyze the behavior of current systems, and predict the feasibility of making smooth and cost-efficient transitions from older technologies to newer ones. The RLV SHM design methodology will reduce program costs, decrease total program life-cycle time, and ultimately increase mission success.
Coley, Rebekah Levine; Sims, Jacqueline; Dearing, Eric; Spielvogel, Bryn
Research has identified risks of both poverty and affluence for adolescents. This study sought to clarify associations between income and youth mental and behavioral health by delineating economic risks derived from family, neighborhood, and school contexts within a nationally representative sample of high school students (N = 13,179, average age 16). Attending schools with more affluent schoolmates was associated with heightened likelihoods of intoxication, drug use, and property crime, but youth at poorer schools reported greater depressive and anxiety symptoms, engagement in violence, and for male adolescents, more frequent violence and intoxication. Neighborhood and family income were far less predictive. Results suggest that adolescent health risks derive from both ends of the economic spectrum, and may be largely driven by school contexts.
... Your 1- to 2-Year-Old Managing Home Health Care KidsHealth > For Parents > Managing Home Health Care A ... español La atención médica en el hogar Intensive Health Care at Home Kids can need intensive health care ...
Hammond, Walter E.; Jones, W. G.
Background material on vehicle health management (VHM) and health monitoring/control is presented. VHM benefits are described and a list of VHM technology needs that should be pursued is presented. The NASA funding process as it impacts VHM technology funding is touched upon, and the VHM architecture guidelines for generic launch vehicles are described. An example of a good VHM architecture, design, and operational philosophy as it was conceptualized for the National Launch System program is presented. Consideration is given to the Strategic Avionics Technology Working Group's role in VHM, earth-to-orbit, and space vehicle avionics technology development considerations, and some actual examples of VHM benefits for checkout are given.
Health inequities are determined by multiple factors within the health sector and beyond. While gaps in social health protection coverage and effective access to health care are among the most prominent causes of health inequities, social and economic inequalities existing beyond the health sector contribute greatly to barriers to access affordable and acceptable health care.
Khun, Sokrin; Manderson, Lenore
User fees were introduced in public health facilities in Cambodia in 1997 in order to inject funds into the health system to enhance the quality of services. Because of inadequate health insurance, a social safety net scheme was introduced to ensure that all people were able to attend the health facilities. However, continuing high rates of hospitalization and mortality from dengue fever among infants and children reflect the difficulties that women continue to face in finding sufficient cash in cases of medical emergency, resulting in delays in diagnosis and treatment. In this article, drawing on in-depth interviews conducted with mothers of children infected with dengue in eastern Cambodia, we illustrate the profound economic consequences for households when a child is ill. The direct costs for health care and medical services, and added indirect costs, deterred poor women from presenting with sick children. Those who eventually sought care often had to finance health spending through out-of-pocket payments and loans, or sold property, goods or labour to meet the costs. Costs were often catastrophic, exacerbating the extreme poverty of those least able to afford it. PMID:18439268
Meade, Michelle A.; Krause, James S.
Objective: The purpose of this study was to examine the relationship between employment and psychological health and health management as described by individuals with spinal cord injury (SCI) who were employed at least once following injury. Methods: A qualitative approach used 6 focus groups at 2 sites with 44 participants who were at least 10 years post SCI. All had been employed at some point since injury. Heterogeneous and homogeneous groups were delineated based on specific characteristics, such as education, gender, or race. Group sessions followed a semi-structured interview format with questions about personal, environmental, and policy related factors influencing employment following SCI. All group sessions were recorded, transcribed, and coded into conceptual categories to identify topics, themes, and patterns. Inferences were drawn about their meaning. NVivo 10 software using the constant comparative method was used for data analysis. Results: Narratives discussed the relationship between employment and psychological and emotional health and health management. Four themes were identified: (1) adjustment and dealing with emotional reactions, (2) gaining self-confidence, (3) preventing burnout, and (4) attitudes and perspectives. Most themes reflected issues that varied based on severity of injury as well as stage of employment. Conclusions: Individuals with SCI who are successful in working following injury must determine how to perform the behaviors necessary to manage their health and prevent emotional or physical complications. The emotional consequences of SCI must be recognized and addressed and specific behaviors enacted in order to optimize employment outcomes.
This document is the viewgraphs from a presentation concerning the development of the Health Management system for the Space Shuttle Main Engine (SSME). It reviews the historical background of the SSME Advanced Health Management effort through the present final Health management configuration. The document includes reviews of three subsystems to the Advanced Health Management System: (1) the Real-Time Vibration Monitor System, (2) the Linear Engine Model, and (3) the Optical Plume Anomaly Detection system.
Lockwood, M; Baden, S
There must be an awareness of gender issues in poverty reduction programs. For example, program efforts that direct aid to the promotion of labor intensive employment options disregard women's already overburdened work regime. Public expenditures to benefit the poor, such as primary education or reformed agricultural extension, may be based on the assumption that men and women will benefit equally, yet there is often gender bias in the delivery of services. One recommendation is to target female headed households in budget-constrained anti-poverty programs. One of the few examples of such programs provides urban female household heads in Chile with employment training, housing, health care, child care, and legal aid services. Causes of female headship vary, and a simple correlation with poverty is not always the case. Well-intentioned women-in-development credit programs in Ghana and Bangladesh have been "hijacked" by men. Programs to address gender discrimination only among the poor may overlook other oppressed women. In India gender discrimination is often greatest among women in wealthy households. Programs must offer more than economic resources, they must help women stretch traditional gender boundaries and obtain skills such as literacy or financial management. They must help women organize collectively to protest injustices and achieve institutional reforms.
Benach, Joan; Amable, Marcelo
Social classes and poverty are two key social determinants fundamental to understand how disease and health inequalities are produced. During the 90's in Spain there has been a notable oscillation in the inequality and poverty levels, with an increase in the middle of the decade when new forms of social exclusion, high levels of unemployment and great difficulties in accessing the labour market, especially for those workers with less resources, emerged. Today society is still characterized by a clear social stratification and the existence of social classes with a predominance of high levels of unemployment and precarious jobs, and where poverty is an endemic social problem much worse than the EU average. To diminish health inequalities and to improve the quality of life will depend very much on the reduction of the poverty levels and the improvement of equal opportunities and quality of employment. To increase understanding of how social class and poverty affect public health, there is a need to improve the quality of both information and research, and furthermore planners and political decision makers must take into account those determinants when undertaking disease prevention and health promotion.
Young, Glenn; Gerber, Paul J.
Focuses on environmental issues that affect learning disabilities and provides a rationale for learning disabilities as a public health and economic-risk issue. The link between learning disabilities and poverty and the impact of low birth weight and lead poisoning are discussed. Action steps are provided. (CR)
Shah, A.; Penswick, L.; Dodson, C.; Roberts, T.
High performance sensors are playing an increasingly important role in all aspects of all critical DoD missions. There is a family of sensors that operate with improved sensitivities if cooled to very low (cryogenic) temperatures. For these sensors, a healthy and reliable mechanical refrigeration system (cryocooler) is required. The ability to accurately predict the "health" or remaining useful life of the cryocooler has significant benefits from the viewpoint of ensuring that mission critical functions can be carried out with a high probability of success. The paper provides an overview and approaches used for the development of a Cryocooler Prognostic Health Management System (CPHMS) capable of assessing the cryocooler "health" from the viewpoint of the level of performance degradation and/or the potential for near term failure. Additionally, it quantifies the reliable remaining useful life of the cryocooler. While the proposed system is focused on the specific application to linear drive cryocoolers, especially for DoD, many of the attributes of the system can be applied to other specialized system hardware in both commercial and U.S. Government agency for situations where it is critical that all aspects of the hardware "health" and "remaining useful life" be fully understood. Several benefits of the health monitoring system are also described in the paper.
Nepomuceno, Bárbara Barbosa; Cardoso, Antonio Alan Vieira; Ximenes, Verônica Morais; Barros, João Paulo Pereira; Leite, Jáder Ferreira
This article analyzes the relations between mental health and well-being in urban and rural contexts marked by poverty. The analysis takes as its basis a quantitative research conducted with 417 adult inhabitants of two communities, one rural and the other urban, in Northeastern Brazil. The data were constructed using questionnaires composed of sociodemographic data, the Personal Wellbeing Index and Self Report Questionnaire (SRQ-20) scales. We found significant differences between the inhabitants of the rural and urban communities regarding well-being and the prevalence of common mental disorders (CMD), with a higher average well-being score in the rural context; the urban sample had a higher average regarding the prevalence of CMD. The variable income significantly influenced the SRQ-20 average scores; the same was not observed with well-being scores. Besides, it was observed that there is a negative correlation with well-being and CMD.
The central purpose of this book is to challenge current social constructions of poverty, reading education, and the putative relationship between the two. It explores how official and popular representations of poverty are bound to specific historical, social, and economic conditions of their own production. The book offers four stances of…
Webb, Patrick; Block, Steven
This paper explores trends in poverty and nutrition during economic transformation and especially the impacts linked to government support for agriculture during the process. Analysis of multiyear data for 29 developing countries confirms that structural transformation raises total income and that poverty falls faster with strong support for agriculture. In turn, poverty reduction supports improved nutrition, especially in rural areas. However, transformation brings problems through health risks associated with rising obesity in rural as well as urban areas. Thus, the transition process must be managed better, through targeted support for smallholder agriculture and health interventions, if the negative consequences of obesity and chronic disease are to be mitigated.
Webb, Patrick; Block, Steven
This paper explores trends in poverty and nutrition during economic transformation and especially the impacts linked to government support for agriculture during the process. Analysis of multiyear data for 29 developing countries confirms that structural transformation raises total income and that poverty falls faster with strong support for agriculture. In turn, poverty reduction supports improved nutrition, especially in rural areas. However, transformation brings problems through health risks associated with rising obesity in rural as well as urban areas. Thus, the transition process must be managed better, through targeted support for smallholder agriculture and health interventions, if the negative consequences of obesity and chronic disease are to be mitigated. PMID:21173245
Moskowitz, David; Vittinghoff, Eric; Schmidt, Laura
Prior research in the general population has found that social support can buffer the adverse effects of stressors on health. However, both stressors and social support may be qualitatively different for those living in urban poverty. We examined the effects of social support and poverty-specific stressors on self-rated health. We used data from the Welfare Client Longitudinal Survey (WCLS), a 5-year longitudinal study of 718 public aid recipients. We measured received social support and "net social support," defined as the difference between support received and that given to others. We used restricted cubic splines to model the stress-buffering effects of social support on self-rated health as a function of stressful life events and neighborhood disorder. Increased exposure to stressors was associated with poorer self-rated health. Evidence of stress buffering was confined to those with the heaviest exposure to stressors, and its effects decreased across increasing levels of social support. Analyses using net social support had generally more modest effects than those using received social support. Social support does not buffer the effects of stressors on health uniformly for individuals living in conditions of urban poverty. Researchers and policymakers should be cautious in overestimating the beneficial effects that social support may have on health for marginalized populations.
Johnson, Sherryl W
This article provides an overview of traditional and contemporary management theories. Concerns, characteristics, and skills of effective managers are also presented. Further, a self-assessment (survey) of 7 highly effective health care managers in a South Georgia community was conducted to determine their ratings on 6 management indices. The assessment or Scale of Transformational Leadership uses a Likert-type scale to allow for the evaluation of managers. The scale contains 6 management elements for assessment: attention, meaning, trust, self, vision, and feeling. Individual ratings and group summary skills rating are presented. Findings revealed the order of managerial importance of the elements as follows (from highest to lowest): Management of Trust, Management of Attention, Management of Self, Management of Feeling, Management of Meaning, and Management of Risk. As a second tier, the final ratings are corroborated by health care management interns.
Makoge, Valerie; Maat, Harro; Vaandrager, Lenneke; Koelen, Maria
Poverty-Related Diseases (PRDs) emphasize poverty as a 'breeding-ground' for a range of diseases. The study presented here starts from the premise that poverty is a general condition that can limit people's capacity to prevent, mitigate or treat diseases. Using an interpretation of health seeking behaviour (HSB), inspired by the salutogenic approach, we investigated how people deal with PRDs, their ability and strategies put in place to cope. We collected HSB data from two groups of respondents in Cameroon: labourers of the Cameroon Development Corporation (CDC) living in settlements called camps and students of the state universities of Buea and Yaoundé living in settlements we refer to as campuses. By selecting these groups, the study offers a unique view of how different people cope with similar health challenges. We carried out semi-structured interviews with 21 camp dwellers and 21 students in a cross-sectional study. Our findings revealed 1) respondents use multiple resources to cope with PRDs. 2) Respondents' perceptions of diseases and connection with poverty closely ties to general hygienic conditions of their living environment. 3) Utilisation of health facilities is not strongly dependent on financial resources. 4) Volatile health facilities are a major challenge and reason for people to revert to other health resources. The study brings out the need for organisations (governmental and non-governmental) to strengthen people's capacities to cope with health situations through better health and housing policies geared at incorporating practices currently used by the people and supporting pro-hygienic initiatives.
Maat, Harro; Vaandrager, Lenneke; Koelen, Maria
Poverty-Related Diseases (PRDs) emphasize poverty as a ‘breeding-ground’ for a range of diseases. The study presented here starts from the premise that poverty is a general condition that can limit people’s capacity to prevent, mitigate or treat diseases. Using an interpretation of health seeking behaviour (HSB), inspired by the salutogenic approach, we investigated how people deal with PRDs, their ability and strategies put in place to cope. We collected HSB data from two groups of respondents in Cameroon: labourers of the Cameroon Development Corporation (CDC) living in settlements called camps and students of the state universities of Buea and Yaoundé living in settlements we refer to as campuses. By selecting these groups, the study offers a unique view of how different people cope with similar health challenges. We carried out semi-structured interviews with 21 camp dwellers and 21 students in a cross-sectional study. Our findings revealed 1) respondents use multiple resources to cope with PRDs. 2) Respondents’ perceptions of diseases and connection with poverty closely ties to general hygienic conditions of their living environment. 3) Utilisation of health facilities is not strongly dependent on financial resources. 4) Volatile health facilities are a major challenge and reason for people to revert to other health resources. The study brings out the need for organisations (governmental and non-governmental) to strengthen people’s capacities to cope with health situations through better health and housing policies geared at incorporating practices currently used by the people and supporting pro-hygienic initiatives. PMID:28052068
Couto, Richard A.
The Maternal and Infant Health Outreach Worker Program (MIHOW) of Vanderbilt University's Center for Health Services gathered data on family planning, prenatal care, pregnancy outcomes, breastfeeding, and preventive child health care from 60 women in 6 rural, low income communities in Tennessee, Kentucky, and West Virginia. The resulting baseline…
Lammintakanen, Johanna; Kivinen, Tuula; Saranto, Kaija; Kinnunen, Juha
The aim of this study is to describe nurse managers' perceptions of the strategic management of information systems in health care. Lack of strategic thinking is a typical feature in health care and this may also concern information systems. The data for this study was collected by eight focus group interviews including altogether 48 nurse managers from primary and specialised health care. Five main categories described the strategic management of information systems in health care; IT as an emphasis of strategy; lack of strategic management of information systems; the importance of management; problems in privacy protection; and costs of IT. Although IT was emphasised in the strategies of many health care organisations, a typical feature was a lack of strategic management of information systems. This was seen both as an underutilisation of IT opportunities in health care organisations and as increased workload from nurse managers' perspective. Furthermore, the nurse managers reported that implementation of IT strengthened their managerial roles but also required stronger management. In conclusion, strategic management of information systems needs to be strengthened in health care and nurse managers should be more involved in this process.
Weiss, Bahr; Trung, Lam Tu
Background People living in low- and middle-income countries (LMIC) are at increased risk for exposure to major natural disasters, which places them at increased risk for mental health problems. Evidence is less clear, however, regarding the effects of less severe but more frequent natural disasters, which are likely to increase due to global climate change. Aims To examine the mental health and life functioning, and their predictors, of people living in central coastal Vietnam – an area characterised by high risk for natural disasters and poverty. Method One thousand individuals were randomly selected from five provinces in central coastal Vietnam. Individuals were assessed cross-sectionally for exposure to major storms and other traumatic events (Post-traumatic Diagnostic Scale, or PDS), financial stress (Chronic Financial Stress Scale), depression (PHQ-9), anxiety (GAD-7), post-traumatic stress disorder (PTSD) (PDS), somatic syndrome (SCL-90-R), alcohol dependence (ICD-10), self-perceived general physical health (SF-36), and functional impairment (PDS life functioning section); caseness was determined using the various measures’ algorithms. Results 22.7% of the sample (n=227) met caseness criteria in one or more mental health domains, and 22.1% (n=221) reported moderate to severe functional impairment. Lifetime exposure to typhoons and other major storms was 99% (n=978), with 77% (n=742) reporting traumatic major storm exposure. Moderate to high levels of financial stress were reported by 30% (n=297). Frequency of exposure to major storms was not associated with increased risk for mental health problems but traumatic exposure to a major storm was. Overall, the strongest predictor of mental health problems was financial stress. Number of traumatic typhoons and other major storms in turn were significant predictors (r2=0.03) of financial stress. The primary predictor of alcohol dependence was male gender, highlighting the importance of gender roles in
Kulshreshtha, Archana; Zacharia, Anish J; Jarouliya, Urmila; Bhadauriya, Pratiksha; Prasad, G B K S; Bisen, P S
Spirulina is a photosynthetic, filamentous, spiral-shaped and multicellular edible microbe. It is the nature's richest and most complete source of nutrition. Spirulina has a unique blend of nutrients that no single source can offer. The alga contains a wide spectrum of prophylactic and therapeutic nutrients that include B-complex vitamins, minerals, proteins, gamma-linolenic acid and the super anti-oxidants such as beta-carotene, vitamin E, trace elements and a number of unexplored bioactive compounds. Because of its apparent ability to stimulate whole human physiology, Spirulina exhibits therapeutic functions such as antioxidant, anti-bacterial, antiviral, anticancer, anti-inflammatory, anti-allergic and anti-diabetic and plethora of beneficial functions. Spirulina consumption appears to promote the growth of intestinal micro flora as well. The review discusses the potential of Spirulina in health care management.
Coulter, Christopher H
Employers' past solutions to rising health benefit costs--adopting managed care strategies, cost shifting to employees and reducing benefits-are no longer effectively controlling costs and are depressing the value of health benefits for employee recruitment and retention. An alternative strategy is to implement health management approaches that improve the health status of employees. These programs reduce medical costs and have a documented positive impact on workers' compensation, disability costs, absenteeism and productivity. Further, this approach is complementary to health care consumerism as a strategy for health improvement and benefit cost reduction and results in improved employee health, outlook and satisfaction.
Modifiable health risk factors can be improved through effective health promotion and disease management efforts, such as vaccinations. Employers must understand that employee illness is related to not only medical and pharmaceutical costs, but to productivity costs as well.
Malvey, Donna; Alderman, Barbara; Todd, Andrew D
The use of blogs in the workplace has emerged as a communication tool that can rapidly and simultaneously connect managers with their employees, customers, their peers, and other key stakeholders. Nowhere is this connection more critical than in health care, especially because of the uncertainty surrounding health care reform and the need for managers to have access to timely and authentic information. However, most health care managers have been slow to join the blogging bandwagon. This article examines the phenomenon of blogging and offers a list of blogs that every health care manager should read and why. This article also presents a simplified step-by-step process to set up a blog.
Background Partnerships are increasingly common in conducting research. However, there is little published evidence about processes in research-policy partnerships in different contexts. This paper contributes to filling this gap by analysing experiences of research-policy partnerships between Ministries of Health and research organisations for the implementation of the Mental Health and Poverty Project in Ghana, South Africa, Uganda and Zambia. Methods A conceptual framework for understanding and assessing research-policy partnerships was developed and guided this study. The data collection methods for this qualitative study included semi-structured interviews with Ministry of Health Partners (MOHPs) and Research Partners (RPs) in each country. Results The term partnership was perceived by the partners as a collaboration involving mutually-agreed goals and objectives. The principles of trust, openness, equality and mutual respect were identified as constituting the core of partnerships. The MOHPs and RPs had clearly defined roles, with the MOHPs largely providing political support and RPs leading the research agenda. Different influences affected partnerships. At the individual level, personal relationships and ability to compromise within partnerships were seen as important. At the organisational level, the main influences included the degree of formalisation of roles and responsibilities and the internal structures and procedures affecting decision-making. At the contextual level, political environment and the degree of health system decentralisation affected partnerships. Conclusions Several lessons can be learned from these experiences. Taking account of influences on the partnership at individual, organisation and contextual/system levels can increase its effectiveness. A common understanding of mutually-agreed goals and objectives of the partnership is essential. It is important to give attention to the processes of initiating and maintaining partnerships
Cutler, David M.; Lleras-Muney, Adriana
There is a well known large and persistent association between education and health. This relationship has been observed in many countries and time periods, and for a wide variety of health measures. The differences between the more and the less educated are significant: in 1999, the age-adjusted mortality rate of high school dropouts ages 25 to…
Bell, Karen N.; Simkin, Linda S.
This report examines how communities and groups can shape the content of health services to bring more comprehensive health services to poor children and families. The report is based on a study of 11 comprehensive primary care programs and systems some of which offer school-based services: 4 freestanding community-based programs, 4 local systems…
Roe, Daphne A.; Eickwort, Kathleen R.
The aim of this study was to examine the health and nutritional status of low-income women in Upstate New York and to identify problems that interfere with their employment. Questionnaires on health and work, complete medical and employment histories, physical examination, laboratory tests, dental examination and diet recalls were obtained for 469…
Most countries of the Former Soviet Union (FSU) have either initiated or are contemplating reform of the health sector. With negative real income growth and falling government revenues, a key concern of many governments is to secure additional finance through non-budgetary sources such as hypothecated payroll taxes, voluntary insurance, and increased private finance through patient cost-sharing. However, before such reforms can be considered, information is needed both on the current levels and distribution of household expenditures on health care, and the extent to which increased charges may affect access to health services, especially amongst the poor. This paper uses the Tajikistan Livings Standard Survey to investigate the level and distribution of out-of-pocket payments for health care in Tajikistan and to examine the extent to which such payments act as barriers to health-care access. The data show that there are significant differences in health-care utilisation rates across socio-economic groups and that these differences are related to ability to pay. Official and informal payments are acting both to deter people from seeking medical assistance and once advice has been sought, from receiving the most appropriate treatment. Despite informal exemptions, out-of-pocket payments for health care are exacting a high toll on household welfare with households being forced to sell assets or go into debt to meet the costs of care. Urgent action is needed to ensure equity in access to health care.
Zachariasen, Ellen, Comp.
This select bibliography on poverty in the U.S. is divided into the following areas: (1) general references; (2) economics of poverty; (3) the poor; (4) Office of Economic Opportunity Programs - General; (5) Community Action, VISTA, and participation of the poor; (6) manpower and poverty; (7) poverty and health; (8) education and the poor; (9) the…
Nikulina, Valentina; Widom, Cathy Spatz; Czaja, Sally
This study examines the roles of childhood neglect and childhood poverty (family and neighborhood) in predicting Posttraumatic Stress Disorder (PTSD), Major Depressive Disorder (MDD), academic achievement, and crime in young adulthood. Using existing data from a prospective cohort design study, 1,005 children with documented histories of neglect (N = 507) and matched controls (N = 497) were interviewed in young adulthood (mean age 29). Official criminal histories were also used to assess outcomes. Data were analyzed using logistic and ordinary least squares regressions and hierarchical linear modeling (HLM) to control for neighborhood clustering. Results from HLM revealed that childhood neglect and childhood family poverty uniquely predicted PTSD and adult arrest, MDD was predicted only by childhood family poverty, and a significant interaction between childhood family poverty and childhood neighborhood poverty predicted academic achievement for the control group only. Childhood neglect, childhood family poverty, and childhood neighborhood poverty each contribute to poor outcomes later in life. While interventions should be developed for neglected children to prevent negative outcomes, the current findings suggest that it is also important to consider the ecological context in which these children are growing up.
Schteingart, M; Saenz, O
Urbanization in Mexico has given rise to creation of unauthorized squatter settlements on the peripheries of large cities. Such settlements are estimated to house about 1/2 of the urban population of Mexico. These settlers share a low standard of housing resulting from lack of employment and low income. Very often large households are crowded into poor quality structures with no running water or sewage disposal. Health consequences are serious. Although precise data are lacking in Mexico, residents of squatter settlements generally fall below the rest of the urban population in health indicators. Settlers in these makeshift communities all tend to be disadvantaged, but there are significant differences in the health and living conditions of different low income zones on the urban periphery. The relationship between the physical and social environments of squatter settlements and the health of the residents should be analyzed by urban administrators and public health officials as well as by demographers and social scientists, in order that solutions be found to existing problems. An integrated focus on the problem will be necessary. A working hypothesis to guide research is that habitat is a principal factor influencing the health o the population, and it affects health through a series of processes that can be analytically decomposed. In this multicausal approach, health status is the final result of a complex process in which many different factors intervene. A fundamental determinant is that of factors in the general social context, including public policy regarding low income housing, basic services, and health. A 2nd level of determinants is that of underlying factors in the physical and social environment. In squatter settlements, housing and services are central elements of the physical environment in which the life of the inhabitants unfolds. The current cholera epidemic in Latin American demonstrates the importance of housing and related variables for
Sarche, Michelle; Spicer, Paul
This report explores the current state of knowledge regarding inequalities and their effect on American Indian and Alaska Native children, underscoring gaps in our current knowledge and the opportunities for early intervention to begin to address persistent challenges in young American Indian and Alaska Native children's development. This overview documents demographic, social, health, and health care disparities as they affect American Indian and Alaska Native children, the persistent cultural strengths that must form the basis for any conscientious intervention effort, and the exciting possibilities for early childhood interventions.
Public Voice for Food and Health Policy, Washington, DC.
Using five key indicators of nutritional status (dietary intake, biochemical tests for circulating levels of nutrients or their metabolites, anthropometric measures, low birth weight and infant mortality rates, and food, health, and income assistance program participation rates and benefit levels), this 1-year research project identified national,…
Multidisciplinary and participatory workshops with stakeholders in a community of extreme poverty in the Peruvian Amazon: Development of priority concerns and potential health, nutrition and education interventions
Casapia, Martin; Joseph, Serene A; Gyorkos, Theresa W
Background Communities of extreme poverty suffer disproportionately from a wide range of adverse outcomes, but are often neglected or underserved by organized services and research attention. In order to target the first Millennium Development Goal of eradicating extreme poverty, thereby reducing health inequalities, participatory research in these communities is needed. Therefore, the purpose of this study was to determine the priority problems and respective potential cost-effective interventions in Belen, a community of extreme poverty in the Peruvian Amazon, using a multidisciplinary and participatory focus. Methods Two multidisciplinary and participatory workshops were conducted with important stakeholders from government, non-government and community organizations, national institutes and academic institutions. In Workshop 1, participants prioritized the main health and health-related problems in the community of Belen. Problem trees were developed to show perceived causes and effects for the top six problems. In Workshop 2, following presentations describing data from recently completed field research in school and household populations of Belen, participants listed potential interventions for the priority problems, including associated barriers, enabling factors, costs and benefits. Results The top ten priority problems in Belen were identified as: 1) infant malnutrition; 2) adolescent pregnancy; 3) diarrhoea; 4) anaemia; 5) parasites; 6) lack of basic sanitation; 7) low level of education; 8) sexually transmitted diseases; 9) domestic violence; and 10) delayed school entry. Causes and effects for the top six problems, proposed interventions, and factors relating to the implementation of interventions were multidisciplinary in nature and included health, nutrition, education, social and environmental issues. Conclusion The two workshops provided valuable insight into the main health and health-related problems facing the community of Belen. The
Drati, Nathan; Kleiner, Brian
Managed care has become one of the leading developments in health care financial management, but ignorance and confusion surround its meaning and origins. Managed care seeks to reduced costs and increase profits while maintaining quality, yet the evidence that it is able to achieve these aims is mixed. The following analysis is a review of the events leading to the establishment of managed care and what it has become. Various terms and health care organizations involved in managed care are identified, with emphasis placed on the strengths and weaknesses of managed care programs. This analysis is performed to gain insight and better understanding of the direction health care financial management is headed in the 21st century.
