Public Health Trends Research Articles

Health advocacy with Gapminder animated statistics

How can the public s understanding of public health trends be improved? How can health researchers increase their impact on public opinion and policy-making? More media coverage, such as press reports and TV interviews, are needed; however, the internet nowadays provides alternative options for educating and communicating. Gapminder Foundation, which grew out of the Global Health Division of the Karolinska Institute, Sweden, took advantage of the new information technology (IT) opportunities and created a non-profit web service (http://www.gapminder.org), which presents a fact (data) – based view of global development trends. With the freely accessible data from many international organizations (e.g., World Bank, World Health Organization [WHO], and the United Nations Educational, Scientific and Cultural Organization [UNESCO]), the abstruse numbers were

Prevention and Control of Chronic Non-Communicable Disease in Nine Pacific Rim Cities

Populous, economically dynamic, and rapidly urbanizing, the Asia Pacific both reflects and strongly shapes trends in global public health. A comparative assessment of chronic disease prevalence, risk factors, and policy responses in nine Pacific Rim cities shows that chronic diseases are rapidly becoming the leading cause of morbidity and mortality even in the lower income cities of the Pacific Rim. Policy responses are heterogeneous, with few sufficiently funded or adequately informed by evidence. Much could be learned from comparative research and rigorous evaluation of prevention and control initiatives in this region.

Disempowered doctors? A relational view of public health policy implementation in urban India

This article analyses the nature of power relationships between urban hospital practitioners and other groups of actors involved in the implementation of public health policies in India, and the effects of enacting different strategies to strengthen implementation, in the context of these balances of power. It is based on an empirical research study conducted over 18 months in five Indian cities involving 61 in-depth interviews with medical practitioners and policy actors, and an interpretivist analytical approach. An issue case study-of the implementation of national HIV testing guidelines-was used to focus the interviews on specific events and phenomena. Respondents' accounts revealed that practitioners in both private and government hospitals tended to successfully resist or subvert the attempts of regulators and administrators to enforce the guidelines. However, in spite of often possessing perspectives and convictions that differed from the nationally sanctioned guidelines, practitioners were not able to effectively communicate these ideas to other health systems actors, or introduce them into mainstream policy discourse. The metaphor of public health guideline implementation throws light on the problematical nature of the power possessed by medical practitioners in relation to public health systems in India. Even as practitioners wield 'negative' power in their ability to resist authority, they appear to lack the 'positive' power to contribute intellectually to the policy process. This mix of political obduracy and intellectual demoralization among practitioners also underpins a subtle trend in public health, of the separation of the world of ideas from the world of actions. Study findings highlight that stronger regulations and provisions for accountability in Indian health systems critically need to be balanced by measures to develop collective intellectual capital and include the voices of frontline practitioners in public health policy discourse.

Retreat from Alma Ata? The WHO's report on Task Shifting to community health workers for AIDS care in poor countries

This paper examines the potential of community health worker (CHW) programmes, as proposed by the 2008 World Health Organisation (WHO) document Task Shifting to tackle health worker shortages, to contribute to HIV/AIDS prevention and treatment and various Millennium Development Goals in low-income countries. It examines the WHO proposal through a literature review of factors that have facilitated the success of previous CHW experiences. The WHO has taken account of five key lessons learnt from past CHW programmes (the need for strong management, appropriate selection, suitable training, adequate retention structures and good relationships with other healthcare workers). It has, however, neglected to emphasise the importance of a sixth lesson, the ‘community embeddedness’ of CHWs, found to be of critical importance to the success of past CHW programmes. We have no doubt that the WHO plans will increase the number of workers able to perform medically oriented tasks. However, we argue that without community embeddedness, CHWs will be unable to successfully perform the socially oriented tasks assigned to them by the WHO, such as health education and counselling. We locate the WHO's neglect of community embeddedness within the context of a broader global public health trend away from community-focused primary healthcare towards biomedically focused selective healthcare.

HAVE EFFORTS TO REDUCE SMOKING REALLY CONTRIBUTED TO THE OBESITY EPIDEMIC?

