National Public Health Strategies Research Articles

National indicators of child health and well-being in Greenland

The aim of the study was to identify core indicators of children's health and well-being at the national level, adapt them to the needs of children in Greenland, and present empirical data about them. The indicators were based on the actual knowledge about the health of children in Greenland, on the goals identified in the National Public Health Strategy and in the UN Convention on the Rights of the Child, as well as on experiences from international studies. Criteria to determine quality and relevance were identified. It is proposed that the 28 core indicators of child health that fulfilled the selected criteria be implemented immediately and that another 25 indicators be implemented later. Data showed that large subgroups of children are vulnerable because of their socioeconomic and demographic conditions, that morbidity associated with health behaviour and mortality was high, and that at-risk health behaviour was frequent compared to children in the other Nordic countries. The carefully selected indicators could be powerful tools in monitoring core issues in children's health and the factors influencing it. They are also a necessary starting point for determining the outcomes of the country's health and welfare policies. Although relevant indicators were identified, a lack of both validated data sources and routine data collections was obvious. Data on the proposed indicators showed many affected children in Greenland.

Core Indicators of Children’s Health and Well-Being at the Municipal Level in Greenland

The aim of this study was to expose the background for proposing core indicators for children’s health and well-being at the municipal level in Greenland; to define criteria for relevant and scientifically sound indicators; to propose a set of such indicators; to give data on their distribution, and compare the outcomes between different types of municipalities. The indicators were drawn from actual knowledge of children’s health and experiences reported in international studies. They were based on goals from the National Public Health strategy and the UN Convention on the Rights of the Child. A set of 24 indicators were identified in 4 domains (demographic and socio-economic conditions; health status and well-being; determinants of health, risk, and protective factors; and health systems and health policy). Additional indicators were proposed for later implementation, most of these lack available data. Data revealed large differences between municipalities. In general, remote communities have the most unfavourable socio-demographic and health conditions. At the same time, larger communities’ access to health care services is more favourable. A consequence is that the health care system unintentionally contributes to the increasing health gap between privileged and less privileged children. A comprehensive strategy is need to guarantee equitable health standards for all Greenlandic children and that reaches far beyond the aims stated in the present national public health programme.

Multidisciplinary public health: Leading from the front?

This article argues that public health historically evolved in Britain as a multidisciplinary project. The return to its multidisciplinary roots remains an essential but insufficient condition for its future success. Despite its part-emergence from the 'new public health', institutional public health is hampered by short-term strategies and a preoccupation with evidence when it requires a more powerful analysis of contemporary society, a more imaginative engagement with political structures culture and communications, and an embrace of ecological approaches in place of national public health strategies of surrogate consumerism.

The MACH Model: From Competencies to Instruction and Performance of the Public Health Workforce

In A National Public Health Strategy for Terrorism Preparedness and Response 2003–2008, the Centers for Disease Control and Prevention (CDC) outlined the 11 imperatives for preventing death, disability, disease, and injury associated with urgent health threats.1 Imperative five, Competent and Sustainable Workforce, identifies four critical objectives: (1) increase the number and type of professionals who comprise a preparedness and response workforce; (2) deliver certification and competency-based training and education; (3) recruit and retain the highest quality workforce; and (4) evaluate the impact of training to ensure learning has occurred. The plan states: “Challenges that exist … include defining the role of certification, practicing quality assurance and performance measurement, developing customized standard competencies …”1 The MACH (Miner, Alperin, Cioffi, and Hunt) Model, developed at the Rollins School of Public Health, serves as a logic map that describes the associations among the objectives and challenges within this imperative. The MACH Model places into context the organizational and instructional theories that underpin workforce preparation and practice. It also accounts for the two general types of needs within public health: those of the employee with skill deficits for specific tasks, which can be met through training or other expert systems; and those of the institution with deficiencies in the work environment, which can be met through management practices and organizational priorities.

Prevention and nutrition related illnesses. Obesity, diabetes mellitus

Faced with the obesity epidemic there is need for therapy as well as public health strategies for health promotion and obesity prevention. Both strategies add to each other, none should be done in isolation. Obesity is not only an individual problem. It is also a problem of our society. We are now an overweight society, which is on the way to a fat society. There is urgent need for a national public health strategy for population wide prevention of overweight and obesity. Health authorities as well as politicians are asked to support public health strategies creating a supportive environment for making healthy choices the easier choices.

Public health and the development of infant mortality in Germany, 1875–1930

The substantial increase in life expectancy over the past 150 years can largely be attributed to a drastic decline in infant mortality. In the continuing debate about the reasons for this development, recent research has focused attention on the role of public health. Since the 1870s in Germany, municipal and national public health strategies were launched. One major element of this policy was the fight against high infant mortality rates in urban areas. The establishment of municipal milk supplies and the creation of infant welfare centers attacked gastrointestinal disorders, the predominant cause of death among infants. This article investigates these developments in the largest German cities, particularly Düsseldorf, which is located in one of the most industrialized regions.