Uneke, Chigozie Jesse; Ezeoha, Abel Ebeh; Uro-Chukwu, Henry; Ezeonu, Chinonyelum Thecla; Ogbu, Ogbonnaya; Onwe, Friday; Edoga, Chima
Background In Nigeria, one of the major challenges associated with evidence-to-policy link in the control of infectious diseases of poverty (IDP), is deficient information literacy knowledge and skill among policymakers. There is need for policymakers to acquire the skill to discover relevant information, accurately evaluate retrieved information and to apply it correctly. Objectives To use information literacy tool of International Network for Availability of Scientific Publications (INASP) to enhance policymakers' knowledge and skill for policymaking on control of IDP in Nigeria. Methods Modified "before and after" intervention study design was used in which outcomes were measured on target participants both before the intervention is implemented and after. This study was conducted in Ebonyi State, south-eastern Nigeria and participants were career health policy makers. A two-day health-policy information literacy training workshop was organized to enhance participants" information literacy capacity. Topics covered included: introduction to information literacy; defining information problem; searching for information online; evaluating information; science information; knowledge sharing interviews; and training skills. Results A total of 52 policymakers attended the workshop. The pre-workshop mean rating (MNR) of knowledge and capacity for information literacy ranged from 2.15-2.97, while the post-workshop MNR ranged from 3.34-3.64 on 4-point scale. The percentage increase in MNR of knowledge and capacity at the end of the workshop ranged from 22.6%-55.3%. Conclusion The results of this study suggest that through information literacy training workshop policy makers can acquire the knowledge and skill to identify, capture and share the right kind of information in the right contexts to influence relevant action or a policy decision. PMID:26284149
Soil health is defined as the capacity of soil to function and provide ecosystem services to society. The importance of managing for the improvement and maintenance of soil health transcends political boundaries, generations, societies and languages. The challenge of communicating soil health conc...
Mudege, Netsayi N.; Ezeh, Alex C.
This paper is based on data from focus group discussions and in-depth individual interviews carried out in two slum areas, Korogocho and Viwandani in Nairobi, Kenya. It discusses how the division between domestic sphere and public sphere impacts on survival during, and adaptation to old age. Although this paper adopts some of the tenets of the life course approach, it posits that women's participation in the domestic sphere may sometimes give them a ‘gender advantage’ over men in terms of health and adaptation to old age. The paper also discusses the impact of gender roles on the cultivation of social networks and how these networks in turn impact on health and social adjustment as people grow older. It investigates how older people are adjusting and coping with the new challenges they face as a result of high morbidity and mortality among adults in the reproductive age groups. PMID:19907648
Morrison-Beedy, Dianne; Passmore, Denise; Baker, Elizabeth
The purpose of this article is to discuss lessons learned from conducting research with urban communities. A brief overview of the Health Improvement Project for Teens (HIPTeens) will be provided. It will be followed by several suggestions concerning recruitment and retention of participants, challenges related to working in impoverished environments, hiring and training of research teams, interacting with administration and community, and strategies for doing research in diverse settings.
Pethe, V P
This article offers a new paradigm for eradicating poverty in India. It was assumed incorrectly by Mahatma Gandhi that a good society without mass poverty would follow after independence. India copied Western models of development and developed giant factories, big dams, and megacities. Agriculture did not expand the number of jobs for people. The Western paradigm failed in India because of the false assumption of "trickle down" of income to the masses. The targeted programs to the poor did not directly benefit enough of the poor. Mega-industrialization led to reduced employment and higher skill needs. The model failed mainly because it was a proxy and relied on indirect ways of reaching the poor. The models failed to be adapted to conditions in India. The Swadeshi paradigm is a direct model for addressing mass poverty. Poverty is affected by immediate, intermediate, and ultimate determinants. Poverty begets social and economic problems, such as ignorance, ill health, high fertility, unemployment, and crime. In India and developing countries, mass poverty results from under use of human resources; lack of equal opportunities; and an outdated non-egalitarian social structure, an unjust global economic order, human cruelty, and erosion of ethical values. Indians are squandering their precious resources mimicking Western consumerism. Poverty leads to rapid population growth. People become productive assets with universal literacy, compulsory and free education, health services and sanitation, vocational training, and work ethics. India needs people-oriented policies with less emphasis on capital accumulation.
Thompson, Jon M
Managing organizational change has become a significant responsibility of managers. Managing the change process within public health organizations is important because appropriately and systematically managing change is linked to improved organizational performance. However, change is difficult and the change process poses formidable challenges for managers. Managers themselves face increased pressure to respond to environmental influences and provide the necessary leadership to their organizations in the change process. In fact, managing organizational change has become a key competency for healthcare managers. This article addresses the important topic of organizational change in public health organizations. It provides a conceptual foundation for understanding organizational change and its relationship to healthcare organizational performance, and then discusses the types and nature of change, using some examples and evidence from those organizations that have successfully managed change. A framework for guiding public health managers in the change management process is provided. The article concludes with suggested management competencies to establish a change-oriented organization with the culture and capacity for change.
O’Leary, Katie; Liu, Leslie; McClure, Jennifer B.; Ralston, James; Pratt, Wanda
Abstract Health reminders are integral to self-managing chronic illness. However, to act on these health reminders, patients face many challenges, such as lack of motivation and ability to perform health tasks. As a result, patients experience negative consequences for their health. To investigate the design of health reminders that persuade patients to take action, we conducted six participatory design sessions with two cohorts: mothers of children with asthma, and older adults with type 2 diabetes. Participants used collages, storyboards, and photos to express design ideas for future health reminder systems. From their design artifacts, we identified four types of persuasive reminders for health self-management: introspective, socially supportive, adaptive, and symbolic. We contribute insights into desired features for persuasive reminder systems from the perspectives of patients and informal caregivers, including features that support users to understand why and how to complete health tasks ahead of time, and affordances for intra-familial and patient-provider collaboration. PMID:28269896
The article analyses the position of human health in the system of social economic relationships. The notion of material and technical resources in health institutions is defined. It is demonstrated that they are characterized by number of health institutions, their structure according levels and stages of medical care provision, costs of fixed assets, their structure and wear. The conceptual characteristics of actual management of public health resources are analyzed.
Background This research concerns Araucanía, often called the Ninth Region, the poorest region of Chile where inequalities are most extreme. Araucanía hasn't enjoyed the economic success Chile achieved when the country returned to democracy in 1990. The Ninth Region also has the largest ethnic Mapuche population, located in rural areas and attached to small agricultural properties. Written and oral histories of diseases have been the most frequently used methods to explore the links between an ancestral population's perception of health conditions and their deprived environments. With census data and hospital records, it is now possible to incorporate statistical data about the links between poverty and disease among ethnic communities and compare results with non-Mapuche population. Data sources Hospital discharge records from Health Services North N = 24,126 patients, year 2003, and 7 hospitals), Health Services South (N = 81,780 patients and 25 hospitals); CAS-2/Family records (N = 527,539 individuals, 439 neighborhoods, 32 Comunas). Methods Given the over-dispersion of data and the clustered nature of observations, we used the global Moran's I and General G Gettis-Ord procedures to test spatial dependence. These tests confirmed the clusters of disease and the need to use spatial regression within a General Linear Mixed Model perspective. Results Health outcomes indicate significantly higher morbidity rates for the Mapuche compared to non-Mapuche in both age groups < 5 and 15–44, respectively; for the groups 70–79 and 80 + years of age, this trend is reversed. Mortality rates, however, are higher among Mapuches than non-Mapuches for the entire Ninth Region and for all age groups. Mortality caused by respiratory infections is higher among Mapuches than non-Mapuches in all age-groups. A major finding is the link between poverty and respiratory infections. Conclusion Poverty is significantly associated with respiratory infections in the population of Chile
Berretta, Isabel Quint; Lacerda, Josimari Telino de; Calvo, Maria Cristina Marino
This article presents an evaluation model for municipal health planning management. The basis was a methodological study using the health planning theoretical framework to construct the evaluation matrix, in addition to an understanding of the organization and functioning designed by the Planning System of the Unified National Health System (PlanejaSUS) and definition of responsibilities for the municipal level under the Health Management Pact. The indicators and measures were validated using the consensus technique with specialists in planning and evaluation. The applicability was tested in 271 municipalities (counties) in the State of Santa Catarina, Brazil, based on population size. The proposed model features two evaluative dimensions which reflect the municipal health administrator's commitment to planning: the guarantee of resources and the internal and external relations needed for developing the activities. The data were analyzed using indicators, sub-dimensions, and dimensions. The study concludes that the model is feasible and appropriate for evaluating municipal performance in health planning management.
Riecks, Jung; Storm, Walter; Hollingsworth, Mark
This report documents the work performed by Lockheed Martin Aeronautics (LM Aero) under NASA contract NNL06AA08B, delivery order NNL07AB06T. The Concept Development for Software Health Management (CDSHM) program was a NASA funded effort sponsored by the Integrated Vehicle Health Management Project, one of the four pillars of the NASA Aviation Safety Program. The CD-SHM program focused on defining a structured approach to software health management (SHM) through the development of a comprehensive failure taxonomy that is used to characterize the fundamental failure modes of safety-critical software.
Crema, Maria; Verbano, Chiara
This paper highlights the challenges of performance management in health care, wherein multiple different objectives have to be pursued. The literature suggests starting with quality performance, following the sand cone theory, but considering a multidimensional concept of health care quality. Moreover, new managerial approaches coming from an industrial context and adapted to health care, such as lean management and risk management, can contribute to improving quality performance. Therefore, the opportunity to analyze them arises from studying their overlaps and links in order to identify possible synergies and to investigate the opportunity to develop an integrated methodology enabling improved performance. PMID:24255600
Seerainer, Carina; Sabutsch, Stefan W
When it comes to establishing and operating a nationwide personal health record (PHR), effective and efficient terminology management including the development, administration, maintenance and publishing of terminologies is a precondition for semantic interoperability. In the Austrian national patient health record "ELGA" all relevant terminologies are provided and distributed by means of a CTS2-conformant terminology server. In the following article, issues and lessons learned from terminology management in a large-scale eHealth project are presented. Experience has proved the necessity of a national authority for medical terminology management in Austria.
The Global Alliance for Vaccines and Immunization (GAVI), now 10 years old, was established as a successful and innovative public-private partnership to deal with a fundamental inequity. The poorest children in the poorest parts of the world were being denied access to life-saving vaccines simply on the basis of cost. GAVI has been successful in mobilizing significant funding from donors and through innovative financing instruments, immunizing large numbers of children. GAVI has been less successful, at least in the time frames first envisaged, at quickly reducing the prices of new and under-used vaccines to levels affordable by the poorest countries. Vaccines remain some of the most cost effective of public health interventions. As GAVI seeks to introduce a new set of vaccines to tackle major killers such as pneumonia and diarrhoea, and emerging threats such as cervical cancer, it needs to raise significant additional funds. There is no single solution. Multiple and new instruments will be required to raise finance both globally and at the country level, and also to incentivize industry and others to provide vaccines at affordable prices to the poorest countries.
Zakrajsek, James J.; Dempsey, Paula J.; Huff, Edward M.; Augustin, Michael; Safa-Bakhsh, Robab; Ephraim, Piet; Grabil, Paul; Decker, Harry J.
This paper presents an overview of health management issues and challenges that are specific to rotorcraft. Rotorcraft form a unique subset of air vehicles in that their propulsion system is used not only for propulsion, but also serves as the primary source of lift and maneuvering of the vehicle. No other air vehicle relies on the propulsion system to provide these functions through a transmission system with single critical load paths without duplication or redundancy. As such, health management of the power train is a critical and unique part of any rotorcraft health management system. This paper focuses specifically on the issues and challenges related to the dynamic mechanical components in the main power train. This includes the transmission and main rotor mechanisms. This paper will review standard practices used for rotorcraft health management, lessons learned from fielded trials, and future challenges.
Sarp, Nilgun; Yarpuzlu, Aysegul Akbay; Mostame, Fariba
These days, working people are finding it difficult to manage their time, get more done at work, and find some balance in their work and personal lives. Successful time management is often suggested to be a product of organizing skills, however, what works for one person may not work for others. Context current competence assessment formats for physicians, health professionals, and managers during their training years reliably test core knowledge and basic skills. However, they may underemphasize some important domains of professional medical practice. Thus, in addition to assessments of basic skills, new formats that assess clinical reasoning, expert judgment, management of ambiguity, professionalism, time management, learning strategies, and teamwork to promise a multidimensional assessment while maintaining adequate reliability and validity in classic health education and health care institutional settings are needed to be worked on. It should be kept in mind that institutional support, reflection, and mentoring must accompany the development of assessment programs. This study was designed to describe the main factors that consume time, effective hours of work, time management opportunities, and attitudes and behaviors of health professionals and managers on time management concept through assessment by the assessment tool Time Management Inquiry Form (TMIQ-F). The study was conducted at the State Hospital, Social Security Hospital, and University Hospital at Kirikkale, Turkey between October 1999 and January 2000, including 143 subjects defined as medical managers and medical specialists. According to the results, a manager should give priority to the concept of planning, which may be counted among the efficient time management techniques, and educate him/herself on time management.
Hunter, Gary W.; Lekki, John D.; Simon, Donald L.
An Integrated Vehicle Health Management system aims to maintain vehicle health through detection, diagnostics, state awareness, prognostics, and lastly, mitigation of detrimental situations for each of the vehicle subsystems and throughout the vehicle as a whole. This paper discusses efforts to advance Propulsion Health Management technology for in-flight applications to provide improved propulsion sensors measuring a range of parameters, improve ease of propulsion sensor implementation, and to assess and manage the health of gas turbine engine flow-path components. This combined work is intended to enable real-time propulsion state assessments to accurately determine the vehicle health, reduce loss of control, and to improve operator situational awareness. A unique aspect of this work is demonstration of these maturing technologies on an operational engine.
The University of Helsinki has devised a powerful in-service training course for managers of health centres. By working together at the University and their own centres on setting objectives, analysing data and solving problems, the participants greatly enhance their management and teamwork skills.
Smith, D G; Wheeler, J R; Rivenson, H L; Reiter, K L
To understand better the financial management practices and strategies of modern health care organizations, we conducted interviews with chief financial officers (CFOs) of several leading health care systems. In this introduction, we present an overview of the project and summary responses on corporate financial structures and strategic challenges facing CFOs.
Kim, Young-An; Grineski, Sara E.
Prior research suggests that immigrant enclaves provide respiratory health benefits for US Hispanic residents. We test if immigrant enclaves provide differential respiratory health benefits for Hispanic children in El Paso (Texas) based on individual-level factors. Results reveal that higher neighborhood immigrant density is associated with reduced odds of wheezing, but that the protective immigrant enclave effect is modified by poverty, general health status, body mass index (BMI), and caretaker nativity. Higher immigrant density is significantly more protective for poor children and those with foreign-born caretakers; conversely, it is significantly less protective for children in worse health and those with higher BMI. These findings foster a novel understanding of how immigrant enclaves may be differentially protective for Hispanic children based on individual-level factors. PMID:24509419
Layman, Elizabeth J
Health care supervisors and managers are often asked to redesign jobs in their departments. Frequently, little information accompanies the directive. This article lists sources of change in work and defines key terms. Also reviewed are factors that supervisors and managers can weigh in their redesigns. The article suggests actions aligned to common problems in the work environment. Finally, guidelines for a practical, step-by-step approach are provided. For health care supervisors and managers, the key to a successful job redesign is to achieve the unique balance of factors that matches the situation.
Watzman, N; Woodall, P
The top dozen national managed health care companies and two industry trade groups spent at least $2,023,041 on lobbying expenses and campaign contributions to key lawmakers during last year's health care debate, according to an analysis of Federal Election Commission data and federal lobbying disclosure forms. Five of the top six spenders are large insurance companies that are rapidly transferring their business from traditional indemnity insurance to HMOs. Over half--52 percent--of campaign donations from the top managed care companies' and trade associations' PACs and employees went to members sitting on the five Congressional committees with jurisdiction over health care reform.
Hall, J. W.
Our recent research on water security (Sadoff et al., 2015, Dadson et al., 2015) has revealed the dynamic relationship between water security and human well-being. A version of this dynamic is materialising in the coastal polder areas of Khulna, Bangladesh. Repeated coastal floods increase salinity, wipe out agricultural yields for several years and increase out-migration. As a tool to help inform and target future cycles of investment in improvements to the coastal embankments, in this paper we propose a dynamical model of biophysical processes and human well-being, which downscales our previous research to the Khulna region. State variables in the model include agricultural production, population, life expectancy and child mortality. Possible infrastructure interventions include embankment improvements, groundwater wells and drainage infrastructure. Hazard factors include flooding, salinization and drinking water pollution. Our system model can be used to inform adaptation decision making by testing the dynamical response of the system to a range of possible policy interventions, under uncertain future conditions. The analysis is intended to target investment and enable adaptive resource reallocation based on learning about the system response to interventions over the seven years of our research programme. The methodology and paper will demonstrate the complex interplay of factors that determine system vulnerability to climate change. The role of climate change uncertainties (in terms of mean sea level rise and storm surge frequency) will be evaluated alongside multiple other uncertain factors that determine system response. Adaptive management in a 'learning system' will be promoted as a mechanism for coping with climate uncertainties. References:Dadson, S., Hall, J.W., Garrick, D., Sadoff, C. and Grey, D. Water security, risk and economic growth: lessons from a dynamical systems model, Global Environmental Change, in review.Sadoff, C.W., Hall, J.W., Grey, D
Epidemiologists cannot afford to ignore poverty. To do so would, first, wrongly obscure the devastating impact of poverty on population health, and, second, undercut our commitment to scientific rigor. At issue is doing correct science, not "politically correct" science. Blot poverty and inequity from view, and not only will we contribute to making suffering invisible but our understanding of disease etiology and distribution will be marred. To make this case, I address current debates about the causal relationships between poverty and health, and provide examples of how failing to consider the impact of socioeconomic position has biased epidemiologic knowledge and harmed the public's health. By definition, the people we study are simultaneously social beings and biologic organisms-and we cannot study the latter without taking into account the former. It is the responsibility of all epidemiologists, and not only social epidemiologists, to keep in mind the connections between poverty and health.
Background One in five Americans under age 18 lives in a family below the Federal poverty threshold. These more than 15 million children are at increased risk of a wide variety of adverse long-term health and developmental outcomes. The early years of life are critical to short- and long-term health and well-being. The Legacy for ChildrenTM model was developed in response to this need and marries the perspectives of epidemiology and public health to developmental psychology theory in order to better address the needs of children at environmental risk for poor developmental outcomes. Methods/design The Legacy for ChildrenTM group-based parenting intervention model was evaluated as a pair of randomized controlled trials among low-income families in Miami and Los Angeles. The study was designed to allow for site-stratified analysis in order to evaluate each model implementation separately. Evaluation domains include comprehensive assessments of family, maternal, and child characteristics, process outcomes, and prospective programmatic cost. Data collection began prenatally or at birth and continues into school-age. Discussion The societal costs of poor developmental outcomes are substantial. A concerted effort from multiple sectors and disciplines, including public health, is necessary to address these societal concerns. Legacy uses a public health model to engage parents and promote overall child well-being in families in poverty through rigorous evaluation methodologies and evidence-based intervention strategies. This study collects rich and modular information on maternal and child outcomes, process, and cost that will enable a detailed understanding of how Legacy works, how it can be refined and improved, and how it can be translated and disseminated. Taken together, these results will inform public policy and help to address issues of health disparities among at-risk populations. Trial registration NCT00164697 PMID:22917446
Atkins, Robert; Bluebond-Langner, Myra; Read, Nichole; Pittsley, Jerri; Hart, Daniel
Although there is a considerable literature on how adolescents make decisions which lead to risky behaviors (e.g., unprotected sex, drug use) and adversely affect the health and well-being of youth, little is known about the routine behaviors youth engage in which influence their health (e.g., having permanent teeth extracted, discontinuing antibiotics prematurely, delaying or going without treatment of subacute illnesses and minor injuries) and concomitantly the factors which influence these behaviors. In an effort to begin to fill this gap, we have undertaken a study of routine health behaviors and the factors which bear on them in adolescents from a high-poverty urban neighborhood. In this article, we present the results of the pilot phase of the study in which we documented the behavior of 10 adolescents from Camden, New Jersey, the fifth poorest city in the United States, and explored with them their perceptions of the decisions they made and the factors that gave rise to them. We found that participants had an insufficient understanding of their health problems and consequences of their health actions, problems in understanding and being understood by health care professionals, and reluctance to involve parents in routine health care decisions. The implications of these findings are discussed in relation to improving the health of vulnerable youth.
Liberzon, Israel; Ma, Sean T; Okada, Go; Ho, S Shaun; Swain, James E; Evans, Gary W
One in five American children grows up in poverty. Childhood poverty has far-reaching adverse impacts on cognitive, social and emotional development. Altered development of neurocircuits, subserving emotion regulation, is one possible pathway for childhood poverty's ill effects. Children exposed to poverty were followed into young adulthood and then studied using functional brain imaging with an implicit emotion regulation task focused. Implicit emotion regulation involved attention shifting and appraisal components. Early poverty reduced left dorsolateral prefrontal cortex recruitment in the context of emotional regulation. Furthermore, this emotion regulation associated brain activation mediated the effects of poverty on adult task performance. Moreover, childhood poverty also predicted enhanced insula and reduced hippocampal activation, following exposure to acute stress. These results demonstrate that childhood poverty can alter adult emotion regulation neurocircuitry, revealing specific brain mechanisms that may underlie long-term effects of social inequalities on health. The role of poverty-related emotion regulatory neurocircuitry appears to be particularly salient during stressful conditions.
Population is estimated to increase from 5.5 billion in 1990 to 10 billion by 2050; the poverty level is expected to increase from 1 billion to 2-3 billion people. Women in development has been promoted throughout the UN and development system, but women in poverty who perform work in the informal sector are still uncounted, and solutions are elusive. The issue of extreme poverty can not be approached as just another natural disaster with immediate emergency relief. Many people live in precarious economic circumstances throughout their lives. Recent research reveals a greater understanding of the underlying causes and the need for inclusion of poor women in sustainable development. Sanitation, water, housing, health facilities need to be improved. Women must have access to education, opportunities for trading, and loans on reasonable terms. UNESCO makes available a book on survival strategies for poor women in the informal sector. The profile shows common problems of illiteracy, broken marriages, and full time involvement in provision of subsistence level existence. Existence is a fragile balance. Jeanne Vickers' "Women and the World" offers simple, low cost interventions for aiding extremely poor women. The 1992 Commission on the Status of Women was held in Vienna. Excerpts from several speeches are provided. The emphasis is on some global responses and an analysis of solutions. The recommendation is for attention to the gender dimension of poverty. Women's dual role contributes to greater disadvantages. Women are affected differently by macroeconomic factors, and that there is intergenerational transfer of poverty. Social services should be viewed as investments and directed to easing the burdens on time and energy. Public programs must be equipped to deal with poverty and to bring about social and economic change. Programs must be aware of the different distribution of resources within households. Women must be recognized as principal economic providers within
McDonald, S C
Total quality management (TQM), continuous quality improvement (CQI) and quality control are terms that are becoming very familiar to workers in the health care environment. The purpose of this article is to discuss these terms and the concepts they describe. The origins of TQM and the keen interest in its application to the health care environment today are addressed. In other environments, TQM has shown significant increases in productivity while increasing effectiveness. Its application to the health care environment is the provision of the best possible care through continuously improving service to meet or exceed the needs and expectations of the customer. The customer in the health care environment could be the patient, staff, physician and community serviced by the hospital. Characteristics of the new organizational structure are reviewed. Established techniques and processes are commonly used to identify process-improvement opportunities to assist the manager in continuously evaluating quality trends.
Reviews data on child poverty worldwide, providing statistics on 20 poverty-related problems. Examines effects of economic factors (i.e., unemployment, wage stagnation, inflation, and internal migration) and political policies (i.e., military spending over health and education) on child well-being, arguing that families and children themselves…
Ferreira, Vanessa Alves; Silva, Aline Elizabeth; Rodrigues, Chrystiellen Ayana Aparecida; Nunes, Nádia Lúcia Almeida; Vigato, Tássia Cassimiro; Magalhães, Rosana
National studies have been demonstrating the positive relationship among inequality, poverty and obesity revealing the singularities and complexity of the nutritional transition in Brazil. In this direction, the women constitute a vulnerable group to the dynamics of the obesity in the poverty context. Such fact imposes the theoretical deepening and the accomplishment of researches that make possible a larger approach with the phenomenon in subject. In this perspective, the study analyzed the daily life of poor and obese women, users of basic units of health of the city of Diamantina, Vale do Jequitinhonha, Minas Gerais State. The results revealed the complex relationship between feminine obesity and poverty. The cultural and material aspects of life, as well as the different feeding and body conceptions that demonstrated to be fundamental elements for the analysis of the multiple faces of the obesity among the investigated group. Facing these results it is appropriate to encourage public policies that promote equity widening the access of those groups to the main resources for the prevention and combat of obesity.
Davenport, Roy F.; Tolbert, Marsha; Myers-Oliver, Donna; Brissett, Julia M.; Roland, Annissa J.
In "A Framework of Poverty," Ruby Payne (1998) itemizes the things that characterize poverty-stricken people. She talks about how hard it is for a person to move out of poverty. To not pass poverty on to another generation, one must have a vision. One must have a desire to achieve a better life or a strong support system. Schools must…
WITMER, HELEN L.
THREE MAJOR QUESTIONS ARE RAISED--(1) WHAT IS MEANT BY POVERTY AND TO WHAT EXTENT DOES THE OVERALL AMOUNT OF POVERTY DEPEND ON THE SORT OF MEASURING ROD USED. (2) HOW MANY AND WHAT PROPORTION OF THE NATION'S CHILDREN ARE GROWING UP IN POVERTY. AND (3) WHERE, GEOGRAPHICALLY AND SOCIALLY, ARE THESE CHILDREN OF THE POOR TO BE FOUND. POVERTY IS…
Reeves, Richard; Rodrigue, Edward; Kneebone, Elizabeth
Poverty is about a lack of money, but it's not only about that. As a lived experience, poverty is also characterized by ill health, insecurity, discomfort, isolation, and more. To put it another way: Poverty is multidimensional, and its dimensions often cluster together to intensify the negative effects of being poor. In this first of a two-part…
Fox, Robert A; Mattek, Ryan J; Gresl, Brittany L
A university-community partnership is described that resulted in the development of community-based mental health services for young children from families living in poverty. The purpose of this pilot project was to implement an evidence-based treatment program in the homes of an at-risk population of children with significant emotional and behavior problems that were further complicated by developmental delays. Outcomes for 237 children who participated in the clinic's treatment program over a 2 year period are presented. Comparisons are included between treatment completers and non-completers and the issues of subject attrition, potential subject selection bias, and the generalizability of the results are addressed. The need for more professionals who are trained to address mental health issues in very young children who live in very challenging conditions are discussed.
Structural Health Management in the NAVY Ignacio Perez,1,* Michael DiUlio ,2 Scott Maley3 and Nam Phan3 1Office of Naval Research, Arlington, VA 22202...Savage, C., DiUlio , M., Finley, B., Krooner, K., Martinez, P. and Horten, P. (2005). Enterprise Remote Monitoring (ICAS & Distance Support), Tomorrow’s
This paper draws on research which considers the implications for practitioners and managers of implementing new ideas for practice gained from learning and education in mental health in the UK. Using a questionnaire survey followed by eight semi-structured interviews, the research set out to identify the issues facing workers trying to implement change in the workplace as a result of new learning gained from study of an Open University mental health course. The paper argues that much management literature on change within organisations is problematic in this specific context. This is largely because it takes insufficient account of the complexities surrounding work within social care (particularly mental health). Findings show that workers who have undertaken learning in mental health often feel disempowered and isolated when attempting to introduce new ideas for practice into the workplace. The first line manager operates at the intersection of practice and learning and has a key role in enabling and supporting staff through practice as well as service change and professional development. This paper locates the distance learning experience within a wider framework of student/practitioner support, and explores the role of the first line manager in supporting and enabling staff.
Mohammadisadr, Mohammad; Siadat, Seyyedali; Arbabisarjou, Azizollah
The main purpose of this paper is to study the relationship between managers' performance in the field of interpersonal, informational and decision-making tasks with organizational health. To measure the indicators of the model, a questionnaire was prepared and distributed among 113 company of Tehran stock Exchange Market. According to the…
Figueroa, Fernando; Melcher, Kevin
The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. It is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this paper, concepts, procedures, and approaches are presented as a foundation for implementing an intelligent systems ]relevant ISHM capability. The capability stresses integration of DIaK from all elements of a system. Both ground-based (remote) and on-board ISHM capabilities are compared and contrasted. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.