Two of the most notable trends in public health over the past 30 yr are the reductions in smoking rates and the rapid rise in obesity rates. Several studies have investigated the relationship between these trends but have drawn different conclusions. In this article, we revisit this issue, attempting to clarify the prior discrepant results. Overall, we find no support for the claim that rising cigarette taxes have significantly contributed to rising obesity rates. Instead, we find only a moderately sized effect among former smokers. (JEL I12)

Apparent decreases in Swedish public health indicators after 1997—Are they due to improved diagnostics or to environmental factors?

The object of this work was to review recent trends in public health in Sweden. Data on different adverse health indicators were collected from official Swedish registries. We found that population health generally improved during the early 1990s but suddenly started to deteriorate from 1997 onwards. This quite dramatic change is not likely to be explained only by improved diagnostics but physical causes need immediately to be searched for. A connection with the increasing exposure of the population to GHz radiation from mobile phones, base stations and other communication technologies cannot be ruled out.

NHS Connecting for Health and the National Programme for Information Technology

Key content NHS Connecting for Health aims to introduce modern computer systems into the National Health Service (NHS) nationally to integrate patient care. The NHS Care Records Service (NHS CRS) comprises national (the ‘Spine’) and local databases. The maternity Do Once and Share (DOAS) programme looks specifically at the needs of maternity units through locally based action teams. Learning objectives To understand how engagement with clinicians and representatives from the RCOG will be paramount in the successful development of the National Programme for Information Technology (NPfIT) in maternity care. To learn about the Secondary Uses Service (SUS), which uses anonymous patient data to study public health trends, efficacy of treatments and planning of NHS needs. Ethical issues What concerns will there be regarding breach in patient confidentiality with accessibility to electronic health records, particularly in obstetrics and gynaecology? Please cite this article as: Khong S‐Y, Currie I, Eccles S. NHS Connecting for Health and the National Programme for Information Technology. The Obstetrician & Gynaecologist 2008;10:27–32.

52 The end of the beginning: a bibliometric analysis of recent trends in physical activity and public health

52 The end of the beginning: a bibliometric analysis of recent trends in physical activity and public health

Commonalities in Effective Behavioral Interventions for Children and Adolescents With Type 1 Diabetes: A Review of Reviews

A major public health trend of the 1990s was to focus on health status and health-related quality of life outcomes.1,2 Work in the field of diabetes treatment and research during this time provided examples of this focus,3 and much research has benefited, both directly and indirectly, from many of these earlier studies.4–6 It is in the spirit of this focus on health status and quality of life, along with these earlier studies, that many current efforts to examine, understand, and refine interventions aimed at promoting physical and psychological health outcomes are conducted. Pediatric diabetes is no exception, with at least three comprehensive reports being published since 2000 on the effectiveness of behaviorally oriented interventions to optimize health outcomes in children and adolescents with type 1 diabetes.7–9 Hampson et al.7 conducted a meta-analysis to determine which behavioral interventions were effective in promoting psychosocial, metabolic, self-management, and diabetes knowledge outcomes. Their statistically rigorous approach highlighted certain treatments, particularly those with a theoretical foundation, that offered greater promise in terms of psychological and physiological outcomes.10–12 Further, they were able to provide a quantitative examination of the public health impact of these interventions through use of the RE-AIM framework.13 However, their overarching conclusion about behavioral interventions for adolescents with type 1 diabetes was that they offered small to medium beneficial effects across these outcomes. Northam et al.8provided a comprehensive review of the literature on behavioral interventions for children and adolescents with type 1 diabetes across psychological and metabolic outcomes. They noted that most interventions contained some aspect of psycho-educational or cognitive-behavioral techniques ultimately aimed at promoting behavior change related to diabetes management. However, most used nonstandardized, study-specific interventions that involved multiple components, making it difficult to draw …

Análise da relação entre custo e consumo dos antipsicóticos típicos e atípicos: implicações para a saúde pública