En Afrique, le sida réformateur ?

The Fight against AIDS and change in African Health systems. As the HIV epidemics spread in the early 80's, some expected changes in Health systems. In Africa especially, AIDS should have put the light on health systems dysfunction, the limits of medical consultation for a global patient's care, economic difficulties regarding curing chronic patients, the issue to take account of individual behaviour in health projects, the importance of ethic, the role of “civil society” to tackle with health problems. Fifteen years later, we have to face the facts and conclude that expected changes were not very important. The HIV programs have not been really integrated into the national public health strategies. AIDS became de facto the unique responsibility of a chosen few with the result that other public health staff took no interest in HIV risk within the context of their day-to-day activities, meanwhile the burden of HIV infected persons was heavier and heavier for health facilities. The extent of the epidemic, linked with the question of the difficulty to access to a care of quality, led sometimes to consider specific ethic rules for Southern countries which have not universal validity. In certain countries, the People living with HIV/AIDS associations are not independent from HIV national programs; therefore they cannot play an important role in critisizing health care professionals, a role which has contributed to an evolution in care for people with HIV for Northern countries. We can mention also that some topics (like homosexuality) seem still be taboo considering African context. Due to the organisation of the national AIDS strategies and to the general state of health care systems in AFrica, all of the various initiatives run the risk of having a very weak impact because the expected “AIDS culture” is not yet implemented in African countries. En Afrique, le sida réformateur ? L'émergence du sida au début des années 1980 aurait dû avoir une fonction de « révélation å. En Afrique notamment, on attendait qu'elle mette en évidence le dysfonctionnement des systèmes de santé, les limites de la consultation médicale, les problèmes économiques liés à la prise en charge des maladies chroniques, la nécessaire prise en compte des comportements individuels dans les projets de santé, etc. Vingt ans plus tard, cette vertu réformatrice des activités liées au sida, et en particulier les transformations attendues du système de santé ne se sont réalisées que très partiellement. Les préoccupations relatives au sida (à sa prise en charge et à sa prévention) touchent rarement l'ensemble des systèmes de santé nationaux ; une éthique spécifique aux pays du Sud tend à se développer ; et la réflexion sur les comportements des populations vulnérables semble avoir peu évolué. Il apparaît alors qu'il ne s'est guère développé une « culture du sida å qui aurait pu faire progresser la prise en charge des malades en Afrique en général.

The new Swedish national public health policy

By international comparison, Swedish public health public sector and a restructuring of Swedish welfare policy. The labour market underwent transformations work has been successful. The age-standardized mortality ® gures are low in most age groups. Although and there was a signi® cant decrease in the total employment rate. Furthermore there was an increase in job inequity in health is considerable in relative terms, the number of excess deaths in lower social classes is strain, especially in the care sector. These changes took place without any governmental agency taking responssmaller than in most other countries. In spite of this rather positive picture, Sweden has ibility for an analysis of the health consequences. In 1994 the new social democratic government no comprehensive public health policy. It has been recognized that politics is a health determinant in declared that public health was a central political issue. In 1997 a public health committee with a broad parliadiVerent sectors of society but there has not been any eVort to coordinate diVerent governmental oYces in mentary base was formed. The major objective was to propose a national strategy and speci® c goals for public order to promote public health. The problem of how to implement a public health health that would guide governmental oYces, regional and local public authorities, and NGOs. The committee policy has been discussed for more than a decade. In 1987 the Swedish government appointed a task group at comprised members from all major political parties and a number of experts, representing governmental high administrative level with the participation of oYcials and scientists in the ® eld of public health. The aim authorities, scienti® c institutions, labour-market organizations, and representatives for immigrants and was to outline a national public health strategy. An allembracing objective was to promote increased equity in retired persons. The committee worked openly and in dialogue health. Another important issue was how to integrate public health with the general welfare policy system. with public health activists. Two preliminary reports were published and distributed to several hundred The task group proposed a new governmental authority, the National Institute of Public Health. The authorities and voluntary organizations. In the end of 2000 a green paper was published with purpose of the institute was to direct health promotion and disease prevention activities at a national level and proposals for 18 national public health goals. All goals were formulated in terms of health determinants and to cooperate with other national authorities and NGOs in health matters. fundamental infrastructure for preventive work. The goals related to structural and environmental determinThe National Institute of Public Health was established in 1992. At that time there had been a change ants of health as well as lifestyles. All goals are broken down into a number of sub-goals and quantitative of government, which may have contributed to the fact that the institute did not take on its intended strategic indicators have been constructed. It is presumed that the targets will be achieved in 2010. It is also proposed role in the Swedish public health work. Instead its activities focused on programmes directed towards that each respective public sector will be accountable for contributing to the achievement of the goals. speci® c health problems such as alcohol, illicit drugs, HIV/AIDS, injuries, allergic disorders and tobacco use. At present the government is revising the goals and a governmental bill will be put forward to the Swedish There was a quite strong emphasis on information directly to the public. parliament in the end of 2001. There are a number of advantages in expressing the In the 1990s there were considerable cutbacks in the

The pharmaceutical care of patients with hypertension: an examination of service models in primary care in the US.