Mengshoel, Ole; Schumann, JOhann
Most modern aircraft as well as other complex machinery is equipped with diagnostics systems for its major subsystems. During operation, sensors provide important information about the subsystem (e.g., the engine) and that information is used to detect and diagnose faults. Most of these systems focus on the monitoring of a mechanical, hydraulic, or electromechanical subsystem of the vehicle or machinery. Only recently, health management systems that monitor software have been developed. In this paper, we will discuss our approach of using Bayesian networks for Software Health Management (SWHM). We will discuss SWHM requirements, which make advanced reasoning capabilities for the detection and diagnosis important. Then we will present our approach to using Bayesian networks for the construction of health models that dynamically monitor a software system and is capable of detecting and diagnosing faults.
A recent Harvard study on national dietary trends found that the gap in healthy dietary behaviors between low-income and middle/upper-income Americans widened between 2000 and 2010. Hawai'i Behavioral Risk Factor Surveillance System (BRFSS) data from 2001-2009 on differences in obesity-related behaviors between moderate-high income, low-income, and poverty-level Hawai'i residents were examined to explore whether Hawai'i data on obesity-related behaviors reflected this national trend. While most differences between groups were not statistically significant, a consistent pattern was seen across all measures that suggested a growing gap between low-income and moderate/high income Hawai'i residents. Data from community studies on pedestrian injury, park use, transportation, and healthy food access were examined. This data suggests that individuals residing in low-income neighborhoods in Hawai'i experience higher barriers to the adoption of healthier behaviors. Further data is needed to document poverty-related gaps in the adoption of health behaviors among youth and within Hawai'i's ethnic groups, communities and geographic areas.
Gibson, C. J.; Abrams, K.
Summary Clearly defined boundaries are disappearing among the activities, sources, and uses of health care data and information managed by health information management (HIM) and health informatics (HI) professionals. Definitions of the professional domains and scopes of practice for HIM and HI are converging with the proliferation of information and communication technologies in health care settings. Convergence is changing both the roles that HIM and HI professionals serve in their organizations as well as the competencies necessary for training future professionals. Many of these changes suggest a blurring of roles and responsibilities with increasingly overlapping curricula, job descriptions, and research agendas. Blurred lines in a highly competitive market create confusion for students and employers. In this essay, we provide some perspective on the changing landscape and suggest a course for the future. First we review the evolving definitions of HIM and HI. We next compare the current domains and competencies, review the characteristics as well as the education and credentialing of both disciplines, and examine areas of convergence. Given the current state, we suggest a path forward to strengthen the contributions HIM and HI professionals and educators make to the evolving health care environment. PMID:25848421
At the time of independence majority of Indians were poor. In spite of spending over 80 per cent of their income on food, they could not get adequate food. Living in areas of poor environmental sanitation they had high morbidity due to infections; nutrition toll due to infections was high because of poor access to health care. As a result, majority of Indians especially children were undernourished. The country initiated programmes to improve economic growth, reduce poverty, improve household food security and nutritional status of its citizens, especially women and children. India defined poverty on the basis of calorie requirement and focused its attention on providing subsidized food and essential services to people below poverty line. After a period of slow but steady economic growth, the last decade witnessed acceleration of economic growth. India is now one of the fastest growing economies in the world with gross domestic product (GDP) growth over 8 per cent. There has been a steady but slow decline in poverty; but last decade's rapid economic growth did not translate in to rapid decline in poverty. In 1970s, country became self sufficient in food production; adequate buffer stocks have been built up. Poor had access to subsidized food through the public distribution system. As a result, famines have been eliminated, though pockets of food scarcity still existed. Over the years there has been a decline in household expenditure on food due to availability of food grains at low cost but energy intake has declined except among for the poor. In spite of unaltered/declining energy intake there has been some reduction in undernutrition and increase in overnutrition in adults. This is most probably due to reduction in physical activity. Under the Integrated Child Development Services (ICDS) programme food supplements are being provided to children, pregnant and lactating women in the entire country. In spite of these, low birth weight rates are still over 30 per
5. Realign the TRICARE Management Activity and establish a Joint Military Health Service Directorate to consolidate shared services and common...Directorate to consolidate shared services and common functions Realign TRICARE Management Activity and establish a TRICARE Health Plan Agency to...Uniformed Services University of the Health Sciences, (2) TRICARE health plan, (3) Health Management Support, and (4) Shared Services division
In 2006, ECRI's Health Devices Group instituted the Health Devices Achievement Award to honor excellence in health technology management. The application process for this award yielded descriptions of many unique and effective technology management initiatives. This Guidance Article presents some of the best practices gleaned from the top award submissions. The following topics are discussed: The role of human factors testing in the technology management process. We describe one facility's approach to solving a particularly vexing problem: slow telemetry-alarm response times. The use of performance-based service contracting to improve inspection and preventive maintenance (IPM) completion rates. The advantages associated with one health system's process for grouping ventilator-dependent patients who are being cared for outside the intensive care unit. The ability of a technology assessment committee to bring a disciplined approach to the adoption of new technologies. The importance of customer satisfaction to a clinical engineering department. We describe how meeting the caregivers' needs contributes to building a patient-safe environment. The successful implementation of a new patient care technology: local anesthetic pumps.
Sportsman, Susan; Hamilton, Patti
The purpose of the study was to determine prevalent conflict management styles chosen by students in nursing and to contrast these styles with those chosen by students in allied health professions. The associations among the level of professional health care education and the style chosen were also determined. A convenience sample of 126 students in a comprehensive university completed the Thomas-Kilmann Conflict Mode Instrument (TKI), which requires respondents to choose behaviors most characteristic of their response to conflict and classifies these behaviors as one of five styles. There was no significant difference between the prevalent conflict management styles chosen by graduate and undergraduate nursing students and those in allied health. Some of the students were already licensed in their discipline; others had not yet taken a licensing exam. Licensure and educational level were not associated with choice of styles. Women and men had similar preferences. The prevalent style for nursing students was compromise, followed by avoidance. In contrast, avoidance, followed by compromise and accommodation, was the prevalent style for allied health students. When compared to the TKI norms, slightly more than one half of all participants chose two or more conflict management styles, commonly avoidance and accommodation at the 75th percentile or above. Only 9.8% of the participants chose collaboration at that level. Implications for nurse educators, researchers, and administrators are discussed.
Willacy, Erika; Bratton, Shelly
Public health management is a pillar of public health practice. Only through effective management can research, theory, and scientific innovation be translated into successful public health action. With this in mind, the U.S. Centers for Disease Control and Prevention (CDC) has developed an innovative program called Improving Public Health Management for Action (IMPACT) which aims to address this critical need by building an effective cadre of public health managers to work alongside scientists to prepare for and respond to disease threats and to effectively implement public health programs. IMPACT is a 2-year, experiential learning program that provides fellows with the management tools and opportunities to apply their new knowledge in the field, all while continuing to serve the Ministry of Health (MoH). IMPACT will launch in 2016 in 2 countries with the intent of expanding to additional countries in future years resulting in a well-trained cadre of public health managers around the world.
Goldenberg, Jamie L.; Arndt, Jamie
This article introduces a terror management health model (TMHM). The model integrates disparate health and social psychology literatures to elucidate how the conscious and nonconscious awareness of death can influence the motivational orientation that is most operative in the context of health decisions. Three formal propositions are presented.…
Thompson, Joyce E Beebe
Healthy, prosperous nations require healthy women and newborns. Young girls and women in resource-poor nations suffer the greatest ill-health consequences from low status, denial of basic human rights, and poverty. Poverty and poor health result in poor economic development. The Millennium Development Goals call for immediate efforts to reduce poverty, improve health, especially of girls and women, and foster development in the world's poorest nations.
Sharma, Suparna; Ford-Jones, Elizabeth
The harmful effects of child poverty are well documented. Despite this, progress in poverty reduction in Canada has been slow. A significant gap exists between what is known about eradicating poverty and its implementation. Paediatricians can play an important role in bridging this gap by understanding and advancing child poverty reduction. Establishment of a comprehensive national poverty reduction plan is essential to improving progress. The present review identifies the key components of an effective poverty reduction strategy. These elements include effective poverty screening, promoting healthy child development and readiness to learn, ensuring food and housing security, providing extended health care coverage for the uninsured and using place-based solutions and team-level interventions. Specific economic interventions are also reviewed. Addressing the social determinants of health in these ways is crucial to narrowing disparities in wealth and health so that all children in Canada reach their full potential.
Horvath, Gregory A.; Wagner, David A.; Wen, Hui Ying; Barry, Matthew
The FAILSAFE project is developing concepts and prototype implementations for software health management in mission- critical, real-time embedded systems. The project unites features of the industry-standard ARINC 653 Avionics Application Software Standard Interface and JPL s Mission Data System (MDS) technology (see figure). The ARINC 653 standard establishes requirements for the services provided by partitioned, real-time operating systems. The MDS technology provides a state analysis method, canonical architecture, and software framework that facilitates the design and implementation of software-intensive complex systems. The MDS technology has been used to provide the health management function for an ARINC 653 application implementation. In particular, the focus is on showing how this combination enables reasoning about, and recovering from, application software problems.
Averill, Richard F; Goldfield, Norbert; Hughes, John S
Lessons from outcomes-based fee-for-service payment models that can be applied to population health management models include the following: Focus on outcomes, not processes. Limit the number of outcomes measures used. Ensure that the amount distributed is substantial enough to motivate behavior change. Communicate results clearly and transparently. Ensure that the financial consequence of poor performance is proportional to the cost increase it generates. Focus on reducing the rate of excess preventable outcomes.
Malin, Jane T.; Oliver, Patrick J.
This paper identifies work needed by developers to make integrated system health management (ISHM) technology ready and by programs to make mission infrastructure ready for this technology. This paper examines perceptions of ISHM technologies and experience in legacy programs. Study methods included literature review and interviews with representatives of stakeholder groups. Recommendations address 1) development of ISHM technology, 2) development of ISHM engineering processes and methods, and 3) program organization and infrastructure for ISHM technology evolution, infusion and migration.
Rangeland health assessment provides qualitative information on ecosystem attributes. Successional management is a conceptual framework that allows managers to link information gathered in rangeland health assessment to ecological processes that need to be repaired to allow vegetation to change in ...
Figueroa, Fernando; Melcher, Kevin
The implementation of an integrated system health management (ISHM) capability is fundamentally linked to the management of data, information, and knowledge (DIaK) with the purposeful objective of determining the health of a system. Management implies storage, distribution, sharing, maintenance, processing, reasoning, and presentation. ISHM is akin to having a team of experts who are all individually and collectively observing and analyzing a complex system, and communicating effectively with each other in order to arrive at an accurate and reliable assessment of its health. In this chapter, concepts, procedures, and approaches are presented as a foundation for implementing an ISHM capability relevant to intelligent systems. The capability stresses integration of DIaK from all elements of a system, emphasizing an advance toward an on-board, autonomous capability. Both ground-based and on-board ISHM capabilities are addressed. The information presented is the result of many years of research, development, and maturation of technologies, and of prototype implementations in operational systems.
Guo, Kristina L
This research develops an integrated systems model of entrepreneurship management as a method for achieving health care organizational survival and growth. Specifically, it analyzes current health care environment challenges, identifies roles of managers and discusses organizational theories that are relevant to the health care environment, outlines the role of entrepreneurship in health care, and describes the entrepreneurial manager in the entrepreneurial management process to produce desirable organizational outcomes. The study concludes that as current health care environment continues to show intense competition, entrepreneurial managers are responsible for creating innovations, managing change, investing in resources, and recognizing opportunities in the environment to increase organizational viability.
Breton, Mylaine; Haggerty, Jeannie; Roberge, Danièle; Freeman, George K
Introduction Patients increasingly receive care from multiple providers in a variety of settings. They expect management continuity that crosses boundaries and bridges gaps in the healthcare system. To our knowledge, little research has been done to assess coordination across organizational and professional boundaries from the patients’ perspective. Our objective was to assess whether greater local health network integration is associated with management continuity as perceived by patients. Method We used the data from a research project on the development and validation of a generic and comprehensive continuity measurement instrument that can be applied to a variety of patient conditions and settings. We used the results of a cross-sectional survey conducted in 2009 with 256 patients in two local health networks in Quebec, Canada. We compared four aspects of management continuity between two contrasting network types (highly integrated vs. poorly integrated). Results The scores obtained in the highly integrated network are better than those of the poorly integrated network on all dimensions of management continuity (coordinator role, role clarity and coordination between clinics, and information gaps between providers) except for experience of care plan. Conclusion Some aspects of care coordination among professionals and organizations are noticed by patients and may be valid indicators to assess care coordination. PMID:22977427
Vandsburger, Etty; Duncan-Daston, Rana; Akerson, Emily; Dillon, Tom
This research examines the impact of the Poverty Simulation Project, an experiential learning modality, on students' understanding of life in poverty. A total of 101 students representing 5 undergraduate majors in the College of Health and Human Services completed measures of critical thinking, understanding of others, and the active learning…
Cluver, Lucie; Orkin, Mark
Research shows that AIDS-orphaned children are more likely to experience clinical-range psychological problems. Little is known about possible interactions between factors mediating these high distress levels. We assessed how food insecurity, bullying, and AIDS-related stigma interacted with each other and with likelihood of experiencing clinical-range disorder. In South Africa, 1025 adolescents completed standardised measures of depression, anxiety and post-traumatic stress. 52 potential mediators were measured, including AIDS-orphanhood status. Logistic regressions and hierarchical log-linear modelling were used to identify interactions among significant risk factors. Food insecurity, stigma and bullying all independently increased likelihood of disorder. Poverty and stigma were found to interact strongly, and with both present, likelihood of disorder rose from 19% to 83%. Similarly, bullying interacted with AIDS-orphanhood status, and with both present, likelihood of disorder rose from 12% to 76%. Approaches to alleviating psychological distress amongst AIDS-affected children must address cumulative risk effects.
Schwartz, Jeremy I.; Dunkle, Ashley; Akiteng, Ann R.; Birabwa-Male, Doreen; Kagimu, Richard; Mondo, Charles K.; Mutungi, Gerald; Rabin, Tracy L.; Skonieczny, Michael; Sykes, Jamila; Mayanja-Kizza, Harriet
Background The burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. Methods Integrated approaches to health service delivery and healthcare worker (HCW) training will be necessary in order to successfully combat the great challenge posed by NCDs. Results In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD), a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. Discussion Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda. PMID:25563451
Schwartz, Jeremy I; Dunkle, Ashley; Akiteng, Ann R; Birabwa-Male, Doreen; Kagimu, Richard; Mondo, Charles K; Mutungi, Gerald; Rabin, Tracy L; Skonieczny, Michael; Sykes, Jamila; Mayanja-Kizza, Harriet
Background The burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. Methods Integrated approaches to health service delivery and healthcare worker (HCW) training will be necessary in order to successfully combat the great challenge posed by NCDs. Results In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD), a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. Discussion Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda.
Schumann, Johann; Mengshoel, Ole J.; Darwiche, Adnan
This presentation presents status and results of research on Software Health Management done within the NRA "ISWHM: Tools and Techniques for Software and System Health Management." Topics include: Ingredients of a Guidance, Navigation, and Control System (GN and C); Selected GN and C Testbed example; Health Management of major ingredients; ISWHM testbed architecture; and Conclusions and next Steps.
..., Occupational Health and Safety Management Systems; The International Standards Organization's (ISO's) ISO 9001:2008 (E), Quality management systems--Requirements; and The British Standards Institution's (BSI's) BS... Safety and Health Administration 30 CFR Chapter I RIN 1219-AB71 Safety and Health Management Programs...
Lybeck, Nancy; Coble, Jamie B.; Tawfik, Magdy; Bond, Leonard J.
In order to meet the ever increasing demand for energy, the United States nuclear industry is turning to life extension of existing nuclear power plants (NPPs). Economically ensuring the safe, secure, and reliable operation of aging NPPs presents many challenges. The 2009 Light Water Reactor Sustainability Workshop identified online monitoring of active and structural components as essential to better understanding and management of the challenges posed by aging NPPs. Additionally, there is increasing adoption of condition-based maintenance (CBM) for active components in NPPs. These techniques provide a foundation upon which a variety of advanced online surveillance, diagnostic, and prognostic techniques can be deployed to continuously monitor and assess the health of NPP systems and components. The next step in the development of advanced online monitoring is to move beyond CBM to estimating the remaining useful life of active components using prognostic tools. Deployment of prognostic health management (PHM) on the scale of an NPP requires the use of an integrated health management (IHM) framework - a software product (or suite of products) used to manage the necessary elements needed for a complete implementation of online monitoring and prognostics. This paper provides a thoughtful look at the desirable functions and features of IHM architectures. A full PHM system involves several modules, including data acquisition, system modeling, fault detection, fault diagnostics, system prognostics, and advisory generation (operations and maintenance planning). The standards applicable to PHM applications are indentified and summarized. A list of evaluation criteria for PHM software products, developed to ensure scalability of the toolset to an environment with the complexity of an NPP, is presented. Fourteen commercially available PHM software products are identified and classified into four groups: research tools, PHM system development tools, deployable architectures
Cox, E. L., Jr.
While the global community is struck by pandemics and epidemics from time to time the ability to fully utilize earth observations and integrate environmental information has been limited - until recently. Mature science understanding is allowing new levels of situational awareness be possible when and if the relevant data is available and shared in a timely and useable manner. Satellite and other remote sensing tools have been used to observe, monitor, assess and predict weather and water impacts for decades. In the last few years much of this has included a focus on the ability to monitor changes on climate scales that suggest changes in quantity and quality of ecosystem resources or the "one-health" approach where trans-disciplinary links between environment, animal and vegetative health may provide indications of best ways to manage susceptibility to infectious disease or outbreaks. But the scale of impacts and availability of information from earth observing satellites, airborne platforms, health tracking systems and surveillance networks offer new integrated tools. This presentation will describe several recent events, such as Superstorm Sandy in the United States and the Ebola outbreak in Africa, where public health and health infrastructure have been exposed to environmental hazards and lessons learned from disaster response in the ability to share data have been effective in risk reduction.
Chen, Wen-Hao; Corak, Miles
This article offers a cross-country overview of child poverty, changes in child poverty, and the impact of public policy in North America and Europe. Levels and changes in child poverty rates in 12 Organisation for Economic Co-operation and Development (OECD) countries during the 1990s are documented using data from the Luxembourg Income Study project, and a decomposition analysis is used to uncover the relative role of demographic factors, labor markets, and income transfers from the state in determining the magnitude and direction of the changes. Child poverty rates fell noticeably in only three countries and rose in three others. In no country were demographic factors a force for higher child poverty rates, but these factors were also limited in their ability to cushion children from adverse shocks originating in the labor market or the government sector. Increases in the labor market engagement of mothers consistently lowered child poverty rates, while decreases in the employment rates and earnings of fathers were a force for higher rates. Finally, there is no single road to lower child poverty rates. Reforms to income transfers intended to increase labor supply may or may not end up lowering the child poverty rate.
Mori, Koji; Nagata, Tomohisa; Kajiki, Shigeyuki; Hino, Yoshiyuki; Nagata, Masako
Objectives: It has become necessary for Japanese corporations to manage occupational health (OH) programs consistently throughout their organizations. Corporations need to clarify their health policies, develop standardized programs, assign OH staff, and ensure that they communicate with each other. To realize such conditions, many occupational physicians (OPs), who have the skills to lead corporation-wide OH activities, are now being assigned to head offices of corporations and referred to as corporate OH managers. However, there has been no research to date in Japan on their actual situation and function. We conducted an interview study of corporate OH managers to clarify their functions and positions in corporations. Subjects and Methods: We conducted semi-structural interviews with 14 corporate OH managers in large corporations employing more than 5,000 workers and multiple OPs. Interview scripts were coded to identify their functions as corporate OH managers and the context of their positions within corporate-wide OH management systems. Results: Five contexts were suggested. 1) Corporate OH managers played central roles in developing corporate health policies, standards and plans. 2) Head office department managers who supervised the sites distributed the policies and standards, and corporate OH managers instructed site OPs and OH staff. 3) In some corporations, corporate OH managers participated in the evaluation process of OH programs as part of occupational safety and health management systems or business audits. 4) Corporate OH managers led communications among OPs and OH staff by facilitating corporate OH meetings, and provided technical training. 5) Corporate OH managers in positions that enabled them to report directly or indirectly to decision makers (i.e., directors in charge) on human resource issues. Discussion: The results of this study suggest that companies that promote consistent company-wide OH programs also utilized the professional knowledge
The purpose of this literature review is to provide a comprehensive summary of the topic of poverty and its effects upon student behavior and academic performance. Presented in this chapter of the review of the related literature will be: (a) description of poverty and the role of education, (b) effects of poverty on student behavior, (c) effects…
Wight, Vanessa R.
More youth live in poverty and poor youth comprise a larger share of the youth population than was the case a decade ago. This article first provides a descriptive analysis of children in poverty; examining the incidence of poverty among children by selected demographic, socioeconomic, and geographic characteristics with a particular focus on…
Rural Housing Alliance, Washington, DC.
Today poverty in rural America remains pervasive and persistent. A decade ago, 14 million rural Americans were classified as "officially" poor. In 1973, nearly 9.2 million were classified poor. The decline in rural poverty over the years has been minimal. This paper briefly documents the poverty statistics according to the living standards used by…
Bhaskar, Saha; Saha, Sankalita; Goebel, Kai
This paper introduces a generic distributed prognostic health management (PHM) architecture with specific application to the electrical power systems domain. Current state-of-the-art PHM systems are mostly centralized in nature, where all the processing is reliant on a single processor. This can lead to loss of functionality in case of a crash of the central processor or monitor. Furthermore, with increases in the volume of sensor data as well as the complexity of algorithms, traditional centralized systems become unsuitable for successful deployment, and efficient distributed architectures are required. A distributed architecture though, is not effective unless there is an algorithmic framework to take advantage of its unique abilities. The health management paradigm envisaged here incorporates a heterogeneous set of system components monitored by a varied suite of sensors and a particle filtering (PF) framework that has the power and the flexibility to adapt to the different diagnostic and prognostic needs. Both the diagnostic and prognostic tasks are formulated as a particle filtering problem in order to explicitly represent and manage uncertainties; however, typically the complexity of the prognostic routine is higher than the computational power of one computational element ( CE). Individual CEs run diagnostic routines until the system variable being monitored crosses beyond a nominal threshold, upon which it coordinates with other networked CEs to run the prognostic routine in a distributed fashion. Implementation results from a network of distributed embedded devices monitoring a prototypical aircraft electrical power system are presented, where the CEs are Sun Microsystems Small Programmable Object Technology (SPOT) devices.
Prosser, W. H.; Allison, S. G.; Woodard, S. E.; Wincheski, R. A.; Cooper, E. G.; Price, D. C.; Hedley, M.; Prokopenko, M.; Scott, D. A.; Tessler, A.
Structural Health Management (SHM) will be of critical importance to provide the safety, reliability and affordability necessary for the future long duration space missions described in America's Vision for Space Exploration. Long duration missions to the Moon, Mars and beyond cannot be accomplished with the current paradigm of periodic, ground based structural integrity inspections. As evidenced by the Columbia tragedy, this approach is also inadequate for the current Shuttle fleet, thus leading to its initial implementation of on-board SHM sensing for impact detection as part of the return to flight effort. However, future space systems, to include both vehicles as well as structures such as habitation modules, will require an integrated array of onboard in-situ sensing systems. In addition, advanced data systems architectures will be necessary to communicate, store and process massive amounts of SHM data from large numbers of diverse sensors. Further, improved structural analysis and design algorithms will be necessary to incorporate SHM sensing into the design and construction of aerospace structures, as well as to fully utilize these sensing systems to provide both diagnosis and prognosis of structural integrity. Ultimately, structural integrity information will feed into an Integrated Vehicle Health Management (IVHM) system that will provide real-time knowledge of structural, propulsion, thermal protection and other critical systems for optimal vehicle management and mission control. This paper will provide an overview of NASA research and development in the area of SHM as well as to highlight areas of technology improvement necessary to meet these future mission requirements.
Disease management has become an important element in the improvement of care for people with chronic illnesses and has become embedded in the discussion on health policy in recent years. The approach has been introduced very differently to the health systems worldwide. Since 1 January 2003 accredited disease management programs (DMPs) have been a part of the risk structure compensation scheme of the German statutory health insurance. This is seen as the first step to a morbidity orientation of the risk structure compensation. DMPs have to be evaluated according the German Social Law, especially whether the objectives of the programs and the criteria for inclusion of the patients have been met and the quality of care for the patients is insured. The criteria for evaluation are threefold: medical issues, economic issues and subjective quality of life of the patients. Due to the immense amounts of data which can be expected the evaluation of the German DMPs is a huge logistical challenge. Until now not very much is known about the data quality. The evaluation is focused on the perspective of the sickness funds as e.g. information about indirect cost is not collected. In the article the methods for evaluation are described and critically discussed.
Merrick, Elizabeth Levy; Horgan, Constance M; Garnick, Deborah W; Hodgkin, Dominic; Morley, Melissa
Although the disease management industry has expanded rapidly, there is little nationally representative data regarding medical and behavioral health disease management programs at the health plan level. National estimates from a survey of private health plans indicate that 90% of health plan products offered disease management for general medical conditions such as diabetes but only 37% had depression programs. The frequency of specific depression disease management activities varied widely. Program adoption was significantly related to product type and behavioral health contracting. In health plans, disease management has penetrated more slowly into behavioral health and depression program characteristics are highly variable.
The focus of the May-June issue is on outage management and health physics. Major articles/reports in this issue include: A design with experience for the U.S., by Michael J. Wallace, Constellation Generation Group; Hope to be among the first, by Randy Hutchinson, Entergy Nuclear; Plans to file COLs in 2008, by Garry Miller, Progress Energy; Evolution of ICRP's recommendations, by Lars-Erik Holm, ICRP; European network on education and training in radiological protection, by Michele Coeck, SCK-CEN, Belgium; Outage managment: an important tool for improving nuclear power plant performance, by Thomas Mazour and Jiri Mandula, IAEA, Austria; and Plant profile: Exploring new paths to excellence, by Anne Thomas, Exelon Nuclear.
Cheng, Shunfeng; Azarian, Michael H; Pecht, Michael G
Prognostics and health management (PHM) is an enabling discipline consisting of technologies and methods to assess the reliability of a product in its actual life cycle conditions to determine the advent of failure and mitigate system risk. Sensor systems are needed for PHM to monitor environmental, operational, and performance-related characteristics. The gathered data can be analyzed to assess product health and predict remaining life. In this paper, the considerations for sensor system selection for PHM applications, including the parameters to be measured, the performance needs, the electrical and physical attributes, reliability, and cost of the sensor system, are discussed. The state-of-the-art sensor systems for PHM and the emerging trends in technologies of sensor systems for PHM are presented.
This report is to present the work that was performed during the summer in the Advance Computing Application office. The NFFP (NASA Faculty Fellow Program) had ten summer faculty members working on IVHM (Integrated Vehicle Health Management) technologies. The objective of this project was two-fold: 1) to become familiar with IVHM concepts and key demonstrated IVHM technologies; and 2) to integrate the research that has been performed by IVHM faculty members into the MASTLAB (Marshall Avionic Software Test Lab). IVHM is a NASA-wide effort to coordinate, integrate and apply advanced software, sensors and design technologies to increase the level of intelligence, autonomy, and health state of future vehicles. IVHM is an important concept because it is consistent with the current plan for NASA to go to the moon, mars, and beyond. In order for NASA to become more involved in deep exploration, avionic systems will need to be highly adaptable and autonomous.
Cheng, Shunfeng; Azarian, Michael H.; Pecht, Michael G.
Prognostics and health management (PHM) is an enabling discipline consisting of technologies and methods to assess the reliability of a product in its actual life cycle conditions to determine the advent of failure and mitigate system risk. Sensor systems are needed for PHM to monitor environmental, operational, and performance-related characteristics. The gathered data can be analyzed to assess product health and predict remaining life. In this paper, the considerations for sensor system selection for PHM applications, including the parameters to be measured, the performance needs, the electrical and physical attributes, reliability, and cost of the sensor system, are discussed. The state-of-the-art sensor systems for PHM and the emerging trends in technologies of sensor systems for PHM are presented. PMID:22219686
Villalbí, Joan R; Ballestín, Manuela; Casas, Conrad; Subirana, Teresa
This article describes the introduction of quality improvement actions in a public health organization. After ISO 17025 accreditation, which was legally mandated, was granted to the official control laboratory, the management decided to expand a quality policy in 2003, through a series of actions based on process analysis and proposals for improvement, further definition of standard operating procedures, exploration of users' opinions, the creation of improvement groups, and external audits or certification. The organizational response to these initiatives was diverse. External audit or certification of services seems to be the most powerful tool for change. Costing studies showed that up to 75% of the total expenditure of the agency in 2010 was spent on public health services subject to external audit or certification.