O objetivo deste estudo foi verificar a relação entre custo e consumo dos antipsicóticos típicos e atípicos. A coleta de dados foi realizada no Hospital Psiquiátrico Dr. João Machado, Natal, Rio Grande do Norte (RN), Brasil, no período de 2002 a 2005. Para a comparação do custo ou consumo entre os dois grupos de antipsicóticos, utilizou-se o Teste <em>t </em>de Student com nível de significância de 5 %. A correlação entre custo e consumo para cada grupo de antipsicótico foi verificada pelo Coeficiente de Correlação de Pearson, com nível de significância de 5 %. Os resultados mostraram uma diferença estatisticamente significante entre o custo dos medicamentos típicos e atípicos (p < 0,0001), bem como uma correlação positiva entre custo e consumo para medicamentos atípicos (r = 0,96, p < 0,02). O estudo demonstrou que existe preocupação e compromisso do Estado do Rio Grande do Norte, Brasil, em incrementar a terapia com os antipsicóticos atípicos. A diferença entre os custos dos antipsicóticos típicos e atípicos podem representar um empecilho para incrementar o acesso dos pacientes com esquizofrenia a uma terapêutica que possibilite melhor qualidade de vida.

The biopesticide market for global agricultural use

The biopesticide market for global agricultural use

Infant feeding and the media: the relationship between Parents' Magazine content and breastfeeding, 1972-2000.

Mass media content likely influences the decision of women to breastfeed their newborn children. Relatively few studies have empirically assessed such a hypothesis to date, however. Most work has tended to focus either on specific interventions or on broad general commentary about the role of media. In this study, we examined infant feeding advertisements in 87 issues of Parents' Magazine, a popular parenting magazine, from the years 1971 through 1999. We then used content analysis results to predict subsequent changes in levels of breastfeeding among U.S. women. When the frequency of hand feeding advertisements increased, the percentage change in breastfeeding rates reported the next year generally tended to decrease. These results underscore the need to acknowledge the potential role of popular media content in understanding breastfeeding patterns and public health trends.

Child Health Assessment at School Entry (CHASE) project: evaluation in 10 London primary schools

To assess the feasibility of implementing the Child Health Assessment at School Entry (CHASE) questionnaire, developed to capture the multiple dimensions of the health of children in their first year at school, and to evaluate data quality, reliability and validity. Parents of 278 year-1 children, from 10 primary schools in two London boroughs, received a parent questionnaire and school nurses completed a separate questionnaire from health and education records for children whose parents consented. Additional data on free school meal eligibility and ethnicity were obtained from the two Local Education Authorities. The parent questionnaire included the Strengths and Difficulties Questionnaire (SDQ) and four dimensions of the Child Health Questionnaire Parent Form-28 (CHQ-PF28). Response rate was 61%. The association between school free school meals eligibility and response rate in each school approached significance (r = -0.62, P = 0.05). Data completeness of the parent questionnaire was high (mean 98%). Data completeness of the school nurse questionnaire was more variable (mean 82%). Cronbach's Alpha was greater than 0.6 for four of the five SDQ scales and greater than 0.7 for the two CHQ-PF28 multi-item scales. Relative to parents with qualifications, parents with no qualifications rated their children as having significantly more conduct problems, peer problems, and overall mental health problems (P < 0.01) as assessed by the SDQ, and significantly lower global health (P < 0.01) as assessed by the CHQ-PF28. Children with special educational needs and children with long-standing illness or disability were rated as having significantly lower global health (P < 0.05) than children without these. Sample tables of inter-school and inter-borough comparison of key findings demonstrate considerable differences in physical and mental health status. The questionnaire was acceptable to parents and school nurses, and feasible to implement within existing school resources. Initial tests of internal reliability and validity are satisfactory. These data have the potential to inform interventions and service provision at school and borough level, and public health trends over time.