In the UK, the delivery of health care in cardiovascular disease is guided by national service frameworks', which are a source of standards of practice and evidence that help to define and aid the implementation of service models capable of responding to public health goals. The revised British Hypertension Society guidelines reflect a lower target blood pressure consistent with those recommended in the US and by the WHO. The lowering of the target for the control of blood pressure has increased the estimated proportion of treated patients with inadequate control in the UK from 37% to 72%. To identify the requirements for the provision of a pharmacy service that supports hypertension monitoring, and to gain insights into how such a service might be delivered as part of a wider provision of pharmaceutical care in the UK. Two pharmacists followed a structured programme of observation involving three centres in the United States (Minnesota, Colorado and Iowa). Twelve clinical settings were observed, and the pharmacists who provided the services were also the subjects of documented interviews. The settings offered different models of pharmaceutical care from which issues relevant to the international development of such services were identified. Differences noted between the service models observed included; physical environment of the community pharmacy, the use and type of documentation, methods of blood pressure measurement, extent of monitoring and follow-up, inter-professional communication and service orientation in terms of the provision of comprehensive pharmaceutical care to patients or specific disease management. If clearly defined operational models of pharmaceutical care practice in the primary care setting are to form part of a national public health strategy in the UK, they must also be capable of responding to local opportunities and patients' needs. Future development of models and services must be patient-centred and more widely informed by the range of practice experience gained elsewhere.

The experience of setting health targets in England

Background: This paper presents an analysis of the English experience of setting and monitoring targets during the 1990s. It draws on two studies of the former national public health strategy, ‘Health of the Nation’ (HOTN). Methods: the two evaluations conducted 16 case studies between them, two in each health region in England. Over 250 individual and group interviews were conducted and over 400 documents were analysed. In eight health authorities, an analysis of expenditure was also carried out to determine what impact, if any, HOTN had on resource allocation. Results: Full results are published elsewhere. Lessons for the new strategy are as follows: i) the role of central government is key in ensuring that there is a consistent message across government in support of the health strategy and in fostering the development and dissemination of an evidence-base for public health, ii) The new strategy needs to address the underlying social and structural determinants of health and health inequalities directly, iii) Both studies found widespread support for targets as a helpful way to prioritise and focus efforts. However, national targets must be credible i.e. based on sound and convincing evidence. The development of local targets needs to be encouraged, and process targets should supplement outcomes locally and nationally, iv) The new strategy needs to be communicated widely – to broaden ownership outside the National Health Service, and include the public, v) To sustain momentum and ensure effective implementation, the strategy must be embedded in the performance management framework for health and local authorities, vi) Partnerships between key local agencies to work together for health need to be encouraged, either via a statutory framework or with other incentives. Discussion: The new English strategy, ‘Saving Lives’, is outlined in relation to the development of targets. The wider issues of a target-based approach to health policy include: i) Importance of distinguishing between the objective to ensure that policy is directed towards the achievement of health outcomes, and monitoring progress to ensure that health policy objectives are being achieved, ii) The role of targets as an inspiration as well as or instead of a management tool, iii) A target-based health policy should: set targets which are realistic, achievable and challenging; involve stakeholders; link targets to implementation; consider technical issues e.g. small numbers, availability of data; be based on evidence; express targets in terms of health improvement, iv) Target-based health policies should avoid: perverse incentives; distortion of data; too many targets; target setting without resources, v) The experience from England provides lessons for other European countries introducing a target-based approach to health policy.

Global Coordination of National Public Health Strategies

Three periods can be distinguished in the brief history of global AIDS: silence, discovery and mobilization. The first period, starting in the mid-l970s, was the time of the “silent pandemic,” during which HIV spread — unnoticed—to at least five continents. During this period, when the virus was unrecognized, HIV could have — but did not — spread even more widely.The description of AIDS in 1981 ended the silence and initiated the second period in the history of global AIDS — a period of discovery which culminated symbolically at the first International Conference on AIDS in June 1985 (Atlanta, USA). During this period, the modes of transmission were defined, the virus was discovered, and the capacity to detect anti-viral antibodies led to the discovery of large numbers of infected persons and to awareness of the long latency between infection and manifest disease.