The focus of the May-June issue is on outage management and health physics. Major articles include: Outage optimization initiatives, by George B. Beam, AREVA NP, Inc.; New plant based on excellent track records, by Jim Scarola, Progress Energy; Meeting customer needs and providing environmental benefits, by Peter S. Hastings, Duke Energy; Plants with 3-D design, by Jack A. Bailey, Tennessee Valley Authority; and Highest quality with exceptional planning, by Jason A. Walls, Duke Energy. Industry innovation articles include: Integrated exposure reduction plan, by Ed Wolfe, Exelon; Performance-based radiation worker training, by Joe Giuffre and Timothy Vriezerma, American Electric Power.
Yasumura, Seiji; Abe, Masafumi
After the Great East Japan Earthquake on March 11, 2011, the Tokyo Electric Power Company Fukushima Daiichi Nuclear Power Plant accident occurred. The Fukushima prefectural government decided to launch the Fukushima Health Management Survey; Fukushima Medical University was entrusted to design and implement the survey. The survey process and development is described from the standpoint of its background and aim. An overview of the basic survey and 4 detailed surveys is briefly provided. Issues related to the survey are discussed from the perspective of supporting the Fukushima residents.
MacLennan, Calman A.; Saul, Allan
With the 2010s declared the Decade of Vaccines, and Millennium Development Goals 4 and 5 focused on reducing diseases that are potentially vaccine preventable, now is an exciting time for vaccines against poverty, that is, vaccines against diseases that disproportionately affect low- and middle-income countries (LMICs). The Global Burden of Disease Study 2010 has helped better understand which vaccines are most needed. In 2012, US$1.3 billion was spent on research and development for new vaccines for neglected infectious diseases. However, the majority of this went to three diseases: HIV/AIDS, malaria, and tuberculosis, and not neglected diseases. Much of it went to basic research rather than development, with an ongoing decline in funding for product development partnerships. Further investment in vaccines against diarrheal diseases, hepatitis C, and group A Streptococcus could lead to a major health impact in LMICs, along with vaccines to prevent sepsis, particularly among mothers and neonates. The Advanced Market Commitment strategy of the Global Alliance for Vaccines and Immunisation (GAVI) Alliance is helping to implement vaccines against rotavirus and pneumococcus in LMICs, and the roll out of the MenAfriVac meningococcal A vaccine in the African Meningitis Belt represents a paradigm shift in vaccines against poverty: the development of a vaccine primarily targeted at LMICs. Global health vaccine institutes and increasing capacity of vaccine manufacturers in emerging economies are helping drive forward new vaccines for LMICs. Above all, partnership is needed between those developing and manufacturing LMIC vaccines and the scientists, health care professionals, and policy makers in LMICs where such vaccines will be implemented. PMID:25136089
MacLennan, Calman A; Saul, Allan
With the 2010s declared the Decade of Vaccines, and Millennium Development Goals 4 and 5 focused on reducing diseases that are potentially vaccine preventable, now is an exciting time for vaccines against poverty, that is, vaccines against diseases that disproportionately affect low- and middle-income countries (LMICs). The Global Burden of Disease Study 2010 has helped better understand which vaccines are most needed. In 2012, US$1.3 billion was spent on research and development for new vaccines for neglected infectious diseases. However, the majority of this went to three diseases: HIV/AIDS, malaria, and tuberculosis, and not neglected diseases. Much of it went to basic research rather than development, with an ongoing decline in funding for product development partnerships. Further investment in vaccines against diarrheal diseases, hepatitis C, and group A Streptococcus could lead to a major health impact in LMICs, along with vaccines to prevent sepsis, particularly among mothers and neonates. The Advanced Market Commitment strategy of the Global Alliance for Vaccines and Immunisation (GAVI) Alliance is helping to implement vaccines against rotavirus and pneumococcus in LMICs, and the roll out of the MenAfriVac meningococcal A vaccine in the African Meningitis Belt represents a paradigm shift in vaccines against poverty: the development of a vaccine primarily targeted at LMICs. Global health vaccine institutes and increasing capacity of vaccine manufacturers in emerging economies are helping drive forward new vaccines for LMICs. Above all, partnership is needed between those developing and manufacturing LMIC vaccines and the scientists, health care professionals, and policy makers in LMICs where such vaccines will be implemented.
McKibbon, K Ann; Lokker, Cynthia; Handler, Steve M; Dolovich, Lisa R; Holbrook, Anne M; O'Reilly, Daria; Tamblyn, Robyn; J Hemens, Brian; Basu, Runki; Troyan, Sue; Roshanov, Pavel S; Archer, Norman P; Raina, Parminder
OBJECTIVES The objective of the report was to review the evidence on the impact of health information technology (IT) on all phases of the medication management process (prescribing and ordering, order communication, dispensing, administration and monitoring as well as education and reconciliation), to identify the gaps in the literature and to make recommendations for future research. DATA SOURCES We searched peer-reviewed electronic databases, grey literature, and performed hand searches. Databases searched included MEDLINE®, Embase, CINAHL (Cumulated Index to Nursing and Allied Health Literature), Cochrane Database of Systematic Reviews, International Pharmaceutical Abstracts, Compendex, Inspec (which includes IEEE Xplore), Library and Information Science Abstracts, E-Prints in Library and Information Science, PsycINFO, Sociological Abstracts, and Business Source Complete. Grey literature searching involved Internet searching, reviewing relevant Web sites, and searching electronic databases of grey literatures. AHRQ also provided all references in their e-Prescribing, bar coding, and CPOE knowledge libraries. METHODS Paired reviewers looked at citations to identify studies on a range of health IT used to assist in the medication management process (MMIT) during multiple levels of screening (titles and abstracts, full text and final review for assignment of questions and data abstrction). Randomized controlled trials and cohort, case-control, and case series studies were independently assessed for quality. All data were abstracted by one reviewer and examined by one of two different reviewers with content and methods expertise. RESULTS 40,582 articles were retrieved. After duplicates were removed, 32,785 articles were screened at the title and abstract phase. 4,578 full text articles were assessed and 789 articles were included in the final report. Of these, 361 met only content criteria and were listed without further abstraction. The final report included data
Eryurt, Mehmet Ali; Koç, Ismet
The United Nations Children's Fund (UNICEF) defines child poverty as the inability of the child to realize their existing potential due to their inability to access resources across different dimensions of life (income, health, nutrition, education, environment, etc.). On the basis of this definition, an attempt has been made in this study to put forth the disadvantaged positions children have in different dimensions of their lives, specifically by taking regional disparities into account. As the data source, the Turkey Demographic and Health Survey 2008 is used, a survey that consists of detailed information about the different dimensions of child poverty. In this study, in order to measure poverty in four different dimensions (education and work, health and nutrition, family environment, and domestic environment), a total of 25 variables were used and descriptive and multivariate analyses were made in order to highlight the regional disparities in child poverty. Principle components analysis conducted through the use of a deficit approach reveals that the variables closely related with education and health and nutrition were the critical dimensions behind child poverty in Turkey. The results of this study indicate that 22.4% of children in Turkey are poor when various dimensions of life are taken into account; the region with the highest child poverty is Central East Anatolia, at 34.9%, while the region with the lowest rate is East Marmara, at 15.6%.
Dijkstra, H Paul; Pollock, N; Chakraverty, R; Alonso, J M
Elite athletes endeavour to train and compete even when ill or injured. Their motivation may be intrinsic or due to coach and team pressures. The sports medicine physician plays an important role to risk-manage the health of the competing athlete in partnership with the coach and other members of the support team. The sports medicine physician needs to strike the right ethical and operational balance between health management and optimising performance. It is necessary to revisit the popular delivery model of sports medicine and science services to elite athletes based on the current reductionist multispecialist system lacking in practice an integrated approach and effective communication. Athlete and coach in isolation or with a member of the multidisciplinary support team, often not qualified or experienced to do so, decide on the utilisation of services and how to apply the recommendations. We propose a new Integrated Performance Health Management and Coaching model based on the UK Athletics experience in preparation for the London Olympic and Paralympic Games. The Medical and Coaching Teams are managed by qualified and experienced individuals operating in synergy towards a common performance goal, accountable to a Performance Director and ultimately to the Board of Directors. We describe the systems, processes and implementation strategies to assist the athlete, coach and support teams to continuously monitor and manage athlete health and performance. These systems facilitate a balanced approach to training and competing decisions, especially while the athlete is ill or injured. They take into account the best medical advice and athlete preference. This Integrated Performance Health Management and Coaching model underpinned the Track and Field Gold Medal performances at the London Olympic and Paralympic Games. PMID:24620040
Dijkstra, H Paul; Pollock, N; Chakraverty, R; Alonso, J M
Elite athletes endeavour to train and compete even when ill or injured. Their motivation may be intrinsic or due to coach and team pressures. The sports medicine physician plays an important role to risk-manage the health of the competing athlete in partnership with the coach and other members of the support team. The sports medicine physician needs to strike the right ethical and operational balance between health management and optimising performance. It is necessary to revisit the popular delivery model of sports medicine and science services to elite athletes based on the current reductionist multispecialist system lacking in practice an integrated approach and effective communication. Athlete and coach in isolation or with a member of the multidisciplinary support team, often not qualified or experienced to do so, decide on the utilisation of services and how to apply the recommendations. We propose a new Integrated Performance Health Management and Coaching model based on the UK Athletics experience in preparation for the London Olympic and Paralympic Games. The Medical and Coaching Teams are managed by qualified and experienced individuals operating in synergy towards a common performance goal, accountable to a Performance Director and ultimately to the Board of Directors. We describe the systems, processes and implementation strategies to assist the athlete, coach and support teams to continuously monitor and manage athlete health and performance. These systems facilitate a balanced approach to training and competing decisions, especially while the athlete is ill or injured. They take into account the best medical advice and athlete preference. This Integrated Performance Health Management and Coaching model underpinned the Track and Field Gold Medal performances at the London Olympic and Paralympic Games.
Goebel, Kai; Saxena, Abhinav; Roychoudhury, Indranil; Celaya, Jose R.; Saha, Bhaskar; Saha, Sankalita
Prognostics and Health Management (PHM) principles have considerable promise to change the game of lifecycle cost of engineering systems at high safety levels by providing a reliable estimate of future system states. This estimate is a key for planning and decision making in an operational setting. While technology solutions have made considerable advances, the tie-in into the systems engineering process is lagging behind, which delays fielding of PHM-enabled systems. The derivation of specifications from high level requirements for algorithm performance to ensure quality predictions is not well developed. From an engineering perspective some key parameters driving the requirements for prognostics performance include: (1) maximum allowable Probability of Failure (PoF) of the prognostic system to bound the risk of losing an asset, (2) tolerable limits on proactive maintenance to minimize missed opportunity of asset usage, (3) lead time to specify the amount of advanced warning needed for actionable decisions, and (4) required confidence to specify when prognosis is sufficiently good to be used. This paper takes a systems engineering view towards the requirements specification process and presents a method for the flowdown process. A case study based on an electric Unmanned Aerial Vehicle (e-UAV) scenario demonstrates how top level requirements for performance, cost, and safety flow down to the health management level and specify quantitative requirements for prognostic algorithm performance.
Perreault, M; Trempe-Masson, C; Gastaldo, D; Boyer, G; Colin, C
One of the essential elements of the "Programme intégré de prévention en périnatalité--Naître-égaux-Grandir-en-san t" (Born Equal--Brought up Healthy) is to have a health professional offering general support to pregnant women living in poverty. This research is based on a secondary analysis of the transcriptions of interviews done in order to implement the program. The thematic content analysis was employed to analyze the women's perception of the support provided by the health professional, the relationship between client-professional, and the perceptions of these women about the impact that the social support had on their pregnancy experience. The categories of support that emerged from the analysis are: information support, emotional support, instrumental support, changing life style support, recreational support, and availability of support. The categories of impact perceived by the participants are: learning, changes in life style, to be in a good mood, and the use of community resources. A key element in the perception of support by the participants is the establishment of a relationship of trust between professional and client. This relationship of trust is important to the development of intimacy and to foster the perception of a more intense kind of support. Hence social support and the relationship of trust work in synergy and reinforce each other.
The main contributors to inequities in health relates to widespread poverty. Health cannot be achieved without addressing the social determinants of health, and the answer does not lie in the health sector alone. One of the potential pathways to address vulnerabilities linked to poverty, social exclusion, and empowerment of women is aligning health programmes with empowerment interventions linked to access to capital through microfinance and self-help groups. This paper presents a framework to analyse combined health and financial interventions through microfinance programmes in reducing barriers to access health care. If properly designed and ethically managed such integrated programmes can provide more health for the money spent on health care.
The main contributors to inequities in health relates to widespread poverty. Health cannot be achieved without addressing the social determinants of health, and the answer does not lie in the health sector alone. One of the potential pathways to address vulnerabilities linked to poverty, social exclusion, and empowerment of women is aligning health programmes with empowerment interventions linked to access to capital through microfinance and self-help groups. This paper presents a framework to analyse combined health and financial interventions through microfinance programmes in reducing barriers to access health care. If properly designed and ethically managed such integrated programmes can provide more health for the money spent on health care. PMID:25364028
Wicclair, Mark R
It is argued that the primary aim of institutional management is to protect the moral integrity of health professionals without significantly compromising other important values and interests. Institutional policies are recommended as a means to promote fair, consistent, and transparent management of conscience-based refusals. It is further recommended that those policies include the following four requirements: (1) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient's/surrogate's timely access to information, counseling, and referral. (2) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient's timely access to health care services offered within the institution. (3) Conscience-based refusals will be accommodated only if the accommodation will not impose excessive burdens on colleagues, supervisors, department heads, other administrators, or the institution. (4) Whenever feasible, health professionals should provide advance notification to department heads or supervisors. Formal review may not be required in all cases, but when it is appropriate, several recommendations are offered about standards and the review process. A key recommendation is that when reviewing an objector's reasons, contrary to what some have proposed, it is not appropriate to adopt an adversarial approach modelled on military review boards' assessments of requests for conscientious objector status. According to the approach recommended, the primary function of reviews of objectors' reasons is to engage them in a process of reflecting on the nature and depth of their objections, with the objective of facilitating moral clarity on the part of objectors rather than enabling department heads, supervisors, or ethics committees to determine whether conscientious objections are sufficiently genuine.
Codd, Geoffrey A.; Morrison, Louise F.; Metcalf, James S
This paper reviews the occurrence and properties of cyanobacterial toxins, with reference to the recognition and management of the human health risks which they may present. Mass populations of toxin-producing cyanobacteria in natural and controlled waterbodies include blooms and scums of planktonic species, and mats and biofilms of benthic species. Toxic cyanobacterial populations have been reported in freshwaters in over 45 countries, and in numerous brackish, coastal, and marine environments. The principal toxigenic genera are listed. Known sources of the families of cyanobacterial toxins (hepato-, neuro-, and cytotoxins, irritants, and gastrointestinal toxins) are briefly discussed. Key procedures in the risk management of cyanobacterial toxins and cells are reviewed, including derivations (where sufficient data are available) of tolerable daily intakes (TDIs) and guideline values (GVs) with reference to the toxins in drinking water, and guideline levels for toxigenic cyanobacteria in bathing waters. Uncertainties and some gaps in knowledge are also discussed, including the importance of exposure media (animal and plant foods), in addition to potable and recreational waters. Finally, we present an outline of steps to develop and implement risk management strategies for cyanobacterial cells and toxins in waterbodies, with recent applications and the integration of Hazard Assessment Critical Control Point (HACCP) principles.
Anyinam, C A
A primary health care (PHC) strategy was adopted in Ghana in 1978, but the civilian government at the time failed to implement the program designed to achieve health for all Ghanaians. In 1982, the revolutionary military government under Rawlings indicated its commitment to the full implementation of the PHC program. In this article, the author seeks to examine the extent to which the Economic Recovery Program initiated by the Rawlings' regime, its policy of decentralization and mobilization of the masses, and its promise to institute some fundamental organizational and structural changes in the health care delivery system, are contributing to the process of achieving "health for all" Ghanaians.
This paper estimates multidimensional poverty in China by applying the Alkire-Foster methodology to the China Health and Nutrition Survey 2000-2009 data. Five dimensions are included: income, living standard, education, health and social security. Results suggest that rapid economic growth has resulted not only in a reduction in income poverty but…
Ranasinghe, Kaduruwane Indika; Chan, Taizan; Yaralagadda, Prasad
Good management, supported by accurate, timely and reliable health information, is vital for increasing the effectiveness of Health Information Systems (HIS). When it comes to managing the under-resourced health systems of developing countries, information-based decision making is particularly important. This paper reports findings of a self-report survey that investigated perceptions of local health managers (HMs) of their own regional HIS in Sri Lanka. Data were collected through a validated, pre-tested postal questionnaire, and distributed among a selected group of HMs to elicit their perceptions of the current HIS in relation to information generation, acquisition and use, required reforms to the information system and application of information and communication technology (ICT). Results based on descriptive statistics indicated that the regional HIS was poorly organised and in need of reform; that management support for the system was unsatisfactory in terms of relevance, accuracy, timeliness and accessibility; that political pressure and community and donor requests took precedence over vital health information when management decisions were made; and use of ICT was unsatisfactory. HIS strengths included user-friendly paper formats, a centralised planning system and an efficient disease notification system; weaknesses were lack of comprehensiveness, inaccuracy, and lack of a feedback system. Responses of participants indicated that HIS would be improved by adopting an internationally accepted framework and introducing ICT applications. Perceived barriers to such improvements were high initial cost of educating staff to improve computer literacy, introduction of ICTs, and HIS restructure. We concluded that the regional HIS of Central Province, Sri Lanka had failed to provide much-needed information support to HMs. These findings are consistent with similar research in other developing countries and reinforce the need for further research to verify causes of
Figueroa, Fernando; Schmalzel, John
Integrated System Health Management (ISHM) describes a set of system capabilities that in aggregate perform: determination of condition for each system element, detection of anomalies, diagnosis of causes for anomalies, and prognostics for future anomalies and system behavior. The ISHM should also provide operators with situational awareness of the system by integrating contextual and timely data, information, and knowledge (DIaK) as needed. ISHM capabilities can be implemented using a variety of technologies and tools. This chapter provides an overview of ISHM contributing technologies and describes in further detail a novel implementation architecture along with associated taxonomy, ontology, and standards. The operational ISHM testbed is based on a subsystem of a rocket engine test stand. Such test stands contain many elements that are common to manufacturing systems, and thereby serve to illustrate the potential benefits and methodologies of the ISHM approach for intelligent manufacturing.
Adams, Alexandra; Thompson, Kim D
Biotechnology has many applications in fish health management. The application of monoclonal antibodies (mAbs) provides a rapid means of pathogen identification; antibodies to immunoglobulins from different fish species can be used to monitor the host response following vaccination; and mAbs also have the potential for screening broodstock for previous exposure to pathogens. Luminex technology exemplifies a novel antibody-based method that can be applied to both pathogen detection and vaccine development. Molecular technologies, such as the polymerase chain reaction (PCR), real time PCR and nucleic acid sequence-based amplification (NASBA), have enabled detection, identification and quantification of extremely low levels of aquatic pathogens, and microarray technologies offer a new dimension to multiplex screening for pathogens and host response. Recombinant DNA technology permits large-scale, low-cost vaccine production, moreover DNA vaccination, proteomics, adjuvant design and oral vaccine delivery will undoubtedly foster the development of effective fish vaccines in the future.
Larkin, Robert P
Soil health has been defined as the capacity of soil to function as a vital living system to sustain biological productivity, maintain environmental quality, and promote plant, animal, and human health. Building and maintaining soil health are essential to agricultural sustainability and ecosystem function. Management practices that promote soil health, including the use of crop rotations, cover crops and green manures, organic amendments, and conservation tillage, also have generally positive effects on the management of soilborne diseases through a number of potential mechanisms, including increasing soil microbial biomass, activity, and diversity, resulting in greater biological suppression of pathogens and diseases. However, there also may be particular disease issues associated with some soil health management practices. In this review, research and progress made over the past twenty years regarding soil health, sustainability, and soil health management practices, with an emphasis on their implications for and effects on plant disease and disease management strategies, are summarized.
Integrated Systems Health Management (ISHM) is a system engineering discipline that addresses the design, development, operation, and lifecycle management of components, subsystems, vehicles, and other operational systems with the purpose of maintaining nominal system behavior and function and assuring mission safety and effectiveness under off-nominal conditions. NASA missions are often conducted in extreme, unfamiliar environments of space, using unique experimental spacecraft. In these environments, off-nominal conditions can develop with the potential to rapidly escalate into mission- or life-threatening situations. Further, the high visibility of NASA missions means they are always characterized by extraordinary attention to safety. ISHM is a critical element of risk mitigation, mission safety, and mission assurance for exploration. ISHM enables: In-space maintenance and repair; a) Autonomous (and automated) launch abort and crew escape capability; b) Efficient testing and checkout of ground and flight systems; c) Monitoring and trending of ground and flight system operations and performance; d) Enhanced situational awareness and control for ground personnel and crew; e) Vehicle autonomy (self-sufficiency) in responding to off-nominal conditions during long-duration and distant exploration missions; f) In-space maintenance and repair; and g) Efficient ground processing of reusable systems. ISHM concepts and technologies may be applied to any complex engineered system such as transportation systems, orbital or planetary habitats, observatories, command and control systems, life support systems, safety-critical software, and even the health of flight crews. As an overarching design and operational principle implemented at the system-of-systems level, ISHM holds substantial promise in terms of affordability, safety, reliability, and effectiveness of space exploration missions.
Gazeley, Ian; Newell, Andrew
This article introduces a newly discovered household budget data set for 1904. We use these data to estimate urban poverty among working families in the British Isles. Applying Bowley's poverty line, we estimate that at least 23 per cent of people in urban working households and 18 per cent of working households had income insufficient to meet minimum needs. This is well above Rowntree's estimate of primary poverty for York in 1899 and high in the range that Bowley found in northern towns in 1912–13. The skill gradient of poverty is steep; for instance, among labourers' households, the poverty rates are close to 50 per cent. Measures of the depth of poverty are relatively low in the data, suggesting that most poor male-headed working households were close to meeting Bowley's new standard.
Weiner, Jonathan P; Famadas, Joanna Case; Waters, Hugh R; Gikic, Djordje
This article provides an overview of the current role of private health insurance and private care management organizations around the globe. We describe past experiences and challenges associated with the export of U.S.-style managed care. We provide a framework for understanding the potential opportunities within a national health system for expanding managed care approaches and also private health insurance more generally. This article is relevant to both the United States and members of the international community.
Alena, Richard; Duncavage, Dan
Traditional mission and vehicle management involves teams of highly trained specialists monitoring vehicle status and crew activities, responding rapidly to any anomalies encountered during operations. These teams work from the Mission Control Center and have access to engineering support teams with specialized expertise in International Space Station (ISS) subsystems. Integrated System Health Management (ISHM) applications can significantly augment these capabilities by providing enhanced monitoring, prognostic and diagnostic tools for critical decision support and mission management. The Intelligent Systems Division of NASA Ames Research Center is developing many prototype applications using model-based reasoning, data mining and simulation, working with Mission Control through the ISHM Testbed and Prototypes Project. This paper will briefly describe information technology that supports current mission management practice, and will extend this to a vision for future mission control workflow incorporating new ISHM applications. It will describe ISHM applications currently under development at NASA and will define technical approaches for implementing our vision of future human exploration mission management incorporating artificial intelligence and distributed web service architectures using specific examples. Several prototypes are under development, each highlighting a different computational approach. The ISStrider application allows in-depth analysis of Caution and Warning (C&W) events by correlating real-time telemetry with the logical fault trees used to define off-nominal events. The application uses live telemetry data and the Livingstone diagnostic inference engine to display the specific parameters and fault trees that generated the C&W event, allowing a flight controller to identify the root cause of the event from thousands of possibilities by simply navigating animated fault tree models on their workstation. SimStation models the functional power flow
that will determine how rapidly we can eliminate poverty in the United States will be the rate of increase in average incomes . And one of the key...The problems of poverty in the United States, and their resolution, are inextricably connected with the nature of the economic growth process and its...economic deprivation, but the adjustments required by growth have left in their wake new pockets of poverty . In the future, one of the key variables
Ćaǧlayan, Alper; Yüca, Songül
Herd management requires multidisciplinary practices including animal feeding, gynecology, artificial insemination, immunology, and similar topics. Animal feeding is the most delicate subject as the fodder expense is 70% of the farm cost and as nearly all of the metabolic diseases arising out as health problem are because of misfeeding. However, a business organization's being able to maintain making profit will be possible by taking a healthy calf from breeding herd every year. For this reason, precision registrations of birth and artificial insemination, following-up pregnant state of animals, and making the other animals pregnant as soon as possible should be primary aim. It should not be forgotten that diarrhea and pneumonia in calves are among the most frequently witnessed infection related health problems. Mastitis, metritis and foot diseases take an important place in mature cows. These diseases can be minimized by vaccinations that are done properly and in suitable time, in-service training of staffs, making shelters suitable for animals welfare, and improving the hygienic conditions.
... Safety and Health Administration RIN 1219-AB71 Safety and Health Management Programs for Mines AGENCY: Mine Safety and Health Administration, Labor. ACTION: Notice of public meetings. SUMMARY: The Mine Safety and Health Administration (MSHA) is holding a public meeting, and plans to hold additional...
Shen, Minxue; Hu, Ming; Sun, Zhenqiu
Background Few studies on nutrition and food safety education intervention for students in remote areas of China were reported. The study aimed to assess the questionnaire used to measure the knowledge, attitude and behavior with respect to nutrition and food safety, and to evaluate the effectiveness of a quasi-experimental nutrition and food safety education intervention among primary school students in poverty-stricken counties of west China. Methods Twelve primary schools in west China were randomly selected from Zhen’an of Shaanxi province and Huize of Yunnan province. Six geographically dispersed schools were assigned to the intervention group in a nonrandom way. Knowledge, attitude and behavior questionnaire was developed, assessed, and used for outcome measurement. Students were investigated at baseline and the end of the study respectively without follow-up. Students in intervention group received targeted nutrition and food safety lectures 0.5 hour per week for two semesters. Item response theory was applied for assessment of questionnaire, and a two-level difference-in-differences model was applied to assess the effectiveness of the intervention. Results The Cronbach’s alpha of the original questionnaire was 0.84. According to item response model, 22 knowledge items, 6 attitude items and 8 behavior items showed adequate discrimination parameter and were retained. 378 and 478 valid questionnaires were collected at baseline and the end point. Differences of demographic characteristics were statistically insignificant between the two groups. Two-level difference-in-differences models showed that health education improved 2.92 (95% CI: 2.06–3.78) and 2.92 (95% CI: 1.37–4.47) in knowledge and behavior scores respectively, but had no effect on attitude. Conclusion The questionnaire met the psychometric standards and showed good internal consistence and discrimination power. The nutrition and food safety education was effective in improving the knowledge
Prince, L H; Carroll-Barefield, A
Health care professionals are faced with ever-changing rules and regulations and technological advances. Add to this the 1996 Health Insurance Portability and Accountability Act (HIPAA) and the health care manager's list of challenges continues to expand. This article presents an overview of HIPAA requirements and tools for use by health care managers in ensuring their facility is in compliance with the latest rulings.
Willis, Erin; Royne, Marla B
This research uses content analysis (N = 1,960) to examine the computer-mediated communication within online health communities for evidence of chronic disease self-management behaviors, including the perceived benefits and perceived barriers to participating in such behaviors. Online health communities act as informal self-management programs led by peers with the same chronic disease through the exchange of health information. Online health communities provide opportunities for health behavior change messages to educate and persuade regarding chronic disease self-management behaviors.
This paper considers how operational research and management science can improve the design of health systems and the delivery of health care, particularly in low-resource settings. It identifies some gaps in the way operational research is typically used in global health and proposes steps to bridge them. It then outlines some analytical tools of operational research and management science and illustrates how their use can inform some typical design and delivery challenges in global health. The paper concludes by considering factors that will increase and improve the contribution of operational research and management science to global health.
Abstract This paper considers how operational research and management science can improve the design of health systems and the delivery of health care, particularly in low-resource settings. It identifies some gaps in the way operational research is typically used in global health and proposes steps to bridge them. It then outlines some analytical tools of operational research and management science and illustrates how their use can inform some typical design and delivery challenges in global health. The paper concludes by considering factors that will increase and improve the contribution of operational research and management science to global health. PMID:21897489
Lin, I-Fen; Brown, Susan L; Hammersmith, Anna M
Increasingly, older adults are unmarried, which could mean a larger share is at risk of economic disadvantage. Using data from the 2010 Health and Retirement Study, we chart the diverse range of marital biographies, capturing marital sequences and timing, of adults who are age eligible for Social Security and examine three indicators of economic well-being: Social Security receipt, Social Security benefit levels, and poverty status. Partnereds are disproportionately likely to receive Social Security and they enjoy relatively high Social Security benefits and very low poverty levels. Among singles, economic well-being varies by marital biography and gender. Gray divorced and never-married women face considerable economic insecurity. Their Social Security benefits are relatively low, and their poverty rates are quite high (over 25%), indicating Social Security alone is not sufficient to prevent these women from falling into poverty. By comparison, gray widoweds are the most advantaged singles.
Ung, Brian L; Mullins, C Daniel
The U.S. Patient Protection and Affordable Care Act (hence, Affordable Care Act, or ACA) was signed into law on March 23, 2010. Goals of the ACA include decreasing the number of uninsured people, controlling cost and spending on health care, increasing the quality of care provided, and increasing insurance coverage benefits. This manuscript focuses on how the ACA affects pharmacy benefit managers and consumers when they have prescriptions dispensed. PBMs use formularies and utilization control tools to steer drug usage toward cost-effective and efficacious agents. A logic model was developed to explain the effects of the new legislation. The model draws from peer-reviewed and gray literature commentary about current and future U.S. healthcare reform. Outcomes were identified as desired and undesired effects, and expected unintended consequences. The ACA extends health insurance benefits to almost 32 million people and provides financial assistance to those up to 400% of the poverty level. Increased access to care leads to a similar increase in overall health care demand and usage. This short-term increase is projected to decrease downstream spending on disease treatment and stunt the continued growth of health care costs, but may unintentionally exacerbate the current primary care physician shortage. The ACA eliminates limitations on insurance and increases the scope of benefits. Online health care insurance exchanges give patients a central location with multiple insurance options. Problems with prescription drug affordability and control utilization tools used by PBMs were not addressed by the ACA. Improving communication within the U.S. healthcare system either by innovative health care delivery models or increased usage of health information technology will help alleviate problems of health care spending and affordability.
Geronimus, Arline T; Colen, Cynthia G; Shochet, Tara; Ingber, Lori Barer; James, Sherman A
Black youth residing in high-poverty areas have dramatically lower probabilities of surviving to age 65 if they are urban than if they are rural. Chronic disease deaths contribute heavily. We begin to probe the reasons using the Harlem Household Survey (HHS) and the Pitt County, North Carolina Study of African American Health (PCS). We compare HHS and PCS respondents on chronic disease rates, health behaviors, social support, employment, indicators of health care access, and health insurance. Chronic disease profiles do not favor Pitt County. Smoking uptake is similar across samples, but PCS respondents are more likely to quit. Indicators of access to health care and private health insurance are more favorable in Pitt County. Findings suggest rural mortality is averted through secondary or tertiary prevention, not primary. Macroeconomic and health system changes of the past 20 years may have left poor urban Blacks as medically underserved as poor rural Blacks.
The following reflections on the author's management practice are based on the text of an address given by the author at the 1999 International Conference of the Royal Australasian College of Medical Administrators in Sydney. These reflections arise out of the author's experience for the past 5 years as manager of Nganampa Health Council, an Aboriginal community-controlled health organisation located in the remote north-west of South Australia. Nganampa Health Council is a large regional service with a national reputation for clinical and administrative excellence. It has several leading-edge health programs, which provide an exemplar for other remote health services across Australia. The author discusses three generic key management issues that remote health services managers typically encounter and argues that services are likely to be most effective when resources are applied in a focused and strategic manner and when management practices that are pragmatic and culturally appropriate are adopted.
Hung, Ming-Chien; Jen, Wen-Yuan
As their populations age, many countries are facing the increasing economic pressure of providing healthcare to their people. In Taiwan, this problem is exacerbated by an increasing rate of obesity and obesity-related conditions. Encouraging the adoption of personal health management services is one way to maintain current levels of personal health and to efficiently manage the distribution of healthcare resources. This study introduces Mobile Health Management Services (MHMS) and employs the Technology Acceptance Model (TAM) to explore the intention of students in Executive Master of Business Management programs to adopt mobile health management technology. Partial least squares (PLS) was used to analyze the collected data, and the results revealed that "perceived usefulness" and "attitude" significantly affected the behavioral intention of adopting MHMS. Both "perceived ease of use" and "perceived usefulness," significantly affected "attitude," and "perceived ease of use" significantly affected "perceived usefulness" as well. The results also show that the determinants of intention toward MHMS differed with age; young adults had higher intention to adopt MHMS to manage their personal health. Therefore, relevant governmental agencies may profitably promote the management of personal health among this population. Successful promotion of personal health management will contribute to increases in both the level of general health and the efficient management of healthcare resources.
Muir-Cochrane, Eimear; Gerace, Adam; Mosel, Krista; O'Kane, Debra; Barkway, Patricia; Curren, David; Oster, Candice
Risk assessment and management is a major component of contemporary mental health practice. Risk assessment in health care exists within contemporary perspectives of management and risk aversive practices in health care. This has led to much discussion about the best approach to assessing possible risks posed by people with mental health problems. In addition, researchers and commentators have expressed concern that clinical practice is being dominated by managerial models of risk management at the expense of meeting the patient's health and social care needs. The purpose of the present study is to investigate the risk assessment practices of a multidisciplinary mental health service. Findings indicate that mental health professionals draw on both managerial and therapeutic approaches to risk management, integrating these approaches into their clinical practice. Rather than being dominated by managerial concerns regarding risk, the participants demonstrate professional autonomy and concern for the needs of their clients.
Lee, Hye Won; Choi, Jiae; Lee, YoungJoo; Kil, Ki-Jung; Lee, Myeong Soo
Abstract Background: The aim of this systematic review was to update, complete, and critically evaluate the evidence from placebo-controlled randomized clinical trials (RCTs) of ginseng for managing menopausal women's health. Methods: We searched the literature using 13 databases (MEDLINE, AMED, EMBASE, the Cochrane Library, 6 Korean Medical, and 3 Chinese Databases) from their inception to July 2016 and included all double-blind RCTs that compared any type of ginseng with a placebo control in postmenopausal women. The methodological quality of all studies was assessed using a Cochrane risk of bias tool. Results: Ten RCTs met our inclusion criteria. Most RCTs had unclear risk of bias. One RCT did not show a significant difference in hot flash frequency between Korean red ginseng (KRG) and placebo. The second RCT reported positive effects of KRG on menopausal symptoms. The third RCT found beneficial effects of ginseng (Ginsena) on depression, well-being, and general health. Four RCTs failed to show significant differences in various hormones between KRG and placebo controls except dehydroepiandrosterone. Two other RCTs failed to show effects of KRG on endometrial thickness in menopausal women. The other RCT also failed to show the effects of American ginseng on oxidative stress markers and other antioxidant enzymes. Conclusion: Our systematic review provided positive evidence of ginseng for sexual function and KRG for sexual arousal and total hot flashes score in menopausal women. However, the results of KRG or ginseng failed to show specific effects on hot flash frequency, hormones, biomarkers, or endometrial thickness. The level of evidence for these findings was low because of unclear risk of bias. PMID:27661038
Yeager, Valerie A; Bertrand, Jane
The current limited focus on management in global health activities is highly problematic given the amounts of financial and human resources that are pouring into health system strengthening interventions and the complexity of clinical operations across settings. By ensuring that public health and healthcare practitioners in domestic and international settings receive management training in their educational programs and that we build management capacity among individuals already in the health workforce, we can begin to prepare for more effective health systems strengthening efforts. Rigorous evaluation of health systems strengthening and the impact of management capacity building is crucial to building evidence for the field.
How many people reading this brief believes they could financially survive in a household of four people on $19,784 a year? Yet, this was the official poverty threshold as determined by the federal government for 2005. During this same year, 17% of children under 18 lived below the poverty line, of which 14% were white, 11% Asian, 28% Hispanic and…
Wamba, Nathalis, Ed.
There is a mutual dependence between poverty and academic achievement, creative pedagogies for low-income pupils, school models that "beat the odds", and the resiliency of low-income families dedicated to the academic success of their children. This book examines the connection between poverty and literacy, looking at the potential roles and…
SCHORR, ALVIN L.
TWO OBSERVATIONS ARE MADE ABOUT ATTITUDE AND BEHAVIOR--THAT ATTITUDES ASSOCIATED WITH THE CULTURE OF POVERTY ARE A REALISTIC RESPONSE TO THE FACTS OF POVERTY, AND THAT SOME PEOPLE TAKE A STATIC VIEW OF POOR PEOPLE'S ATTITUDES SO THAT THEY CAN REMAIN UNMOVED OR FEEL SUPERIOR. FOOD AFFECTS ATTITUDE AND BEHAVIOR. LACK OF IT CAUSES DEPRESSION,…
In this article the author discusses the multiple ways in which the enduring, and increasing, problems associated with child poverty blight young people's educational opportunities in the school system. Current policies, supported by a sympathetic media, blame individuals for their poverty, and blame teachers when they fail to "close the…
Procopio, Mariellen; Perella, Frederick J., Jr.
This second edition of "Poverty Profile", published by the Missionary Society of St. Paul the Apostle as part of their Campaign for Human Development, updates the data examined in the earlier (1972) edition and examines some of the current social welfare programs designed to alleviate the affects of poverty. The extent to which poverty…
Baldwin, Barbara, Ed.
Articles in this theme issue are based on presentations at the Pathways from Poverty Workshop held in Albuquerque, New Mexico, on May 18-25, 1995. The event aimed to foster development of a network to address rural poverty issues in the Western Rural Development Center (WRDC) region. Articles report on outcomes from the Pathways from Poverty…
Jancey, Jonine; Meuleners, Lynn; Phillips, Maureen
Objective: To explore health professionals' perceptions of sexual assault management practices and identify issues related to these practices across Western Australia (WA). Design: A two-round electronic Delphi study was undertaken with health professionals (medical doctors, registered nurses, social workers and managers). Setting: Healthcare…
Langman-Dorwart, Nancy; Peebles, Thomas
Asserts that managing mental health and substance abuse utilization in a complex network health maintenance organization (HMO) can be accomplished through comprehensive approach. Describes prescreening of admissions and preferred provider contracts of one HMO's managed care system. Explains savings resulting from averting unnecessary admissions.…
Schooley, Michael W.
The author, a federal manager who leads development and maintenance of evaluation for specific public health programs at the Centers for Disease Control and Prevention, tells the story of developing an evaluation unit in the Office on Smoking and Health. Lessons about managing evaluation, including his practices and related principles, are…
Rekhter, Natalia; Togunov, Igor A.
Introduction: For more than 70 years, health care management in the Soviet Union reflected a centralized directive style familiar to the Soviet political system. Market-oriented reform in post-Soviet Russia is pushing practicing physicians and physician-executives to acquire new information and skills regarding health care management. To assist…
Damon, Maria; Zivin, Joshua Graff; Thirumurthy, Harsha
Poverty and altered planning horizons brought on by the HIV/AIDS epidemic can change individual discount rates, altering incentives to conserve natural resources. Using longitudinal household survey data from western Kenya, we estimate the effects of health status on investments in soil quality, as indicated by households' agricultural land fallowing decisions. We first show that this effect is theoretically ambiguous: while health improvements lower discount rates and thus increase incentives to conserve natural resources, they also increase labor productivity and make it more likely that households can engage in labor-intensive resource extraction activities. We find that household size and composition are predictors of whether the effect of health improvements on discount rates dominates the productivity effect, or vice-versa. Since households with more and younger members are better able to reallocate labor to cope with productivity shocks, the discount rate effect dominates for these households and health improvements lead to greater levels of conservation. In smaller families with less substitutable labor, the productivity effect dominates and health improvements lead to greater environmental degradation.
Damon, Maria; Zivin, Joshua Graff; Thirumurthy, Harsha
Poverty and altered planning horizons brought on by the HIV/AIDS epidemic can change individual discount rates, altering incentives to conserve natural resources. Using longitudinal household survey data from western Kenya, we estimate the effects of health status on investments in soil quality, as indicated by households’ agricultural land fallowing decisions. We first show that this effect is theoretically ambiguous: while health improvements lower discount rates and thus increase incentives to conserve natural resources, they also increase labor productivity and make it more likely that households can engage in labor-intensive resource extraction activities. We find that household size and composition are predictors of whether the effect of health improvements on discount rates dominates the productivity effect, or vice-versa. Since households with more and younger members are better able to reallocate labor to cope with productivity shocks, the discount rate effect dominates for these households and health improvements lead to greater levels of conservation. In smaller families with less substitutable labor, the productivity effect dominates and health improvements lead to greater environmental degradation PMID:25558117
Mohan, R; Spiby, J; Leonardi, G S; Robins, A; Jefferis, S
This paper discusses waste management in the UK and its relationship with health. It aims to outline the role of health professionals in the promotion of waste management, and argues for a change in their role in waste management regulation to help make the process more sustainable. The most common definition of sustainable development is that by the Brundtland commission, i.e. "development that meets the needs of the present without compromising the ability of future generations to meet their own needs". Managing waste sites in a manner that minimises toxic impacts on the current and future generations is obviously a crucial part of this. Although the management of waste facilities is extremely complex, the Integrated Pollution Prevention and Control regime, which requires the input of public health professionals on the regulation of such sites, means that all waste management installations should now be operating in a fashion that minimises any toxicological risks to human health. However, the impacts upon climate change, resource use and health inequalities, as well as the effects of waste transportation, are currently not considered to be part of public health professionals' responsibilities when dealing with these sites. There is also no requirement for public health professionals to become involved in waste management planning issues. The fact that public health professionals are not involved in any of these issues makes it unlikely that the potential impacts upon health are being considered fully, and even more unlikely that waste management will become more sustainable. This paper aims to show that by only considering direct toxicological impacts, public health professionals are not fully addressing all the health issues and are not contributing towards sustainability. There is a need for a change in the way that health professionals deal with waste management issues.
Parsell, Cameron; Ten Have, Charlotte; Denton, Michelle; Walter, Zoe
Objectives The aims of the present study were to examine tenants' experiences of a model of integrated health care and supportive housing and to identify whether integrated health care and supportive housing improved self-reported health and healthcare access.Methods The present study used a mixed-method survey design (n=75) and qualitative interviews (n=20) performed between September 2015 and August 2016. Participants were tenants of permanent supportive housing in Brisbane (Qld, Australia). Qualitative data were analysed thematically.Results Integrated health care and supportive housing were resources for tenants to overcome systematic barriers to accessing mainstream health care experienced when homeless. When homeless, people did not have access to resources required to maintain their health. Homelessness meant not having a voice to influence the health care people received; healthcare practitioners treated symptoms of poverty rather than considering how homelessness makes people sick. Integrated healthcare and supportive housing enabled tenants to receive treatment for health problems that were compounded by the barriers to accessing mainstream healthcare that homelessness represented.Conclusions Extending the evidence about housing as a social determinant of health, the present study shows that integrated health care and supportive housing enabled tenants to take control to self-manage their health care. In addition to homelessness directly contributing to ill health, the present study provides evidence of how the experience of homelessness contributes to exclusions from mainstream healthcare.What is known about the topic? People who are homeless experience poor physical and mental health, have unmet health care needs and use disproportionate rates of emergency health services.What does the paper add? The experience of homelessness creates barriers to accessing adequate health care. The provision of onsite multidisciplinary integrated health care in
The development and implementation of theory-driven programs capable of addressing poverty-impacted children's health, mental health, and prevention needs: CHAMP and CHAMP+, evidence-informed, family-based interventions to address HIV risk and care.
McKernan McKay, Mary; Alicea, Stacey; Elwyn, Laura; McClain, Zachary R B; Parker, Gary; Small, Latoya A; Mellins, Claude Ann
This article describes a program of prevention and intervention research conducted by the CHAMP (Collaborative HIV prevention and Adolescent Mental health Project; McKay & Paikoff, 2007 ) investigative team. CHAMP refers to a set of theory-driven, evidence-informed, collaboratively designed, family-based approaches meant to address the prevention, health, and mental health needs of poverty-impacted African American and Latino urban youth who are either at risk for HIV exposure or perinatally infected and at high risk for reinfection and possible transmission. CHAMP approaches are informed by theoretical frameworks that incorporate an understanding of the critical influences of multilevel contextual factors on youth risk taking and engagement in protective health behaviors. Highly influential theories include the triadic theory of influence, social action theory, and ecological developmental perspectives. CHAMP program delivery strategies were developed via a highly collaborative process drawing upon community-based participatory research methods in order to enhance cultural and contextual sensitivity of program content and format. The development and preliminary outcomes associated with a family-based intervention for a new population, perinatally HIV-infected youth and their adult caregivers, referred to as CHAMP+, is described to illustrate the integration of theory, existing evidence, and intensive input from consumers and healthcare providers.
Vergara, Marcos; Bisama, Ligia; Moncada, Patricio
We suggest that in order to fulfill the health needs of the majority of the Chilean population, which is beneficiary of the public health system, essential organizational skills should be developed for network administration among Self-administered Hospitals, Network Manager and Primary Health Care facilities. Self-administered Hospitals should be competent in managing service options according to their strategy for development, reference and counter-reference mechanisms and waiting lists, to optimize queuing. The Network Manager should be competent in demand management that is regulated, investments management that determines future development in terms of population needs and stakeholders' management, which is a political viability type of management. Finally, the Primary Health Care manager should be competent in demand management as a strategic partner of the Network Manager, community participation and management of interlinked areas, articulating social networks and sanitary impact management. At each level and within levels, there are crossroads that promote synergies. Based on the development of essential skills, a practice with strategic intentions, organization managers will develop team work skills.
Cuffel, B J; Snowden, L; Masland, M; Piccagli, G
The movement towards managed care in the public mental health system has surpassed efforts to develop a systematic literature concerning its theory, practice, and outcome. In particular little has been written about potential challenges and difficulties in translating managed care systems from their origins in the private sector to the delivery of public sector mental health services. This paper provides an overview of managed care definitions, organizational arrangements, administrative techniques, and roles and responsibilities using a theoretical framework adopted from economics referred to as principal-agent theory. Consistent with this theory, we assert that the primary function of the managed care organization is to act as agent for the payor and to manage the relationships between payors, providers, and consumers. From this perspective, managed care organizations in the public mental health system will be forced to manage an extremely complex set of relationships between multiple government payors, communities, mental health providers, and consumers. In each relationship, we have identified many challenges for managed care including the complexity of public financing, the vulnerable nature of the population served, and the importance of synchronization between managed care performance and community expectations for the public mental health system. In our view, policy regarding the role of managed care in the public mental health system must evolve from an understanding of the dynamics of government-community-provider-consumer "agency relationships".
Tebaldi, Edinaldo; Mohan, Ramesh
This study utilises eight alternative measures of institutions and the instrumental variable method to examine the impacts of institutions on poverty. The estimates show that an economy with a robust system to control corruption, an effective government, and a stable political system will create the conditions to promote economic growth, minimise income distribution conflicts, and reduce poverty. Corruption, ineffective governments, and political instability will not only hurt income levels through market inefficiencies, but also escalate poverty incidence via increased income inequality. The results also imply that the quality of the regulatory system, rule of law, voice and accountability, and expropriation risk are inversely related to poverty but their effect on poverty is via average income rather than income distribution.
Feather, Martin S.; Uckun, Serdar; Hicks, Kenneth A.
Despite two decades of significant investments in R&D of Integrated System Health Management (ISHM), mission-critical applications of it in aerospace are few and far between. ISHM is subject to the general difficulty of transitioning technologies out of R&D labs and into practical applications. New and unproven methods such as ISHM introduce multiple mission risks (technology, schedule, cost), and may require a transition to unconventional and as-yet-unproven operations concepts in order to be effective. Laboratory and flight demonstrations are necessary but insufficient to adequately reduce those risks. What is needed is a solid business case before a new technology can be considered for fleetwide deployment. To address these problems, we recently applied a technology maturation assessment process developed at NASA's Jet Propulsion Laboratory to study the challenges of ISHM technology maturation. This application resulted in identification of the technologies (and technology maturation activities) that would result in the greatest risk reduction per investment dollar. Our approach and its results are described herein.
Rao, Shaline; Brammer, Craig; McKethan, Aaron; Buntin, Melinda B
Adoption of health information technology (HIT) is a key effort in improving care delivery, reducing costs of health care, and improving the quality of health care. Evidence from electronic health record (EHR) use suggests that HIT will play a significant role in transforming primary care practices and chronic disease management. This article shows that EHRs and HIT can be used effectively to manage chronic diseases, that HIT can facilitate communication and reduce efforts related to transitions in care, and that HIT can improve patient safety by increasing the information available to providers and patients, improving disease management and safety.
Rahmani, Arshad H.
Cassia fistula Linn is known as Golden shower has therapeutics importance in health care since ancient times. Research findings over the last two decade have confirmed the therapeutics consequence of C. fistula in the health management via modulation of biological activities due to the rich source of antioxidant. Several findings based on the animal model have confirmed the pharmacologically safety and efficacy and have opened a new window for human health management. This review reveals additional information about C. fistula in the health management via in vivo and in vitro study which will be beneficial toward diseases control. PMID:26130932
Reddick, W. T.
Rapid change in the health care environment mandates a more comprehensive approach to the education of future health administrators. The area of consideration in this study is that of health care strategic management. A comprehensive literature review suggests microcomputer-based simulation as an appropriate vehicle for addressing the needs of both educators and students. Seven strategic management software packages are reviewed and rated with an instrument adapted from the Infoworld review format. The author concludes that a primary concern is the paucity of health care specific strategic management simulations.
Halverson, P K; Mays, G P; Miller, C A; Kaluzny, A D; Richards, T B
Managed care is fast becoming the dominant form of medical care delivery and financing in the United States, yet its effects on public health practice remain largely unknown. Tuberculosis (TB) is a classic example of a disease with both public health and medical care implications, and as such it provides an opportunity for examining the impact on public health of the shift towards managed care in the medical marketplace. The authors approach the role of managed care in TB control by first considering the need for interorganizational coordination at the community level. The authors identify four basic models of how managed care organizations may fit into TB control efforts in local communities, using observations from 12 local public health jurisdictions to illustrate these models. These TB control models provide insight into the general mechanisms through which managed care organizations may affect other areas of public health practice. Images p22-a p23-a p25-a p28-a PMID:9018283
Bodenmann, P; Bossart, R; Di Bernardo, N; Dominice Dao, M; Durieux, S; Faucherre, F; Hudelson, P; Keller, M; Schuster, S; Zellweger, E; Houmard, S
The development of Migrant Friendly Hospitals is an important first step towards eliminating health care disparities in Switzerland and an important reminder to health policy makers and practitioners across the health care system of their responsibility to provide non-discriminatory quality health care to all patients.
Vasic, Milena; Markovic, Roberta; Korac, Vesna; Krstic, Maja
The aim of the paper was to describe and analyse health services management in Serbia, commencing with present status and projecting, as accurately as possible, future changes over the next years, skills and required competencies of the health management workforce. The study was done as a part of Ministry of Health/EU funded Project "Preparation for Health Management Training Programme in Serbia" by a desk review of current and draft legislation, related projects in the health sector and relevant local and international literature; semi-structured interviews with key local and international stakeholders and a structural analysis of the health management sector. The results of the study have shown that there was a big gap in knowledge and skills regarding Health Management in Serbia and a true need for such type of education.
Bradley, Elizabeth H.; Taylor, Lauren A.; Cuellar, Carlos J.
Despite a renewed focus in the field of global health on strengthening health systems, inadequate attention has been directed to a key ingredient of high-performing health systems: management. We aimed to develop the argument that management – defined here as the process of achieving predetermined objectives through human, financial, and technical resources – is a cross-cutting function necessary for success in all World Health Organization (WHO) building blocks of health systems strengthening. Management within health systems is particularly critical in low-income settings where the efficient use of scarce resources is paramount to attaining health goals. More generally, investments in management capacity may be viewed as a key leverage point in grand strategy, as strong management enables the achievement of large ends with limited means. We also sought to delineate a set of core competencies and identify key roles to be targeted for management capacity building efforts. Several effective examples of management interventions have been described in the research literature. Together, the existing evidence underscores the importance of country ownership of management capacity building efforts, which often challenge the status quo and thus need country leadership to sustain despite inevitable friction. The literature also recognizes that management capacity efforts, as a key ingredient of effective systems change, take time to embed, as new protocols and ways of working become habitual and integrated as standard operating procedures. Despite these challenges, the field of health management as part of global health system strengthening efforts holds promise as a fundamental leverage point for achieving health system performance goals with existing human, technical, and financial resources. The evidence base consistently supports the role of management in performance improvement but would benefit from additional research with improved methodological rigor and longer
Bradley, Elizabeth H; Taylor, Lauren A; Cuellar, Carlos J
Despite a renewed focus in the field of global health on strengthening health systems, inadequate attention has been directed to a key ingredient of high-performing health systems: management. We aimed to develop the argument that management - defined here as the process of achieving predetermined objectives through human, financial, and technical resources - is a cross-cutting function necessary for success in all World Health Organization (WHO) building blocks of health systems strengthening. Management within health systems is particularly critical in low-income settings where the efficient use of scarce resources is paramount to attaining health goals. More generally, investments in management capacity may be viewed as a key leverage point in grand strategy, as strong management enables the achievement of large ends with limited means. We also sought to delineate a set of core competencies and identify key roles to be targeted for management capacity building efforts. Several effective examples of management interventions have been described in the research literature. Together, the existing evidence underscores the importance of country ownership of management capacity building efforts, which often challenge the status quo and thus need country leadership to sustain despite inevitable friction. The literature also recognizes that management capacity efforts, as a key ingredient of effective systems change, take time to embed, as new protocols and ways of working become habitual and integrated as standard operating procedures. Despite these challenges, the field of health management as part of global health system strengthening efforts holds promise as a fundamental leverage point for achieving health system performance goals with existing human, technical, and financial resources. The evidence base consistently supports the role of management in performance improvement but would benefit from additional research with improved methodological rigor and longer
... HUMAN SERVICES Office of the Secretary Annual Update of the HHS Poverty Guidelines AGENCY: Department of... Health and Human Services (HHS) poverty guidelines to account for last calendar year's increase in prices... Federal, state, or local office that is responsible for that program. For information about...
... HUMAN SERVICES Office of the Secretary Annual Update of the HHS Poverty Guidelines AGENCY: Department of... Health and Human Services (HHS) poverty guidelines to account for last calendar year's increase in prices... Federal, state, or local office that is responsible for that program. For information about...
... HUMAN SERVICES Office of the Secretary Annual Update of the HHS Poverty Guidelines AGENCY: Department of... Health and Human Services (HHS) poverty guidelines to account for last calendar year's increase in prices... Federal, State, or local office that is responsible for that program. For information about...
Partnership for Hope, Inc., San Antonio, TX.
This publication offers a portrait of poverty in San Antonio (Texas) based on an analysis of available statistical data and focusing on health, education, employment, housing, and human services. Five chapters each contain statistics regarding poverty in the United States, Texas, and San Antonio. Each chapter also begins with true stories about…
Research and Training Center on Family Support and Children's Mental Health, 2004
"Data Trends" reports present summaries of research on mental health services for children and adolescents and their families. The article summarized in this "Data Trends" asks: Does the stress and adversity associated with poverty cause mental illness or is poverty the result of downward social mobility of persons with mental…
Mony, Prem Kumar; Nagaraj, C
Morbidity and mortality data constitute an important component of a health information system and their coding enables uniform data collation and analysis as well as meaningful comparisons between regions or countries. Strengthening the recording and reporting systems for health monitoring is a basic requirement for an efficient health information management system. Increased advocacy for and awareness of a uniform coding system together with adequate capacity building of physicians, coders and other allied health and information technology personnel would pave the way for a valid and reliable health information management system in India. The core requirements for the implementation of disease coding are: (i) support from national/institutional health administrators, (ii) widespread availability of the ICD-10 material for morbidity and mortality coding; (iii) enhanced human and financial resources; and (iv) optimal use of informatics. We describe the methodology of a disease classification and codification system as also its applications for developing and maintaining an effective health information management system for India.
Sowah, Leonard Anang; Busse, Sarah; Amoroso, Anthony
Tobacco use in the U.S. has declined significantly since the 1960s, but differentially by socioeconomic status. Current HIV (human immunodeficiency virus) infection rates in the United States are higher in minorities and underprivileged individuals. Effective highly active anti-retroviral therapy (HAART) has changed HIV into a chronic infection. Mortality among HIV patients is now as likely to be due to heart disease and cancers as HIV-related infections. In the current situation, one would expect public insurance plans to focus on interventions targeting lifestyle-associated behaviors such as tobacco use that have been found to be associated with increased risk for heart disease and cancers. Review of the AIDS Drug Assistance Program formularies and the Medicaid Programs of 50 states and the District of Columbia, however, revealed that coverage for smoking cessation is inadequate in most instances. To reduce health disparities, publicly funded programs that serve the nation's most vulnerable should provide coverage for effective tobacco cessation.
Roberts, James R.; McCurdy, Leyla Erk
These guidelines are the product of a new Pediatric Asthma Initiative aimed at integrating environmental management of asthma into pediatric health care. This document outlines competencies in environmental health relevant to pediatric asthma that should be mastered by primary health care providers, and outlines the environmental interventions…
Ramos, Mary M.; Greenberg, Cynthia; Sapien, Robert; Bauer-Creegan, Judith; Hine, Beverly; Geary, Cathy
Background: As members of interdisciplinary teams, school nurses provide behavioral health services. Studies indicate that school nurses may lack sufficient continuing education in adolescent behavioral health and in the management of behavioral health emergencies, specifically. We conducted this study to describe the adolescent behavioral health…
Nir, Adam E.
Three-year study examines the effects of school-based management (SBM) on the organizational health of 28 elementary schools in Jerusalem using 7 indicators from the Organizational Climate Description Questionnaire and the Organizational Health Inventory. Finds no significant impact of SBM on the schools' organizational health, but finds…
Persson, Louise; Haraldsson, Katarina
Schools are recognized worldwide as settings for health promotion, and leadership has a bearing on schools' ability to be health promoting. School managers have a great influence on what is prioritized in school, which in turn affects students' school performance and health. There is lack of research into school managers' views on health promotion, and what they consider to be central to health promotion. The aim was therefore to examine school managers' views about what health promotion in schools include. An explorative design, qualitative content analysis, was performed. In-depth interviews were conducted with all 13 school managers of a middle-sized municipality in central Sweden. The analysis had both manifest and latent content and three categories: 'Organization and Collaboration', 'Optimize the arena' and 'Strengthen the individual', and 10 subcategories emerged. The theme, 'Opportunities for learning and a good life', describes the latent content of these categories. Taking into account the views of school managers are important because these views help form a more complete picture of how school managers work with health promotion and what is needed to enhance health promotion to improve students' opportunities for learning and a good life. The Ottawa Charter for Health promotion is thereby transformed into practice.
Sadak, Tatiana; Wright, Jacob; Borson, Soo
The National Alzheimer's Plan calls for improving health care for people living with dementia and supporting their caregivers as capable health care partners. Clinically useful measurement tools are needed to monitor caregivers' knowledge and skills for managing patients' often complex health care needs as well as their own self-care. We created and validated a comprehensive, caregiver-centered measure, Managing Your Loved One's Health (MYLOH), based on a core set of health care management domains endorsed by both providers and caregivers. In this article, we describe its development and preliminary cultural tailoring. MYLOH is a questionnaire containing 29 items, grouped into six domains, which requires <20 min to complete. MYLOH can be used to guide conversations between clinicians and caregivers around health care management of people with dementia, as the basis for targeted health care coaching, and as an outcome measure in comprehensive dementia care management interventions.
Africa carries a disproportionate responsibility in terms of blindness and visual impairment. With approximately 10 per cent of the world's population, Africa has 19 per cent of the world's blindness. It is no surprise that this reality also mirrors the situation in terms of the burden of world poverty. There is an increasing recognition of the need to highlight the link between poverty, development and health care. Blindness, disabling visual impairment and the overall lack of eye-care services are too often the result of social, economic and developmental challenges of the developing world. The state of eye care in Africa stands in alarming contrast to that in the rest of the world. Poor practitioner-to-patient ratios, absence of eye-care personnel, inadequate facilities, poor state funding and a lack of educational programs are the hallmarks of eye care in Africa, with preventable and treatable conditions being the leading cause of blindness. Eye diseases causing preventable blindness are often the result of a combination of factors such as poverty, lack of education and inadequate health-care services. The challenge that Vision 2020 has set itself in Africa is enormous. Africa is not a homogenous entity, the inter- and intra-country differences in economic development, prevalence of disease, delivery infrastructure and human resources amplify the challenges of meeting eye-care needs. The successful implementation of Vision 2020 programs will be hindered without the development of a comprehensive, co-ordinated strategy that is cognisant of the differences that exist and the need for comprehensive solutions that are rooted in the economic and political realities of the continent as well as the individual countries and regions within countries. This strategy should recognise the need for economic growth that results in greater state funded eye-care services that focus on health promotion to ensure the prevention of eye disease, the development of eye clinics in
Bainbridge, J.; Sapirie, S.
The manual presents 16 main steps for health project management, from project formulation through termination. The manual defines a health project as a temporary intensive effort to set up and put into operation a new or revised service that will result in the reduction of specific health or health-related problems. (Typical examples include the…
Food Research and Action Center, Washington, DC.
Poverty data released by the U. S. Census Bureau indicates no significant progress toward reducing the poverty rate during a period of economic recovery. The 1986 poverty rate of 13.6 percent remains significantly higher than anytime in the 1970s. Minority group children represent the largest age group of the poverty population. The sluggish…
Gyampoh-Vidogah, Regina; Moreton, Robert; Sallah, David
Health informatics has the potential to improve the quality and provision of care while reducing the cost of health care delivery. However, health informatics is often falsely regarded as synonymous with information management (IM). This chapter (i) provides a clear definition and characteristic benefits of health informatics and information management in the context of health care delivery, (ii) identifies and explains the difference between health informatics (HI) and managing knowledge (KM) in relation to informatics business strategy and (iii) elaborates the role of information communication technology (ICT) KM environment. This Chapter further examines how KM can be used to improve health service informatics costs, and identifies the factors that could affect its implementation and explains some of the reasons driving the development of electronic health record systems. This will assist in avoiding higher costs and errors, while promoting the continued industrialisation of KM delivery across health care communities.
One in three children in Britain lives in poverty (households whose income was less than 50% average earnings). Low income is associated with poor nutrition at all stages of life, from lower rates of breast-feeding to higher intakes of saturated fatty acids and lower intakes of antioxidant nutrients. Moreover, there is increasing evidence that poor nutrition in childhood is associated with both short-term and long-term adverse consequences such as poorer immune status, higher caries rates and poorer cognitive function and learning ability. These problems arise primarily because parents do not have enough money to spend on food, not because money is being spent unwisely. Policy options to improve the dietary health of poor children include: giving more money to the parents by increasing Income Support (social security) payments, providing food stamps or vouchers, and using food budget standards to inform the levels of income needed to purchase an adequate diet; feeding children directly at school (not only at lunchtime but also at breakfast or homework clubs), by providing free fruit at school, and by increasing entitlement to free food amongst children living in households with low incomes; improving access to a healthy and affordable diet by first identifying 'food deserts' and then considering with retailers and local planners how best to provide food in an economical and sustainable way. The value of using food budget standards is illustrated with data relating expenditure on food to growth in children from 'at-risk' families (on low income, overcrowded, headed by a lone parent or with four or more children under 16 years of age) living in a poor area in London. Lower levels of expenditure are strongly associated with poorer growth and health, independent of factors such as birth weight, mother's height, or risk score. The present paper provides evidence that supports the need to review Government legislation in light of nutrition-related inequalities in the
Examined factors affecting the application of learning to practice in British mental health services, considering the role of administrators and emphasizing distance education. Data from administrators and health professionals indicated that workers who studied mental health often felt disempowered and isolated when introducing new practice ideas…
Callander, Emily J; Schofield, Deborah J; Shrestha, Rupendra N
Using the newly created Freedom Poverty Measure, a multidimensional measure of poverty, it can be seen that there were 534,700 individuals who were in freedom poverty, who had either poor health or poor education in addition to having low incomes. This multidimensional disadvantage would not normally be captured by single measures of poverty, such as income poverty measures. Men were significantly less likely to be in freedom poverty than women (OR = 0.63, 95% CI: 0.54-0.74, p < .0001), and the proportion of individuals in freedom poverty increased with age, with those older than 85 being 2.3 times more likely to be in freedom poverty than those aged 65 to 69 years (95% CI: 1.73-3.11, p < .0001). Policy responses to address the marginalization of disadvantaged older people should take a multidisciplinary approach, addressing health inequalities in particular, not just low income.
Rerolle, Francois; Rammohan, Sonali V.; Albohm, Davis C.; Muwowo, George; Moseson, Heidi; Sept, Lesley; Lee, Hau L.; Bendavid, Eran
Objectives. We investigated whether managed transportation improves outreach-based health service delivery to rural village populations. Methods. We examined systematic transportation management in a small-cluster interrupted time series field trial. In 8 districts in Southern Zambia, we followed health workers at 116 health facilities from September 2011 to March 2014. The primary outcome was the average number of outreach trips per health worker per week. Secondary outcomes were health worker productivity, motorcycle performance, and geographical coverage. Results. Systematic fleet management resulted in an increase of 0.9 (SD = 1.0) trips to rural villages per health worker per week (P < .001), village-level health worker productivity by 20.5 (SD = 5.9) patient visits, 10.2 (SD = 1.5) measles immunizations, and 5.2 (SD = 5.4) child growth assessments per health worker per week. Motorcycle uptime increased by 3.5 days per week (P < .001), use by 1.5 days per week (P < .001), and mean distance by 9.3 kilometers per trip (P < .001). Geographical coverage of health outreach increased in experimental (P < .001) but not control districts. Conclusions. Systematic motorcycle management improves basic health care delivery to rural villages in resource-poor environments through increased health worker productivity and greater geographical coverage. PMID:26562131
... HUMAN SERVICES Office of the Secretary Delayed Update of the HHS Poverty Guidelines for the Remainder of... delayed update of the Department of Health and Human Services (HHS) poverty guidelines for the remainder of 2010, and until the 2011 poverty guidelines are published, which is expected to occur in...
Wenzel, F J; Grady, R; Freedman, T J
The current health care environment will require executive leadership with a new set of management competencies to effectively lead and manage the various components of a restructured health care delivery system. The traditional management skills of planning, organizing, directing, controlling, and staffing resources will remain relevant, but the true measure of professional success will be the development of conceptual skills. This means the ability to look at the health care enterprise as a whole, and recognize how changes in the environment shape your strategic mission, goals, and objectives. The successful health care leader will have a demonstrated ability to apply these conceptual skills to the development of information systems and integrated networks that position their organization to accept capitated risks. This paper examines the United States and Canadian health care systems from the perspective of both the more traditional hospital and the emerging medical care organizations. New importance of the team approach to leadership and management and all that entails is stressed.
Murti, Michelle; Ayre, Reg; Shapiro, Howard; de Burger, Ron
In 2009, the City of Toronto, Ontario, Canada, experienced a six-week labor disruption involving 24,000 city workers that included solid waste and public health employees. In an attempt to control illegal dumping and to manage garbage storage across the city during this period, 24 temporary garbage storage sites were established by the city (mostly in local parks) for residents to dispose of their household waste. No other municipality in North America has attempted to operate this many temporary sites for this long a period. Management and nonunion staff from Healthy Environments in Toronto Public Health performed daily inspections, responded to community questions, issued public health orders, and worked closely with Solid Waste Management and the Ministry of the Environment to actively manage the public health concerns associated with these sites. This intensive oversight mitigated public health risks to the community and facilitated an effective, safe solution to the temporary garbage storage problem.
Health and safety management systems have a background in theory and in various interests among employers and workplace health and safety professionals. These have resulted in a number of national systems emanating from national standard-writing centres and from employers' organizations. In some cases these systems have been recognized as national standards. The contenders for an international standard have been the International Organization of Standardization (ISO) and the International Labour Organization (ILO). The quality and environmental management systems of ISO indicate what an ISO health and safety management standard would look like. The ILO Guidelines on Safety and Health Management Systems, by contrast, are stringent, specific and potentially effective in improving health and safety performance in the workplace.
Yang, Yiting; Ma, Chung Wah; Yang, Yide; Wang, Xiaoling; Lin, Xiaoliang; Fu, Lianguo; Wang, Shuo; Yang, Zhongping; Wang, Zhenghe; Meng, Xiangkun; Ma, Dongmei; Ma, Rui
Overweight or obese adults aged 20~55 years and living in Beijing more than one year were randomly divided into different management groups. A one-year integrated health management intervention was applied in the health management groups. The physical indicators and metabolic indicators changed after one-year intervention on the overweight and obese adults. The annual reduction of the physical indicators was significant in all groups (p < 0.05) except the weight loss in the placebo + general management group. The health management and the dietary supplement have statistically significant (p < 0.001, p < 0.001) effects on the annual reduction of these indicators and interactive effect between them was found on some of these indicators such as bodyweight, body mass index (BMI), body fat ratio (BFR), and hipline (p < 0.05). The dietary supplement + health management group had the best annual reduction effects for the indicators among the groups. Integrated health management interventions including both dietary supplements intervention and health management could improve metabolic indicators in overweight and obese adults together with the physical indicators, suggesting the intermediated role of metabolic indictors in controlling obesity. PMID:28115972
van Soest, F J S; Mourits, M C M; Hogeveen, H
The expertise and knowledge of veterinary advisors on improving animal health management is key towards a better herd health status. However, veterinary advisors are not always aware of the goals and priorities of dairy farmers. To dairy farmers animal health is only one aspect of farm management and resources may be allocated to other more preferred areas. Veterinary advisors may experience this as non-compliant with their advice. To explore the preferences of European Union (EU) organic dairy farmers for improved animal health management relative to other farm management areas an adaptive conjoint analysis (ACA) was performed. A total of 215 farmers participated originating from organic dairy farms in France (n = 70), Germany (n = 60), Spain (n = 28) and Sweden (n = 57). The management areas udder health and claw health represented animal health management whereas barn, calf and pasture management represented potential conflicting management areas. Results indicate that EU organic dairy farmers differ in their preferences for improved animal health management within the farming system. In general, improved calf management was the most preferred area and improved claw health management was found to be least preferred, the remaining areas were of intermediate interest. Cluster analyses on claw health measures and udder health measures resulted in respectively seven and nine distinct preference profiles. The results indicate a high degree of variation in farmers' preference, which cannot be explained by the typical herd characteristics. With the individual preferences revealed by ACA, a veterinary advisor can now find out whether his intended advice is directed at a favourable or unfavourable management area of the farmer. If the latter is the case the veterinarian should first create awareness of the problem to the farmer. Insights in individual farmers preferences will allow veterinary advisors to better understand why farmers were incompliant with their advice
Schwartz, Robert; Deber, Raisa
What happens when performance measurement and management (PMM) is applied to public health systems? This review of the experiences of high-income jurisdictions reveals considerable challenges, some familiar from the general public management literature and some more unique to public health. To aid understanding, the PMM ladder, a framework for evaluating PMM systems is developed and applied to 55 public health measurement systems from Australia, Canada, EU, New Zealand, UK and US. Results indicate that: considerable measurement is occurring for informational purposes; measurement focuses more on clinical than on population health measures; and there is relatively little use of measurement results for improving management. Results demonstrate that much public health performance measurement is restricted to population health outcomes and fails to include more proximate activity and output measures that would be more useful for managing public health organizations. There are early signs of the emergence of a new breed of public health performance measurement that attempts to do just this. The PMM ladder proved useful for assessing efforts across a range of jurisdictions. It allows policymakers and managers to easily compare their PMM efforts with others and assists researchers in assessing what happens when PMM is applied to public health.
Sharma, Kavya; Zodpey, Sanjay
Public Health Management has taken a momentous leap and seeks to provide a plausible answer to many issues related to public health. A key area identified to aid the public health objectives in the country is human resource management. The country faces a dire crunch in the available work force in almost all the healthcare network. Countering the current health situation in the country, various institutes have come up offering specialized courses in public health management. The wide gap between supply and demand for trained health care managers/ administrators to work for hospitals, pharmaceutical companies, health insurance and third party administration and other health care provider organizations needs attention. The paper is a situational analysis of all such courses offered pan India. A systematic, predefined approach was used to collect and assemble the data. All the institutes offering such courses were contacted for detailed information. Fifty one institutes have been identified which annually produce around 2122 qualified professional to work in the domain of public health management. The paper also discusses the demand analysis where these prospective students can be placed. An estimated 19,930 professionals would be required based upon the country's present status, which reflects the dearth in their workforce capacity. The paper also enlighten the scope of strengthening the existing system, by effectively training the existing workforce for their capacity building, and highlights training opportunities for working professional to pursue a related academic program.
Prosser, W. H.; Brown, T. L.; Woodard, S. E.; Fleming, G. A.; Cooper, E. G.
NASA is focusing considerable efforts on technology development for Integrated Vehicle Health Management systems. The research in this area is targeted toward increasing aerospace vehicle safety and reliability, while reducing vehicle operating and maintenance costs. Onboard, real-time sensing technologies that can provide detailed information on structural integrity are central to such a health management system. This paper describes a number of sensor technologies currently under development for integrated vehicle health management. The capabilities, current limitations, and future research needs of these technologies are addressed.
West, Daniel J; Ramirez, Bernardo; Filerman, Gary
The impact of globalization on graduate health care management education is evident, yet challenging to quantify. The Commission on Healthcare Management Education (CAHME) recently authorized two research studies to gather specific information and answer important questions about accredited graduate programs in the USA and Canada. Two surveys provided the most comprehensive data impacting international health management education efforts by 70 programs. An inventory was made of 22 countries; information was compiled on 21 accrediting or quality improvement organizations. Observations on leadership and the demand for qualified health care professionals is discussed in terms of accreditation, certification, competency models, outcome assessment, improving quality, and the impact of globalization on higher education.
Nikitovic, M; Brener, S
Background As part of ongoing efforts to improve the Ontario health care system, a mega-analysis examining the optimization of chronic disease management in the community was conducted by Evidence Development and Standards, Health Quality Ontario (previously known as the Medical Advisory Secretariat [MAS]). Objective The purpose of this report was to identify health technologies previously evaluated by MAS that may be leveraged in efforts to optimize chronic disease management in the community. Data Sources The Ontario Health Technology Assessment Series and field evaluations conducted by MAS and its partners between January 1, 2006, and December 31, 2011. Review Methods Technologies related to at least 1 of 7 disease areas of interest (type 2 diabetes, coronary artery disease, atrial fibrillation, chronic obstructive pulmonary disease, congestive heart failure, stroke, and chronic wounds) or that may greatly impact health services utilization were reviewed. Only technologies with a moderate to high quality of evidence and associated with a clinically or statistically significant improvement in disease management were included. Technologies related to other topics in the mega-analysis on chronic disease management were excluded. Evidence-based analyses were reviewed, and outcomes of interest were extracted. Outcomes of interest included hospital utilization, mortality, health-related quality of life, disease-specific measures, and economic analysis measures. Results Eleven analyses were included and summarized. Technologies fell into 3 categories: those with evidence for the cure of chronic disease, those with evidence for the prevention of chronic disease, and those with evidence for the management of chronic disease. Conclusions The impact on patient outcomes and hospitalization rates of new health technologies in chronic disease management is often overlooked. This analysis demonstrates that health technologies can reduce the burden of illness; improve patient
Associations of Continuity and Change in Early Neighborhood Poverty With Adult Cardiometabolic Biomarkers in the United States: Results From the National Longitudinal Study of Adolescent to Adult Health, 1995-2008.
Lippert, Adam M; Evans, Clare Rosenfeld; Razak, Fahad; Subramanian, S V
Limitations of extant research on neighborhood disadvantage and health include general reliance on point-in-time neighborhood measures and sensitivity to residential self-selection. Using data from the US Census and the 1995-2008 National Longitudinal Study of Adolescent to Adult Health, we applied conventional methods and coarsened exact matching to assess how cardiometabolic health varies among those entering, exiting, or remaining in poor and nonpoor neighborhoods. Within the full sample (n = 11,767), we found significantly higher systolic and diastolic blood pressures among those who entered or consistently lived in poor neighborhoods relative to those who never lived in poor neighborhoods. Obesity was similarly more common among those who originated from poor neighborhoods than among those who originated from nonpoor neighborhoods. Having exited poor neighborhoods was associated with lower systolic blood pressure than was consistent residence in low-income communities. Among the matched sample (n = 9,727), results adjusted for confounders and residential self-selection revealed fewer significant contrasts. Compared with peers who had no neighborhood poverty exposure, those who consistently lived in poor neighborhoods had 46% and 52% higher odds of being obese or hypertensive, respectively. Those who exited neighborhood poverty had significantly higher diastolic blood pressures than those who had never lived in poor neighborhoods. These findings underscore the importance of past as well as current residential circumstances for cardiometabolic health.
The transformation to managed care is one of the most important and complex changes ever to take place in the American health system. One key aspect of this transformation is its implications for public health policy and practice. Both public and private buyers purchase managed care; increasingly, public programs that used to act as their own insurers (i.e., Medicare, Medicaid and CHAMPUS) are purchasing large quantities of managed care insurance from private companies. The transformation to managed care is altering the manner in which public health policy makers conceive of and carry out public health activities (particularly activities that involve the provision of personal health services). The degree to which managed care changes public health and in turn is altered by public health will depend in great measure on the extent to which public and private policy makers understand the implications of their choices for various aspects of public health and take steps to address them. Because both publicly and privately managed care arrangements are relatively deregulated, much of the dialogue between public health and managed care purchasers can be expected to take place within the context of the large service agreements that are negotiated between buyers and sellers of managed care products. This is particularly true for Medicaid because of the importance of Medicaid coverage, payment and access policies to public health policy makers, and because of the public nature of the Medicaid contracting process. A nationwide study of Medicaid managed care contracts offers the first detailed analysis of the content and structure of managed care service agreements and the public health issues they raise. Four major findings emerge from a review of the contracts. First, most of the agreements fail to address key issues regarding which Medicaid-covered services and benefits are the contractor's responsibility and which remain the residual responsibility of the state agency
Sword, Wendy; Reutter, Linda; Meagher-Stewart, Donna; Rideout, Elizabeth
Given the link between poverty and health, nurses, in their work in hospitals and in the community, often come into contact with people who are poor. To be effective care providers, nurses must have an adequate understanding of poverty and a positive attitude toward people who are poor. This study examined attitudes toward poverty among baccalaureate nursing students (N = 740) at three Canadian universities. Students' attitudes were neutral to slightly positive. Personal experiences appeared to have an important influence on the development of favorable attitudes. The findings point to several considerations for nursing curricula. Students should not only be provided with classroom opportunities for critical exploration of poverty and its negative effects on individuals and society, but also have clinical learning experiences that bring them face-to-face with people who are poor, their health concerns, and the realities of their circumstances. Thoughtful critique of poverty-related issues and interpersonal contact may be effective strategies to foster attitude change.
Fox, Liana E; Wimer, Christopher; Garfinkel, Irwin; Kaushal, Neeraj; Waldfogel, Jane
Using data from the Consumer Expenditure Survey and the March Current Population Survey, we provide poverty estimates for 1967 to 2012 based on a historical Supplemental Poverty Measure (SPM). During this period, poverty, as officially measured, has stagnated. However, the official poverty measure (OPM) does not account for the effect of near-cash transfers on the financial resources available to families, an important omission since such transfers have become an increasingly important part of government anti-poverty policy. Applying the historical SPM, which does count such transfers, we find that trends in poverty have been more favorable than the OPM suggests and that government policies have played an important and growing role in reducing poverty-a role that is not evident when the OPM is used to assess poverty. We also find that government programs have played a particularly important role in alleviating child poverty and deep poverty, especially during economic downturns.
Physicians are increasingly expected to assume responsibility for the management of human and financial resources in health care, particularly in hospitals. Juggling their new management responsibilities with clinical care, teaching and research can lead to conflicting roles. However, their presence in management is crucial to shaping the future health care system. They bring to management positions important skills and values such as observation, problem-solving, analysis and ethical judgement. To improve their management skills physicians can benefit from management education programs such as those offered by the Physician-Manager Institute and several Canadian universities. To manage in the future environment they must increase their knowledge and skills in policy and political processes, financial strategies and management, human resources management, systems and program quality improvement and organizational design. PMID:8287339
Martin, M E; Henry, M
The nurse who practices from a perspective of cultural relativity attempts to understand client behaviors within the context of the clients' culture. Viewing customs (behaviors) as a reflection of client beliefs and values can enhance the nurse's effectiveness with clients in poverty. This paper presents a case study in which a culturally relativistic perspective was used to assess and intervene with a family living in poverty.
Steinberg, Emma M; Valenzuela-Araujo, Doris; Zickafoose, Joseph S; Kieffer, Edith; DeCamp, Lisa Ross
Providing safe and high-quality health care for children whose parents have limited English proficiency (LEP) remains challenging. Reports of parent perspectives on navigating language discordance in health care are limited. We analyzed portions of 48 interviews focused on language barriers from 2 qualitative interview studies of the pediatric health care experiences of LEP Latina mothers in 2 urban US cities. We found mothers experienced frustration with health care and reported suboptimal accommodation for language barriers. Six themes emerged relevant to health care across settings: the "battle" of managing language barriers, preference for bilingual providers, negative bias toward interpreted encounters, "getting by" with limited language skills, fear of being a burden, and stigma and discrimination experienced by LEP families. Parents' insights highlight reasons why effective language accommodation in health care remains challenging. Partnering with families to address the management of language barriers is needed to improve health care quality and safety for LEP patients and families.
Hannan, Terry J
The management of health care delivery requires the availability of effective 'information management' tools based on e-technologies [eHealth]. In developed economies many of these 'tools' are readily available whereas in Low and Middle Income Countries (LMIC) there is limited access to eHealth technologies and this has been defined as the "digital divide". This paper provides a short introduction to the fundamental understanding of what is meant by information management in health care and how it applies to all social economies. The core of the paper describes the successful implementation of appropriate information management tools in a resource poor environment to manage the HIV/AIDS epidemic and other disease states, in sub-Saharan Africa and how the system has evolved to become the largest open source eHealth project in the world and become the health information infrastructure for several national eHealth economies. The system is known as Open MRS [www.openmrs.org). The continuing successful evolution of the OpenMRS project has permitted its key implementers to define core factors that are the foundations for successful eHealth projects.
Presented to the Faculty Department of Systems Engineering and Management Graduate School of Engineering and Management Air Force Institute of Technology... Engineering Kerwin Chun Seong Teong, B.Eng (Hons) Major (Military Expert 5), Republic of Singapore Air Force September 2013 DISTRIBUTION...the engine , rotor and gearbox. The HUMS will also include software to handle data processing (diagnostics) and prognostics to enhance overall
Purcell, Laura; Milner, Brigid
Purpose--The purpose of this paper is to investigate the dramatic reforms in the health service in recent years. Design/methodology/approach--Examines management development in health care, and explores the experiences of clinical nurse managers. Findings--Duplication of agencies and multiplication of roles have led to tensions in terms of both…
Lekki, J.; Abdul-Aziz, A.; Adamovsky, G.; Berger, D.; Fralick, G.; Gyekenyesi, A.; Hunter, G.; Tokars, R.; Venti, M.; Woike, M.; Wrbanek, J.; Wrbanek, S.
Develop Advanced Sensor Technology and rotordynamic structural diagnostics to address existing Aviation Safety Propulsion Health Management needs as well as proactively begin to address anticipated safety issues for new technologies.
Levin-Zamir, D; Peterburg, Y
Health systems will face new challenges in this millennium. Striking the balance between the best quality of care and optimal use of dwindling resources will challenge health policy makers, managers and practitioners. Increasingly, improvements in the outcomes of interventions for both acute and chronic patients will depend on partnerships between health service providers, the individual and their family. Patient education that incorporates self-management and empowerment has proven to be cost-effective. It is essential that health care providers promote informed decision making, and facilitate actions designed to improve personal capacity to exert control over factors that determine health and improve health outcomes. It is for these reasons that promoting health literacy is a central strategy for improving self-management in health. The different types of health literacy--functional, interactive and critical health literacy--are considered. The potential to improve health literacy at each of these levels has been demonstrated in practice among diabetics and other chronic disease patients in Clalit Health Services (CHS) in Israel is used as an example to demonstrate possibilities. The application of all three types of health literacy is expressed in: (i) developing appropriate health information tools for the public to be applied in primary, secondary and tertiary care settings, and in online and media information accessibility and appropriateness using culturally relevant participatory methods; (ii) training of health professionals at all levels, including undergraduate and in-service training; and (iii) developing and applying appropriate assessment and monitoring tools which include public/patient participatory methods. Health care providers need to consider where their patients are getting information on disease and self-management, whether or not that information is reliable, and inform their patients of the best sources of information and its use. The
Green, Robert L.
This book combines scholarship and personal experiences as several facets of the urban experience are investigated. Eight major chapters focus on poverty, unemployment, welfare, law enforcement, urban finance, housing, education, and health care. Each chapter examines each problem and provides recommendations for dealing with it. The chapter on…
Kim, Pilyoung; Bianco, Hannah
Poverty-associated chronic stress is a serious threat not only to a mother's mental health but also to maternal functioning. Recent neuroimaging studies suggest that a mother's brain undergoes dynamic changes to support her transition to parenthood, including better emotion regulation and heightened sensitivity to infants. However, we propose that…
Collins, Sandra K
The decisions and actions of health care managers are oftentimes heavily scrutinized by the public. Given the current economic climate, managers may feel intense pressure to produce higher results with fewer resources. This could inadvertently test their moral fortitude and their social consciousness. A study was conducted to determine what corporate social responsibility orientation and viewpoint future health care managers may hold. The results of the study indicate that future health care managers may hold patient care in high regard as opposed to profit maximization. However, the results of the study also show that future managers within the industry may continue to need rules, laws, regulations, and legal sanctions to guide their actions and behavior.
Owens, P. R.; Jambor, B. J.; Eger, G. W.; Clark, W. A.
System Health Management functionality is an essential part of any space launch system. Health management functionality is an integral part of mission reliability, since it is needed to verify the reliability before the mission starts. Health Management is also a key factor in life cycle cost reduction and in increasing system availability. The degree of coverage needed by the system and the degree of coverage made available at a reasonable cost are critical parameters of a successful design. These problems are not unique to the launch vehicle world. In particular, the Intelligent Vehicle Highway System, commercial aircraft systems, train systems, and many types of industrial production facilities require various degrees of system health management. In all of these applications, too, the designers must balance the benefits and costs of health management in order to optimize costs. The importance of an integrated system is emphasized. That is, we present the case for considering health management as an integral part of system design, rather than functionality to be added on at the end of the design process. The importance of maintaining the system viewpoint is discussed in making hardware and software tradeoffs and in arriving at design decisions. We describe an approach to determine the parameters to be monitored in any system health management application. This approach is based on Design of Experiments (DOE), prototyping, failure modes and effects analyses, cost modeling and discrete event simulation. The various computer-based tools that facilitate the approach are discussed. The approach described originally was used to develop a fault tolerant avionics architecture for launch vehicles that incorporated health management as an integral part of the system. Finally, we discuss generalizing the technique to apply it to other domains. Several illustrations are presented.
Jacobi, Wendy J.
In Pennsylvania, certified school nurses were governed by the same educational rules and administrative directives as teachers. School nurses were supervised and evaluated by non-nurse managers who had no knowledge of the scope of school nurse practice. A focus of the study was to examine the efficacy of management for school health programs. The…
Nakamura, Naoki; Nakayama, Masaharu; Nakaya, Jun; Tominaga, Teiji; Suganuma, Takuo; Shiratori, Norio
After the Great East Japan Earthquake we constructed a community health care information network system. Focusing on the authentication server and portal server capable of SAML&ID-WSF, we proposed an audit trail management system to look over audit events in a comprehensive manner. Through implementation and experimentation, we verified the effectiveness of our proposed audit trail management system.
Blevins, Amy E; Inman, Megan B
As distance education and blended learning grows, so does the need for health sciences librarians to become involved with course management systems. This article will provide some information on how to become involved with course management systems and will also provide information on a few of the more popular systems available.
Gilmartin, M J
In the era of technological proliferation the potential for the holistic intention and practice of nursing to become overshadowed is immense. This article presents an overview of the stakeholder theory of management as a useful and important management model for the creation of health care delivery environments where the human condition is celebrated, exemplary service is cultivated, and human caring becomes an enterprisewide value.
The effectiveness of health care systems in the developing world is related to the quality of their leadership and management, yet that factor has been neglected by academics and funders. Based on replicable existing models, the article proposes an approach to strengthening local management training institutions.
... AIDS more than women of other races include: Poverty — One in 4 African-American women lives in poverty, which is strongly linked to HIV risk. People living in poverty also get lower-quality health care in general, ...
Little is known about how Deaf people perceive, access, and utilize interpersonal and media sources for health information. In light of the scarcity of research on health information management among this group, a two-phase study was conducted that included eight focus groups (N=39) and survey data (N=366) with Deaf participants to determine the…
This paper intends to present the design and the production of a software for the Occupational Health and Safety Integrated Management System with the view to a rapid drawing up of the system documents in the field of occupational health and safety.
Office of Inspector General (DHHS), Washington, DC.
This report describes school-based health centers and their degree of coordination with managed care providers. Although the investigation focuses on adolescents, many ideas discussed here are germane to elementary school-based health centers as well. Information was gathered through an extensive literature review, relevant legislation, and 88…
Braun, Sharon A.; Cox, Jane A.
In this article, the authors provide an overview of the effectiveness of managed health care systems and their impact on mental health counselors. They review ethical and legal dilemmas involving informed consent, confidentiality, client autonomy, competence, treatment plans, and termination that had not existed prior to the introduction of…
Sommers, Benjamin D; Oellerich, Donald
Medicaid provides health insurance for 54 million Americans. Using the Census Bureau's Supplemental Poverty Measure (which subtracts out-of-pocket medical expenses from family resources), we estimated the impact of eliminating Medicaid. In our counterfactual, Medicaid beneficiaries would become uninsured or gain other insurance. Counterfactual medical expenditures were drawn stochastically from propensity-score-matched individuals without Medicaid. While this method captures the importance of risk protection, it likely underestimates Medicaid's impact due to unobserved differences between Medicaid and non-Medicaid individuals. Nonetheless, we find that Medicaid reduces out-of-pocket medical spending from $871 to $376 per beneficiary, and decreases poverty rates by 1.0% among children, 2.2% among disabled adults, and 0.7% among elderly individuals. When factoring in institutionalized populations, an additional 500,000 people were kept out of poverty. Overall, Medicaid kept at least 2.6 million-and as many as 3.4 million-out of poverty in 2010, making it the U.S.'s third largest anti-poverty program.
Sims, Mario; Sims, Tammy L.; Bruce, Marino A.
This study examined whether the relationship between high poverty and infant mortality rates (IMRs) varied across race- and ethnic-specific populations in large urban areas. Data were drawn from 1990 Census and 1992-1994 Vital Statistics for selected U.S. metropolitan areas. High-poverty areas were defined as neighborhoods in which > or = 40% of the families had incomes below the federal poverty threshold. Bivariate models showed that high poverty was a significant predictor of IMR for each group; however, multivariate analyses demonstrate that maternal health and regional factors explained most of the variance in the group-specific models of IMR. Additional analysis revealed that high poverty was significantly associated with minority-white IMR disparities, and country of origin is an important consideration for ethnic birth outcomes. Findings from this study provide a glimpse into the complexity associated with infant mortality in metropolitan areas because they suggest that the factors associated with infant mortality in urban areas vary by race and ethnicity. PMID:17444423
Sims, Mario; Sims, Tammy L; Bruce, Marino A
This study examined whether the relationship between high poverty and infant mortality rates (IMRs) varied across race- and ethnic-specific populations in large urban areas. Data were drawn from 1990 Census and 1992-1994 Vital Statistics for selected U.S. metropolitan areas. High-poverty areas were defined as neighborhoods in which > or = 40% of the families had incomes below the federal poverty threshold. Bivariate models showed that high poverty was a significant predictor of IMR for each group; however, multivariate analyses demonstrate that maternal health and regional factors explained most of the variance in the group-specific models of IMR. Additional analysis revealed that high poverty was significantly associated with minority-white IMR disparities, and country of origin is an important consideration for ethnic birth outcomes. Findings from this study provide a glimpse into the complexity associated with infant mortality in metropolitan areas because they suggest that the factors associated with infant mortality in urban areas vary by race and ethnicity.
Wurster, Cecil R.; Goodman, John D.
Various approaches to centralized support of computer applications in health care are described. The NIMH project to develop a prototype Management Information System (MIS) for community mental health centers is presented and discussed as a centralized development of an automated data processing system for multiple user organizations. The NIMH program is summarized, the prototype MIS is characterized, and steps taken to provide for the differing needs of the mental health centers are highlighted.
Fox, Liana E.; Wimer, Christopher; Garfinkel, Irwin; Kaushal, Neeraj; Waldfogel, Jane
Using data from the Consumer Expenditure Survey and the March Current Population Survey, we provide poverty estimates for 1967 to 2012 based on a historical Supplemental Poverty Measure (SPM). During this period, poverty, as officially measured, has stagnated. However, the official poverty measure (OPM) does not account for the effect of near-cash transfers on the financial resources available to families, an important omission since such transfers have become an increasingly important part of government anti-poverty policy. Applying the historical SPM, which does count such transfers, we find that trends in poverty have been more favorable than the OPM suggests and that government policies have played an important and growing role in reducing poverty—a role that is not evident when the OPM is used to assess poverty. We also find that government programs have played a particularly important role in alleviating child poverty and deep poverty, especially during economic downturns. PMID:26347369
Adamson, Sheena; Marich, Andrew; Roth, Ian
Zoonoses of public health significance may occur in wildlife, livestock or companion animals, and may be detected by the human or animal health sectors. Of particular public health interest are foodborne, arboviral and emerging zoonoses (known/unknown, endemic/exotic). A coordinated One Health approach to the management of zoonoses in NSW uses measures including: mutually agreed intersectoral procedures for detection and response; surveillance and notification systems for defined endemic and exotic diseases; joint meetings and exercises to ensure currency of response plans; and intersectoral communication during a response. This One Health approach is effective and ensures the interests of both the human health and animal health sectors are addressed.
Howard, Lisa M; Ceci, Christine
To address the growing costs associated with chronic illness care, many countries, both developed and developing, identify increased patient self-management or self-care as a focus of healthcare reform. Health coaching, an implementation strategy to support the shift to self-management, encourages patients to make lifestyle changes to improve the management of chronic illness. This practice differs from traditional models of health education because of the interactional dynamics between nurse and patient, and an orientation to care that ostensibly centres and empowers patients. The theoretical underpinnings of coaching reflect these differences, however in its application, the practices arranged around health coaching for chronic illness self-management reveal the social regulation and professional management of everyday life. This becomes especially problematic in contexts defined by economic constraint and government withdrawal from activities related to the 'care' of citizens. In this paper, we trace the development of health coaching as part of nursing practice and consider the implications of this practice as an emerging element of chronic illness self-management. Our purpose is to highlight health coaching as an approach intended to support patients with chronic illness and at the same time, problematize the tensions contained in (and by) this practice.
A health monitoring expert system software architecture has been developed to support condition-based health monitoring of rocket engines. Its first application is in the diagnosis decisions relating to the health of the high pressure oxidizer turbopump (HPOTP) of Space Shuttle Main Engine (SSME). The post test diagnostic system runs off-line, using as input the data recorded from hundreds of sensors, each running typically at rates of 25, 50, or .1 Hz. The system is invoked after a test has been completed, and produces an analysis and an organized graphical presentation of the data with important effects highlighted. The overall expert system architecture has been developed and documented so that expert modules analyzing other line replaceable units may easily be added. The architecture emphasizes modularity, reusability, and open system interfaces so that it may be used to analyze other engines as well.
Schuch, Gemma; Serrao-Neumann, Silvia; Choy, Darryl Low
Heatwaves kill more people than any other natural hazard in Australia. Current literature on managing health risks of heatwaves highlights the importance of implementing urban planning measures, and engaging with vulnerable groups on a local level to better understand perceptions of risk and tailor health protection measures. This paper reviews arrangements to reduce heatwave health risks in South East Queensland in response to these themes. A literature search and document analysis, stakeholder interviews, and multi-stakeholder cross-sectoral workshops revealed that although heatwave management is not always considered by local government and disaster management stakeholders, many urban planning measures to minimize urban heat have been pursued. However, greater information from vulnerable groups is still needed to better inform heatwave management measures. PMID:28229002
Barrêto, Anne Jaquelyne Roque; de Sá, Lenilde Duarte; Nogueira, Jordana de Almeida; Palha, Pedro Fredemir; Pinheiro, Patrícia Geórgia de Oliveira Diniz; de Farias, Nilma Maria Porto; Rodrigues, Débora Cezar de Souza; Villa, Tereza Cristina Scatena
The scope of this study was to analyze the discourse of managers regarding the relationship between the organization of the health services and tuberculosis care management in a city in the metropolitan region of João Pessoa, State of Pernambuco. Using qualitative research in the analytical field of the French line of Discourse Analysis, 16 health workers who worked as members of the management teams took part in the study. The transcribed testimonials were organized using Atlas.ti version 6.0 software. After detailed reading of the empirical material, an attempt was made to identify the paraphrasic, polyssemic and metaphoric processes in the discourses, which enabled identification of the following discourse formation: Organization of the health services and the relation with TB care management: theory and practice. In the discourse of the managers the fragmentation of the actions of control of tuberculosis, the lack of articulation between the services and sectors, the compliance of the specific activities for TB, as well as the lack of strategic planning for management of care of the disease are clearly revealed. In this respect, for the organization of the health services to be effective, it is necessary that tuberculosis be considered a priority and acknowledged as a social problem in the management agenda.
Sadoughi, Farahnaz; Shahi, Mehraban; Ahmadi, Maryam; Davaridolatabadi, Nasrin
Background: There are increasing change and development of information in healthcare systems. Given the increase in aging population, managers are in need of true and timely information when making decision. Objectives: The aim of this study was to investigate the current status of the health information management system for the elderly health sector in Iran. Materials and Methods: This qualitative study was conducted in two steps. In the first step, required documents for administrative managers were collected using the data gathering form and observed and reviewed by the researcher. In the second step, using an interview guide, the required information was gathered through interviewing experts and faculty members. The convenience, purposeful and snowball sampling methods were applied to select interviewees and the sampling continued until reaching the data saturation point. Finally, notes and interviews were transcribed and content analysis was used to analyze them. Results: The results of the study showed that there was a health information management system for the elderly health sector in Iran. However, in all primary health care centers the documentation of data was done manually; the data flow was not automated; and the analysis and reporting of data are also manually. Eventually, decision makers are provided with delayed information. Conclusions: It is suggested that the steward of health in Iran, the ministry of health, develops an appropriate infrastructure and finally puts a high priority on the implementation of the health information management system for elderly health sector in Iran. PMID:27186383
Ruoyan, Gai; Xu Lingzhong; Li Huijuan; Zhou Chengchao; He Jiangjiang; Yoshihisa, Shirayama; Tang Wei; Chushi, Kuroiwa
In China, national regulations and standards for health care waste management were implemented in 2003. To investigate the current status of health care waste management at different levels of health care facilities (HCF) after the implementation of these regulations, one tertiary hospital, one secondary hospital, and four primary health care centers from Binzhou District were visited and 145 medical staff members and 24 cleaning personnel were interviewed. Generated medical waste totaled 1.22, 0.77, and 1.17 kg/bed/day in tertiary, secondary, and primary HCF, respectively. The amount of medical waste generated in primary health care centers was much higher than that in secondary hospitals, which may be attributed to general waste being mixed with medical waste. This study found that the level of the HCF, responsibility for medical waste management in departments and wards, educational background and training experience can be factors that determine medical staff members' knowledge of health care waste management policy. Regular training programs and sufficient provision of protective measures are urgently needed to improve occupational safety for cleaning personnel. Financing and administrative monitoring by local authorities is needed to improve handling practices and the implementation of off-site centralized disposal in primary health care centers.
Joshi, Spruha; Mooney, Stephen J; Rundle, Andrew G; Quinn, James W; Beard, John R; Cerdá, Magdalena
The pathways through which neighborhood poverty can affect resident depression are still unknown. We investigated mechanisms through which neighborhood poverty may influence depression among older adults. Participants were drawn from the New York City Neighborhood and Mental Health in the Elderly Study II, a 3-wave study of adults aged 65-75 (n=3,497) at baseline. Neighborhood poverty and homicide were associated with depressive symptoms at follow-up waves (RR:1.20, 95%CI: 1.05, 1.36; RR: 1.09, 95%CI: 1.02, 1.17, respectively). Homicide accounted for 30% of the effect of neighborhood poverty on depressive symptoms. Neighborhood exposure to violence may be a key mechanism through which neighborhood poverty influences depression among older adults.
Mutter, J. C.
Poverty is not properly described solely in terms of economics. Certainly the billion people living on less than a dollar a day are the extreme poor and the two billion people who are living today on two dollars a day or less are poor also. One third of all humans live in poverty today. But poverty concerns deprivation - of good health, adequate nutrition, adequate education, properly paid employment, clean water, adequate housing and good sanitation. It is a fundamental denial of opportunity and a violation of basic human rights. Despite its prevalence and persistence of poverty and the attention given it by many scholars, the causes of poverty are not well understood and hence interventions to bring poor societies out of their condition often fail. One commonly missed component in the search for solutions to poverty is the fundamental co-dependence between the state of the Earth and the state of human well-being. These relationships, are compelling but often indirect and non-linear and sometimes deeply nuanced. They are also largely empirical in nature, lacking theory or models that describe the nature of the relationships. So while it is quite apparent that the poorest people are much more vulnerable than the rich to the Earths excesses and even to relatively small natural variations in places where the base conditions are poor, we do not presently know whether the recognized vulnerability is both an outcome of poverty and a contributing cause. Are societies poor, or held from development out of poverty because of their particular relationship to Earth's natural systems? Does how we live depend on where we live? Providing answers to these questions is one of the most fundamental research challenges of our time. That research lies in a domain squarely at the boundary between the natural and social sciences and cannot be answered by studies in either domain alone. What is clear even now, is that an understanding of the Earth gained from the natural sciences is
Chan, I Y S; Leung, M Y; Liu, A M M
Due to its direct impact on the safety and function of organizations, occupational health has been a concern of the construction industry for many years. The inherent complexity of occupational health management presents challenges that make a systems approach essential. From a systems perspective, health is conceptualized as an emergent property of a system in which processes operating at the individual and organizational level are inextricably connected. Based on the fundamental behavior-to-performance-to-outcome (B-P-O) theory of industrial/organizational psychology, this study presents the development of an I-CB-HP-O (Input-Coping Behaviors-Health Performance-Outcomes) health management systems model spanning individual and organizational boundaries. The model is based on a survey of Hong Kong expatriate construction professionals working in Mainland China. Such professionals tend to be under considerable stress due not only to an adverse work environment with dynamic tasks, but also the need to confront the cross-cultural issues arising from expatriation. A questionnaire was designed based on 6 focus groups involving 44 participants, and followed by a pilot study. Of the 500 questionnaires distributed in the main study, 137 valid returns were received, giving a response rate of 27.4%. The data were analyzed using statistical techniques such as factor analysis, reliability testing, Pearson correlation analysis, multiple regression modeling, and structural equation modeling. Theories of coping behaviors and health performance tend to focus on the isolated causal effects of single factors and/or posits the model at single, individual level; while industrial practices on health management tend to focus on organizational policy and training. By developing the I-CB-HP-O health management system, incorporating individual, interpersonal, and organizational perspectives, this study bridges the gap between theory and practice while providing empirical support for a
Avelino, George; Barberia, Lorena G; Biderman, Ciro
This study contributes to the health governance discussion by presenting a new data set that allows for comparisons of the management of health resources among Brazilian municipalities. Research on Brazil is particularly important as the provision of health services was decentralized in 1988 and since then municipalities have been given greater responsibilities for the management of fiscal resources for public health service provision. Based on detailed information on corruption practices (such as over-invoicing, illegal procurement and fake receipts) from audit reports of health programmes in 980 randomly selected Brazilian municipalities, this study deepens understanding of the relationship between health governance institutions and the incidence of corruption at the local level by exploring the extent to which horizontal and vertical accountabilities contribute to reducing the propensity of municipal government officials to divert public health resources for private gain. The results of our multiple regression analysis suggest that the experience of health municipal councils is correlated with reductions in the incidence of corruption in public health programmes. This impact is significant over time, with each additional year of health council experience reducing corruption incidence levels by 2.1% from baseline values. The findings reported in this study do not rely on the subjectivity of corruption measures which usually conflate the actual incidence of corruption with its perception by informants. Based on our results, we provide recommendations that can assist policy makers to reduce corruption.
Rice, Kerrilynn G; Jumamil, Riana B; Jabour, Sarah M; Cheng, Jennifer Kimberly
This study aims to describe patients' and families' perspectives regarding the ideal role and responsibilities of a health coach to facilitate pediatric weight management in the primary care setting. Systematic thematic analysis of semistructured interviews with overweight children and their parents was performed. The majority of participants self-identified as racial/ethnic minorities and were Medicaid eligible. Desired health coaching elements included ( a) customized support and encouragement, including goal setting and maintenance, cultural sensitivity, and consideration of budget and lifestyle; ( b) nutritional guidance, including meal planning, assistance obtaining healthy food, and education and counseling; and ( c) linkage to resources, including social services, physical activity support, and programs for children with special health care needs. We conclude that families' specific needs should be holistically considered in the design of health coaching programs targeting pediatric obesity. Such support may help overcome social and financial barriers to changing health behaviors related to weight management.
During World War II Mexican and US health professionals and organizations constructed a transnational organizational field to manage the border's public health problems. Despite barriers to inter-organizational cooperation, including disparate administrative structures and North-South stratification, the field's transnational approach to health on the border has continued for 60 years. Using archival data to track changes in the number and types of organizations, this article argues that the field practitioners call "border health" reconfigured during the North American Free Trade Association (NAFTA) decade from an era of loosely organized professionals to a specialized bureaucracies era. This change brought new vitality to border health, with transnational ties increasing and diversifying, but has not weakened entrenched cross-border inequalities. The organizational history of the US-Mexico border health field demonstrates how macro-politics and inter-organizational stratification shape transnational public health problems.
Ribeiro, Cléa Regina de Oliveira; Zoboli, Elma Lourdes Campos Pavone
The article presents a reflection on conception of poverty as a condition or circumstance that restricts personal autonomy and increases vulnerability. Focusing on bioethical arguments, the authors discuss two perspectives: (i) economic, that relates poverty to incapacity to work and (ii) ethical-philosophical, which relates poverty to inequality and injustice. The first perspective corresponds to the World Bank's view according to its recommendations to the political and economic adjustment in Latin America. The second one is based on concepts of fairness and equality as components of social justice. The subjects' autonomy and vulnerability have been under question in an international movement that requests revision of ethical guidelines for the biomedical research. The bioethical arguments presented in this article enhance a discussion on unfair treatment to subjects enlisted in protocols sponsored by rich countries and hosted by poor nations.
Mullins, C Daniel; Lavallee, Danielle Chauncey; Pradel, Françoise G; DeVries, Andrea R; Caputo, Nadine
Balancing increased spending for specialty pharmaceuticals while providing affordable and equitable coverage for consumers is a key issue for public and private payers. Health plans rely on an array of strategies, including both medical management and those used for more traditional pharmaceuticals. To explore specific management strategies for outpatient specialty pharmaceuticals, a survey was administered to thirty-eight Blue Cross and Blue Shield plans, focused on identifying core strategies. Prior authorization was the most commonly used strategy, implemented by 83.3 percent of respondents. Other frequently implemented management strategies included claims review (82.8 percent), formulary management (76.7 percent), and utilization review (70 percent).
Venkatesh, Meera; Kapadia, Ravi; Walker, Mark; Wilkins, Kim
A framework of software components has been implemented to facilitate the development of ISHM systems according to a methodology based on Reliability Centered Maintenance (RCM). This framework is collectively referred to as the Toolkit and was developed using General Atomics' Health MAP (TM) technology. The toolkit is intended to provide assistance to software developers of mission-critical system health monitoring applications in the specification, implementation, configuration, and deployment of such applications. In addition to software tools designed to facilitate these objectives, the toolkit also provides direction to software developers in accordance with an ISHM specification and development methodology. The development tools are based on an RCM approach for the development of ISHM systems. This approach focuses on defining, detecting, and predicting the likelihood of system functional failures and their undesirable consequences.
The links between rapid population growth and the absolute poverty currently affecting 780 million people in the developing countries (excluding China and other centrally planned economies) were examined. Absolute poverty is defined as having less than the income necessary to ensure a daily diet of 2150 calories per person ($200 per person a year in 1970 United States dollars). Focus is on poverty and demography in the developing world (defining poverty; income, fertility and life expectancy; demographic change and poverty), effect of poverty on fertility, family planning programs and the poor, and the outlook for the future. Rapid population growth stretches both national and family budgets thin with the increasing numbers of children to be fed and educated and workers to be provided with jobs. Slower per capita income growth, lack of progress in reducing income inequality, and more poverty are the probable consequences. Many characteristics of poverty can cause high fertility -- high infant mortality, lack of education for women in particular, too little family income to invest in children, inequitable shares in national income, and the inaccessibility of family planning. Experience in China, Indonesia, Taiwan, Colombia, Korea, Sri Lanka, Cuba and Costa Rica demonstrate that birthrates can decline rapidly in low income groups and countries when basic health care, education, and low-cost or free family planning services are made widely available.
The link between high fertility and poverty is well established. However, this paper shows how infertility may also generate poverty among childless families in Bangladesh. An ethnographic study was conducted, involving various qualitative research methods that revealed economic consequences to be one of the crucial sequelae of childlessness in Bangladesh. This paper details how the poverty/fertility relationship is dependent on social and institutional characteristics, including patriarchal values, education, urban-rural location and health services. Empirical data show that childlessness generates poverty in various ways, including the deprivation of children's earnings, decline in women's mobility, demoralisation of men to earn an income, marriage devaluation by the husband, disbursements for treatment and denial of microcredit (very small loans to those in poverty, which support them to become self-employed to generate income). The current study shows that the infertility/poverty relationship is mostly contingent upon class and gender. It is therefore the rural poor childless women who are most badly affected economically in Bangladesh rather than the urban middle class childless women. In other words, this study reveal that along with gender, class plays a dominant role in terms of the economic consequences of childlessness in Bangladesh. It sheds light on a different and unusual aspect of poverty and aims to contribute to the gender discussion of livelihood and poverty.
Cannas da Silva, J; Noordhuizen, J P T M; Vagneur, M; Bexiga, R; Gelfert, C C; Baumgartner, W
The nature of veterinary work in dairy health management in Europe has changed over the past years and will change even more dramatically in the near future. The consumers and the media show increasing concern about animal welfare, safety of products of animal origin and traceability of animal products. Farmers in Europe have to produce under strict, often expensive and laborious regulations, while still commercially competing with farmers outside the EU and not subject to the same rules. Veterinarians should adapt their knowledge and skills to the new challenges and developments of the dairy sector. Dairy farmers nowadays ask for support in areas that go beyond clinical activities: environmental protection, welfare, nutrition, grassland management, economics and business management. Bovine practitioners should be able to advise in many different areas and subjects--that is the challenge to our profession. Veterinary education with regards to cattle health management should start with individual animal clinical work, which constitutes the basis of herd health advisory programmes. The bovine practitioner should then look beyond that and regard the herd as the unit. Each diseased cow or group of cows should be detected early enough to avoid financial losses or such losses should be prevented altogether by detecting and managing risk factors contributing to disease occurrence. Herd health and production management programmes represent the first level to optimise dairy farm performance. Expansions to that should further be considered, comprising both animal health and welfare issues, as well as food safety and public health issues. The latter could be addressed by quality risk management programmes following the HACCP-principles. Cattle veterinarians should follow recent developments and invest in new skills and knowledge in order to maintain their usefulness to the modern dairy farmer. Finally we are convinced that the cattle practitioner should evolve into this
Kobza, Joanna; Syrkiewicz-Świtała, Magdalena
Time-based management (TBM) is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms). Over the past two decades a systematic review of Polish literature (since 1990) and peer reviewed articles published in international journals based on PubMed/Medline (2001-2011) have been carried out. The collected results indicate that the demographic and health changes in the populations are one of the main challenges facing general practitioners in the nearest future. Time-based management needs new and effective tools and skills, i.e., identification of priorities, well designed planning, delegation of the tasks, proper coordination, and creation of primary care teams that include additional members and human resources management. Proper reimbursement of health services, development of IT in health care system, better collection, storage, processing, analysis and exchange of information and research findings will also be needed. The use of innovative technologies, like telemedicine consultations, provides the possibility of reducing waiting time for diagnosis and treatment and in some cases could be applied in terms of secondary care. To improve the efficiency of operating rooms it is necessary to introduce different solutions, such as operating room coordinator involvement, application of automation to guide decision-making or use of robotic tools to assist surgical procedures. Overcrowded emergency departments have a major detrimental effect on the quality of hospital functions, therefore, efforts should be made to reduce them. Time-based management training among physicians and health care management in Poland, as well as the implementation of practice-based solutions still applied in highly developed countries seem to be necessary.
Antoun, Joseph; Phillips, Frank; Johnson, Tricia
During the post-Soviet transition of the last 2 decades, ex-Communist countries of the Eastern Bloc, including eastern and central Europe, the Soviet Union, and its satellite and aligned states, have undergone major health system reforms. Many health systems of those countries--previously adopting a Soviet-type Semashko model--are currently called "in transition," as reform agendas, such as shifting to a Bismarck, Beveridge, or mixed financing scheme or adopting new health delivery management policies, are still in development. In this article, we first review common characteristics of Semashko health systems (the predominant health system of Communist countries during the Soviet era) and then discuss the "new public management" principles that ex-Communist countries have recently started to adopt with various degrees of success. We then illustrate experiences with these principles using 2 case studies, from Russia and Albania, and propose health policy options for both cases. Based on a review of the literature and on the our work experience in Russia and Albania, we found that the 2 ex-Semashko systems have not fully capitalized on expected positive outcomes of new public management principles due to low local healthcare financing levels, depreciated healthcare infrastructure and operational capacities, overlapping and contradicting ideology and policies of the former and newer health systems, and finally, lack of leadership that has successful experience with these principles. In the case of pharmaceutical pricing, reimbursement, and access in Russia, we show how a well-intentioned but suboptimally designed and managed pharmaceutical coverage scheme has suffered moral hazard and adverse selection and has adversely impacted the new public management promise of efficient medicine coverage. In the case of Albania, the delayed investment in human resource reform within a depreciated and underfinanced delivery system has adversely affected the implementation of new
Wang, Liang; Xu, Xiaowen; Zhang, Yan; Hao, Hongxia; Chen, Liying; Su, Tianjiao; Zhang, Yan; Ma, Weifeng; Xie, Yuanyuan; Wang, Tiantian; Yang, Fan; He, Li; Wang, Wenjiao; Fu, Xuemei; Ma, Yuanzheng
Osteoporosis, a chronic disease with no therapeutic cure, affects a growing number of people as the aging population in China rapidly increases. Therefore, developing an evidence-based model of health education and management for osteoporosis prevention is required. In the present study, an osteoporosis club was established, which is a novel model of health education and management for osteoporosis prevention. A unified management of membership was used based on a digitized database. A total of 436 patients with osteoporosis were randomly assigned to the osteoporosis club group or the self-management control group. For the osteoporosis club group, multiple activities of health education were performed, including monthly systematic health education lectures, exercise programs and communication parties once a year. For the control group, the participants took charge of their own musculoskeletal health. All data of the participants were collected and evaluated prior to and following intervention. In the pre-intervention assessment, no significant difference was identified in the health education between the two groups. Through the four-year intervention, the osteoporosis knowledge, health beliefs, living behavior, medication compliance, quality of life and bone mineral density of the osteoporosis club group were improved significantly compared with the control group (P<0.001), while the pain degree of the osteoporosis club group was relieved significantly more compared with the control group (P<0.001). The results in the present study suggest that setting up an osteoporosis club is an evidence-based model of health education and management for osteoporosis prevention in China. PMID:28105113
Jardine, Cindy; Hrudey, Steve; Shortreed, John; Craig, Lorraine; Krewski, Daniel; Furgal, Chris; McColl, Stephen
A comprehensive analytical review of the risk assessment, risk management, and risk communication approaches currently being undertaken by key national, provincial/state, territorial, and international agencies was conducted. The information acquired for review was used to identify the differences, commonalities, strengths, and weaknesses among the various approaches, and to identify elements that should be included in an effective, current, and comprehensive approach applicable to environmental, human health and occupational health risks. More than 80 agencies, organizations, and advisory councils, encompassing more than 100 risk documents, were examined during the period from February 2000 until November 2002. An overview was made of the most important general frameworks for risk assessment, risk management, and risk communication for human health and ecological risk, and for occupational health risk. In addition, frameworks for specific applications were reviewed and summarized, including those for (1)contaminated sites; (2) northern contaminants; (3) priority substances; (4) standards development; (5) food safety; (6) medical devices; (7) prescription drug use; (8) emergency response; (9) transportation; (10) risk communication. Twelve frameworks were selected for more extensive review on the basis of representation of the areas of human health, ecological, and occupational health risk; relevance to Canadian risk management needs; representation of comprehensive and well-defined approaches; generalizability with their risk areas; representation of "state of the art" in Canada, the United States, and/or internationally; and extent of usage of potential usage within Canada. These 12 frameworks were: 1. Framework for Environmental Health Risk Management (US Presidential/Congressional Commission on Risk Assessment and Risk Management, 1997). 2. Health Risk Determination: The Challenge of Health Protection (Health and Welfare Canada, 1990). 3. Health Canada Decision
Social Education, 1997
Summarizes the global efforts of the United Nations Development Program (UNDP) to ease poverty and help developing nations to build their capacity for sustainable development. Includes a glossary of poverty and human development terms, a human poverty index ranking for developing countries, and suggested teaching activities. (MJP)
Samaras, Anastasia P.
Discusses the importance of developing curricular initiatives that educate students on the major facts and issues associated with poverty in America. Provides key poverty statistics and highlights useful Internet resources that offer resource lists, success stories, relevant press releases, and curriculum guides. For example, the PovertyUSA Web…
Tichy, N M; Taylor, J I
This article presents the case of Dr. Martin Luther King Jr. Health Center's unique community management system in which neighborhood workers have been developed to assume managerial responsibilities and are directing the Center. The Martin Luther King Center experience is instructive because the Center was able to achieve significant community control by focusing primarily on the internal dimension of control, namely, management, without experiencing destructive conflicts and the deterioration of health services.
In responding to resistance to change in the current health care organization, the new female supervisor can learn to support her staff in encountering and accepting these changes. The strategies and skills discussed above are characteristic of a supervisory style that may naturally occur for women, but also can be incorporated into the leadership style of men in health care management today. Health care leaders of tomorrow must work from an androgynous framework in which the behavior patterns and responses of each gender are learned and used appropriately by both men and women. Sargent suggests that the best managers are androgynous and that this is the inevitable wave of the future. Whether man or woman, a supervisor should learn, accept, and use methods that are characteristic of both sexes to be successful in managing people. Women and men must learn from each other's strengths and share these diverse skills. Given that women now outnumber men in health care management positions and organizations are changing to a more nurturing environment, the androgynous supervisor will be the successful leader of the future. Finally, women in health care supervisory positions have the potential to bring change where it is badly needed. Women in these roles often have a system wide view of health care policy issues that recognizes less federal commitment to social programs. Many women in health care positions believe that the issues of children, women, the elderly, the poor, and the homeless need focused attention. The growing number of women in health care supervisory and leadership roles is an important factor in changing national health policy for the benefit of these groups.(ABSTRACT TRUNCATED AT 250 WORDS)
dos Santos, Adriano Maia; Giovanella, Ligia
OBJECTIVE To analyze the regional governance of the health systemin relation to management strategies and disputes. METHODOLOGICAL PROCEDURES A qualitative study with health managers from 19 municipalities in the health region of Bahia, Northeastern Brazil. Data were drawn from 17 semi-structured interviews of state, regional, and municipal health policymakers and managers; a focus group; observations of the regional interagency committee; and documents in 2012. The political-institutional and the organizational components were analyzed in the light of dialectical hermeneutics. RESULTS The regional interagency committee is the chief regional governance strategy/component and functions as a strategic tool for strengthening governance. It brings together a diversity of members responsible for decision making in the healthcare territories, who need to negotiate the allocation of funding and the distribution of facilities for common use in the region. The high turnover of health secretaries, their lack of autonomy from the local executive decisions, inadequate technical training to exercise their function, and the influence of party politics on decision making stand as obstacles to the regional interagency committee’s permeability to social demands. Funding is insufficient to enable the fulfillment of the officially integrated agreed-upon program or to boost public supply by the system, requiring that public managers procure services from the private market at values higher than the national health service price schedule (Brazilian Unified Health System Table). The study determined that “facilitators” under contract to health departments accelerated access to specialized (diagnostic, therapeutic and/or surgical) services in other municipalities by direct payment to physicians for procedure costs already covered by the Brazilian Unified Health System. CONCLUSIONS The characteristics identified a regionalized system with a conflictive pattern of governance and
Mercer, Carolyn R.; Simon, Donald L.; Hunter, Gary W.; Arnold, Steven M.; Reveley, Mary S.; Anderson, Lynn M.
Integrated vehicle health management technologies promise to dramatically improve the safety of commercial aircraft by reducing system and component failures as causal and contributing factors in aircraft accidents. To realize this promise, fundamental technology development is needed to produce reliable health management components. These components include diagnostic and prognostic algorithms, physics-based and data-driven lifing and failure models, sensors, and a sensor infrastructure including wireless communications, power scavenging, and electronics. In addition, system assessment methods are needed to effectively prioritize development efforts. Development work is needed throughout the vehicle, but particular challenges are presented by the hot, rotating environment of the propulsion system. This presentation describes current work in the field of health management technologies for propulsion systems for commercial aviation.
Klasnja, Predrag; Hartzler, Andrea; Powell, Christopher; Pratt, Wanda
Cancer patients often need to manage care-related information when they are away from home, when they are experiencing pain or treatment side effects, or when their abilities to deal with information effectively are otherwise impaired. In this paper, we describe the results from a four-week evaluation of HealthWeaver Mobile, a mobile phone application that we developed to support such “unanchored” patient information activities. Based on experiences from nine cancer patients, our results indicate that HealthWeaver Mobile can help patients to access care-related information from anywhere, to capture information whenever a need arises, and to share information with clinicians during clinic visits. The enhanced ability to manage information, in turn, helps patients to manage their care and to feel more confident in their ability to stay in control of their information and their health. PMID:22195130
Greenley, J R
Fragmented and often uncoordinated public services for the more severely mentally ill are often characteristic of the current U.S. mental health system. The creation of local mental health authorities has been promoted as part of a solution, as has happened in Wisconsin at the county level and is championed in the ongoing Robert Wood Johnson Foundation funded innovative service sites for severely mentally ill adults. There are indications that these innovative mental health authorities will fall short of fulfilling their promise. Basic principles from the management and organizations literature are used to identify several organization and management issues that may have been neglected. These include resource management, attention to system goals, monitoring and feedback, and the promotion of desirable interorganizational cultures.
Wimer, Christopher; Nam, JaeHyun; Waldfogel, Jane; Fox, Liana
The official measure of poverty has been used to assess trends in children's poverty rates for many decades. But because of flaws in official poverty statistics, these basic trends have the potential to be misleading. We use an augmented Current Population Survey data set that calculates an improved measure of poverty to reexamine child poverty rates between 1967 and 2012. This measure, the Anchored Supplemental Poverty Measure, is based partially on the US Census Bureau and Bureau of Labor Statistics' new Supplemental Poverty Measure. We focus on 3 age groups of children, those aged 0 to 5, 6 to 11, and 12 to 17 years. Young children have the highest poverty rates, both historically and today. However, among all age groups, long-term poverty trends have been more favorable than official statistics would suggest. This is entirely due to the effect of counting resources from government policies and programs, which have reduced poverty rates substantially for children of all ages. However, despite this progress, considerable disparities in the risk of poverty continue to exist by education level and family structure.
Sidorov, Aleksandr I.; Beregovaya, Irina B.; Khanzhina, Olga A.
The article deals with the issues on economic techniques of occupational health and safety management. Authors’ definition of safety management is given. It is represented as a task-oriented process to identify, establish and maintain such a state of work environment in which there are no possible effects of hazardous and harmful factors, or their influence does not go beyond certain limits. It was noted that management techniques that are the part of the control mechanism, are divided into administrative, organizational and administrative, social and psychological and economic. The economic management techniques are proposed to be classified depending on the management subject, management object, in relation to an enterprise environment, depending on a control action. Technoeconomic study, feasibility study, planning, financial incentives, preferential crediting of enterprises, pricing, profit sharing and equity, preferential tax treatment for enterprises, economic regulations and standards setting have been distinguished as economic techniques.
Brand, Helmut; Schröder, Peter; Davies, John K; Escamilla, Ixhel; Hall, Caroline; Hickey, Kieran; Jelastopulu, Eleni; Mechtler, Reli; Yared, Wendy Tse; Volf, Jaroslav; Weihrauch, Birgit
This paper presents reference frameworks which order effective and feasible policies and interventions for the health management of measles, breast cancer and diabetes (type II). These reference frameworks can be used to rapidly appraise regional health policy documents and existing health management systems. Furthermore, the reference frameworks can serve health policy makers for the planning of health management measures.
The American Academy of Pediatrics recommends that chemical-management policy in the United States be revised to protect children and pregnant women and to better protect other populations. The Toxic Substance Control Act (TSCA) was passed in 1976. It is widely recognized to have been ineffective in protecting children, pregnant women, and the general population from hazardous chemicals in the marketplace. It does not take into account the special vulnerabilities of children in attempting to protect the population from chemical hazards. Its processes are so cumbersome that in its more than 30 years of existence, the TSCA has been used to regulate only 5 chemicals or chemical classes of the tens of thousands of chemicals that are in commerce. Under the TSCA, chemical companies have no responsibility to perform premarket testing or postmarket follow-up of the products that they produce; in fact, the TSCA contains disincentives for the companies to produce such data. Voluntary programs have been inadequate in resolving problems. Therefore, chemical-management policy needs to be rewritten in the United States. Manufacturers must be responsible for developing information about chemicals before marketing. The US Environmental Protection Agency must have the authority to demand additional safety data about a chemical and to limit or stop the marketing of a chemical when there is a high degree of suspicion that the chemical might be harmful to children, pregnant women, or other populations.
Palazuelos, Daniel; Payne, Jonathan D; Dalal, Anuj K
Across the globe, the ways in which patients' test results are managed are as varied as the many different types of healthcare systems that manage these data. The outcomes, however, are often not too dissimilar: too many clinically significant test results fall through the cracks. The consequences of not following up test results in a timely manner are serious and often devastating to patients: diagnoses are delayed, treatments are not initiated or altered in time, and diseases progress. In resource-poor settings, test results too commonly get filed away within the paper chart in ways that isolate them and prevent passage to future providers caring for a patient. To make matters worse, the onus to act upon these test results often rests on patients who need to return to the clinic within a specified timeframe in order to obtain their results but who may not have the means or are too ill to do so. Even in more developed healthcare settings that use electronic records, clinical data residing in the electronic medical record (EMR) are often stubbornly "static"-key pieces of clinical information are frequently not recognized, retrieved, or shared easily. In this way, EMRs are not unlike paper record systems, and therefore, EMRs alone will not solve this problem. To illustrate this problem, consider the case of a patient newly diagnosed with HIV in 3 different healthcare delivery settings.
Moen, Anne; Brennan, Patricia Flatley
Objective: Contemporary health care places enormous health information management demands on laypeople. Insights into their skills and habits complements current developments in consumer health innovations, including personal health records. Using a five-element human factors model of work, health information management in the household (HIMH) is characterized by the tasks completed by individuals within household organizations, using certain tools and technologies in a given physical environment. Design: We conducted a descriptive-exploratory study of the work of HIMH, involving 49 community-dwelling volunteers from a rural Midwestern community. Measurements: During in-person interviews, we collected data using semistructured questionnaires and photographs of artifacts used for HIMH. Results: The work of HIMH is largely the responsibility of a single individual, primarily engaged in the tasks of acquiring, managing, and organizing a diverse set of health information. Paper-based tools are most common, and residents develop strategies for storing information in the household environment aligned with anticipated use. Affiliative relationships, e.g., parent-child or spousal, within the household serve as the organization that gives rise to health information management practices. Synthesis of these findings led to identification of several storage strategies employed in HIMH. These strategies are labeled “just-in-time,” “just-because,” “just-in-case,” and “just-at-hand,” reflecting location of the artifacts of health information and anticipated urgency in the need to retrieve it. Conclusion: Laypeople develop and employ robust, complex strategies for managing health information in the home. Capitalizing on these strategies will complement and extend current consumer health innovations to provide functional support to people who face increasing demands to manage personal health information. PMID:16049230
Lombardi, D N
Fifteen years ago, Bill Gates was a college dropout working for a four-member, fledgling company in New Mexico. Today, he is the richest man in America and the head of perhaps the most powerful company in recent corporate history. Ten years ago, managed health care was merely a concept discussed in academic and industry observer circles. Now it is a norm in almost every health-care organization nationally. Five years ago, health-care professionals in every discipline believed the maxim that, ¿as long as people get sick, health-care professionals will have jobs.¿ In 1995, health-care executives have alternately referred to the widescale process of laying off employees as reengineering, rightsizing, downsizing, or RIF (reduction in force). With this massive amount of change, both societally and professionally, health-care managers have been contending with the change management process. Although a breadth of concepts borrowed from other industries and a plethora of conceptual practicums have entered the health-care educational realm, a straightforward, immediately useful approach to managing change is probably more beneficial, as the need to manage change quickly and effectively becomes the paramount criterion for health-care management success in the second half of this decade of change. In this article we will explore the four areas where mistakes are made most frequently by leaders in the change process, and we will provide specific strategies to not only avoid these mistakes but moreover reduce resistance to change, activate positive action, and ultimately improve performance through optimum staff contribution. The four critical areas we will explore are the reasons for resistance to change, the management of the proactive phase of change, creating staff interdependence, and key leadership roles for change management.
Consumer health informatics (CHI) is propelling important changes for medical providers and the lives of patients through information and communications technology. Independently, medical consumers seek, collect, and use health information for decision making. However, when constructing a CHI-based medical platform, high technology must be applied in a fully understandable and usable format for both health care providers and consumers. This study examines the present status of CHI and its effect on medical consumers. For the development of CHI, we discuss the need for tailored health communications and capacity building with chronic patients at the medical center. First, empowerment is a key characteristic needed for medical consumer health care management. However, promoting patient self-care management of illnesses and health is necessary to create conjugation where cooperation with medical service providers is possible. Also, establishing a health care delivery system that will support cooperation is necessary. Second, tailored health communications can uniquely construct the health information of patients, which prevents unnecessary or excessive information from leading patients to confused and inappropriate decisions. Ultimately, through the present environment of health communication, the innovation of a consumer health care information system has become the tide of the times and the positive effect of improved health can be expected.
Health systems, particularly those in low- and middle-income countries (LMICs), need stronger management and leadership capacities. Management and leadership are not synonymous, yet should be considered together as there can be too much of one and not enough of the other. In complex adaptive health systems, the multiple interactions and relationships between people and elements of the system mean that management and leadership, so often treated as domains of the individual, are additionally systemic phenomena, emerging from these relational interactions. This brief commentary notes some significant implications for how we can support capacity strengthening interventions for complex management and leadership. These would necessarily move away from competency-based models focused on training for individuals, and would rather encompass longer-term initiatives explicitly focused on systemic goals of accountability, innovation, and learning. PMID:26673472
Siordia, Carlos; Saenz, Joseph; Tom, Sarah E.
Type II diabetes is a growing health problem in the United States. Understanding geographic variation in diabetes prevalence will inform where resources for management and prevention should be allocated. Investigations of the correlates of diabetes prevalence have largely ignored how spatial nonstationarity might play a role in the macro-level distribution of diabetes. This paper introduces the reader to the concept of spatial nonstationarity—variance in statistical relationships as a function of geographical location. Since spatial nonstationarity means different predictors can have varying effects on model outcomes, we make use of a geographically weighed regression to calculate correlates of diabetes as a function of geographic location. By doing so, we demonstrate an exploratory example in which the diabetes-poverty macro-level statistical relationship varies as a function of location. In particular, we provide evidence that when predicting macro-level diabetes prevalence, poverty is not always positively associated with diabetes PMID:25414731
... AGENCY Best Management Practices for Unused Pharmaceuticals at Health Care Facilities AGENCY... guidance document entitled, Best Management Practices for Unused Pharmaceuticals at Health Care Facilities... been studying unused pharmaceutical disposal practices at health care facilities, prompted by...
Commonwealth Fund, New York, NY.
This report focuses on strategies documented by the Commonwealth Fund Task Force on Academic Health Centers (AHCs) concerning AHCs' management of patient care and research missions. Whatever challenges AHCs face in the future, their ability to respond effectively will be determined by the quality of their governance and management. To improve…
Bates, Percy; And Others
Equity does not require that everyone have the same amount of resources to satisfy basic needs, but it does require that each of us be able to live decently. The articles in this issue focus on poverty and its effects on children, particularly with respect to education and the ability to learn. The following articles are included: (1) "Poor Kids…
Chafel, Judith A., Ed.
This collection documents how far we still are in the United States from putting our knowledge about child well being and policy into practice. It provides an overview of the changing nature of child poverty in the United States through the contributions of authors who use a number of qualitative and quantitative approaches to look at children in…
An intellectual deficit is known to exist in populations where extreme poverty is rife and is thus seen extensively in the lower socio-economic strata of underdeveloped nations. Poverty is a complex entity whose sociological and economic indicators often bear little relevance to the biological agents which can affect the central nervous system. An attempt is made to express poverty in terms of identifiable defects, physiological in nature. Thus adverse socio-economic factors are converted into specific biological entities which, though necessary for adequate development of the brain, are restricted where there is poverty. A number of causative deficiencies, including nutritional, visual, auditory, tactile, vestibular, affective, and other stimuli are postulated. These interact and potentiate one another. Each is capable of an independent action on the brain and examples are given of some sensory deprivations as well as malnutrition and their possible mechanism of action. If the various deficiencies can independently harm the brain, then a number of separate specific functions should be affected; examples are offered. The nature of this intellectual deficit is probably a non-fulfillment of genetic potential of certain specific functions of the brain, which may exhibit limited variations between one community and another, depending on cultural differences. The deleterious effect of this intellectual impairment is seen most clearly in figures of school desertion, for example in Latin America. Analogous data for adults is scarce.
THE POVERTY SYNDROME IS A COMBINATION OF MANY NEGATIVE FACTORS, AMONG WHICH ARE LOW INCOME AND ABSENCE OF FAMILY LIFE. THE EROSION OF FAMILY LIFE IN MANY POOR FAMILIES IS DUE LESS TO A LACK OF RECOGNITION AND AFFIRMATION OF SO-CALLED MIDDLE-CLASS VALUES, THAN TO THE INABILITY TO SUPPORT THESE VALUES. BEHAVIOR OF THE BULK OF POOR FAMILIES APPEARS…
The paradoxical existence of poverty amidst rapid economic growth in the United States is discussed. The problem is considered in terms of average... income levels; adjustments required in view of technological progrrress, production raates, and supply aand demand; and prospects for the future educational needs of skilled and unskilled laborers.
Leone, Bruno, Ed.
Books in the Opposing Viewpoints Series present debates about current issues that can be used to teach critical reading and thinking skills. The varied opinions in each collection explore aspects of a social, cultural, or political issue. A great deal of money has been spent in this country to eradicate poverty, but the problem remains. Some…
Schwartz, Richard H.
Geography teachers can use mathematics to teach fourth, fifth, and sixth grade students about critical global issues. Five sample problems concerning population, poverty, waste, the arms race, and hunger are presented. The global issue related to each problem is discussed, and the solution and mathematical skill are provided. (RM)
Mullen, Carol A.; Kealy, William A.
What are acute poverty challenges for culturally disadvantaged school communities across the United States? How do practicing teacher-researchers, pursuing advanced degrees, view this issue and the 21st century skills and dispositions classroom teachers need to foster change? Curious about this topic from the viewpoints of teachers who are…
Wilson, L.; Spruill, J.; Hong, Y.
In this Proof of Concept analysis on SSFF Health Management the following area was described: the Gas Distribution Subsystem (GDS) was studied and evaluated utilizing the PDR Configuration and with respect to the design features encompassing Health Management (HM) aspects outlined in the Generic Handbook. From the results of this study, it was found that there is a definite need for coordinating measurements within and between the subsystems that will ensure that Functional Failures are properly revealed and substantiated as valid by other measurements, even those from other interfacing subsystems.
Bickford, R. L.
Fault detection and isolation for advanced rocket engine controllers are discussed focusing on advanced sensing systems and software which significantly improve component failure detection for engine safety and health management. Aerojet's Space Transportation Main Engine controller for the National Launch System is the state of the art in fault tolerant engine avionics. Health management systems provide high levels of automated fault coverage and significantly improve vehicle delivered reliability and lower preflight operations costs. Key technologies, including the sensor data validation algorithms and flight capable spectrometers, have been demonstrated in ground applications and are found to be suitable for bridging programs into flight applications.
Qiu, Xiao Ling
Business education has been booming in China due to the increasing demand of business graduates since China's economic reform. Chinese health care professionals are eager for business education to improve their competencies. The purpose of the study was to investigate the determinants of a successful health care management program for Chinese…
Omaswa, F.; Burnham, G.; Baingana, G.; Mwebesa, H.; Morrow, R.
In 1994, a national quality assurance programme was established in Uganda to strengthen district-level management of primary health care services. Within 18 months both objective and subjective improvements in the quality of services had been observed. In the examples documented here, there was a major reduction in maternal mortality among pregnant women referred to Jinja District Hospital, a reduction in waiting times and increased patient satisfaction at Masaka District Hospital, and a marked reduction in reported cases of measles in Arua District. Beyond these quantitative improvements, increased morale of district health team members, improved satisfaction among patients, and greater involvement of local government in the decisions of district health committees have been observed. At the central level, the increased coordination of activities has led to new guidelines for financial management and the procurement of supplies. District quality management workshops followed up by regular support visits from the Ministry of Health headquarters have led to a greater understanding by central staff of the issues faced at the district level. The quality assurance programme has also fostered improved coordination among national disease-control programmes. Difficulties encountered at the central level have included delays in carrying out district support visits and the failure to provide appropriate support. At the district level, some health teams tackled problems over which they had little control or which were overly complex; others lacked the management capacity for problem solving. PMID:9185368
Dixon, Brian E; Samarth, Anita; Starmer, Jack
Technology can be used effectively to improve chronic disease management, impacting health care costs, safety, and quality. The Agency for Healthcare Research and Quality has funded several studies to examine best practices in using technology to impact chronic disease management. These projects have employed a variety of technologies to improve care delivery processes, patient education, and continuity of care. Their stories contain valuable lessons for others looking to enhance chronic disease care.
Umble, Karl E; Orton, Stephen; Rosen, Benson; Ottoson, Judith
The Management Academy for Public Health is a management development program with the goals of helping public health managers learn to manage people, data, and finance, to think and plan like entrepreneurs, and to strengthen public health organizations. Managers enroll as teams and develop business plans in the Academy's extensive project-based learning component. Extensive internal and external evaluation shows that the program improves managers' knowledge, skills, and confidence in key curriculum areas; that participants apply many of the skills in their jobs; that many of the business plans receive funding, resulting in new public health programs; that the training experience helped agencies respond and plan after September 11, 2001; and that many participants report beginning to think more like entrepreneurs through activities like teaming, partnering, innovating, negotiating, finding funds, and generating revenue. The program demonstrates that robust training including extensive work-based project work with coaching can help public health managers gain many skills needed for the drive to "reinvent" government.
In the countries of the European Union, several million workers meet with an accident every year. In the national economy, the costs of accidents at work and occupational diseases are born by different institutions in different proportions, and they are estimated at several percent of the gross domestic product of each of these countries. The issue concerning economic consequences of occupational diseases and accidents at work has been emphasized in the section on health and safety at work of the Community Strategy for 2007-2012. Bearing this in mind, the need have arose to strengthen the efficiency of legal instruments and economic stimuli to motivate actions aimed at improving work conditions. Economic stimuli and legal instruments complement each other in the process of motivating various institutions. The following kinds of economic stimuli have been distinguished: subsidies, grants and financial assistance of the state and stimuli incorporated into tax and insurance systems. Economic evaluation at the information, allocation and educational levels, being an economic tool, may support policymakers who can use this tool to asses economic efficiency of decisions made in the area of health and safety of workers as well as to asses economic consequences of the functioning of legal instruments. The aim of the project, implemented under the Seventh Framework Program by the Nofer Institute of Occupational Medicine, is to promote the system of economic stimuli understood as an incentive to undertake actions for the improvement of work conditions. Owing to this project the discussion forum, addressed to relevant and interested social partners, will be established, and experts in the field will assist in determining directions of further actions aimed at advancing motivation systems.