Change in Autopsy Profiles as a Harbinger of Public Health Trends

Change in Autopsy Profiles as a Harbinger of Public Health Trends

Public Health: An Action Guide to Improving Health in Developing Countries

John Walley: What is Public Health? John Wright: Epidemiology in practice John Wright: Assessing health needs John Walley: Choosing the best public health interventions Sophie Witter: Health economics and funding interventions: what health economics can contribute John Hubley: Managing and implementing interventions John Walley and Sarah Escott: Developing a district health service John Hubley: Health promotion John Walley: Maternal and child health Kathy Holloway: Managing medicines Martin Schweiger: Communicable Disease Control John Wright: Future trends in global public health

MEDICAL SOCIOLOGYAND PUBLIC HEALTH: PROBLEMS AND PROSPECTS FOR COLLABORATION IN THE NEW MILLENNIUM

Medical sociology and public health share many of the same concerns in the study of social and cultural factors that affect the health of the population. Differences in theoretical approaches, methodological procedures, conceptualization and measurement, and research objectives, however, often serve to limit the potential for collaboration between the two disciplines. Sociologists possess many of the theoretical models and analytical techniques needed in public health for the study of the impact of socioeconomic status, poverty, inequality, differentials in power, and social and cultural differences on disease outcomes and health status. Although in the past, public health professionals were dependent primarily on the theoretical and analytical models offered by epidemiology and social psychology, current trendsin public health research have opened a wider variety of opportunities for sociologists to contribute to public health research. Public health has reached a crossroads that leads in two directions: a broad approach that addresses the sociocultural foundations of health and a more narrow approach focusing on more proximal risk factors such as individual lifestyles or health risk behaviors. This article presents a review of the factors that led to this crossroads in public health and offers suggestions as to how sociologists might take advantage of the opportunities afforded by the broader approach to public health that is gaining momentum among some public health practitioners. Medical sociologists are uniquely equipped to assist public health in recapturing its historical commitment to social justice in the maintenance of health for the entire population.

Where Are We Going In Global Health? Some Passionate Forebodings

Where Are We Going In Global Health? Some Passionate Forebodings

Globalization, socioeconomic restructuring, and community health.

New trends in global public health have social, economic, and political underpinnings that can be found in three 20th century revolutions: globalization, a new epidemiological transition, and an historical shift in patterns of production and consumption throughout the world. Globalization is more than the internationalization of commerce and manufacture; it represents a new development paradigm that creates new links among corporations, international organizations, governments, communities, and families. Social and economic restructuring is reflected in the emerging health profile in underdeveloped countries, including those in Latin America. This emerging profile defies simple categorization, however; while the prevalence of cardiovascular disease and cancer has increased, the traditional diseases (infectious and respiratory disease) are still the leading cause of death. At the same time, industrialized countries are experiencing the re-emergence of those same traditional diseases. These apparent anomalies can be understood by examining class structures within and among countries and by linking health outcomes at the local level to new patterns of production and consumption in the global system.

Development planning in South Africa: legacies and current trends in public health

This article discusses current trends in development planning in South Africa. It is argued that it is important to review the institutional framework in particular legal and constitutional factors to understand the problems being faced and the progress made. Public health is analysed as a case study but there is also a focus on local government. The other feature of the argument is that poverty is widespread especially in rural communities and planning has to develop the capacity to respond to this challenge. Despite all sorts of initiatives and some rhetoric there remains a great deal to do. An alternative approach is offered in which there is a more radical shift away from past paradigms which are not appropriate to a development planning geared to poverty alleviation. There are a number of dimensions to consider including technical effectiveness participation (including private sector involvement and community action) and institutional capacity building. Some implications for training and research are also identified. (authors)

An age-period-cohort analysis of 50,875 AIDS cases among injecting drug users in Europe.

The long average incubation time from HIV infection to AIDS makes it difficult to estimate recent HIV transmission from AIDS incidence data. Age-period-cohort (APC) analysis can separate out the effects of age, calendar time and birth cohort to provide a clearer picture of transmission trends. AIDS incidence data from 1981 to 1994 among intravenous drug users (IDU) for 12 Western European countries were used. Yearly incidences per 100,000 population or 100,000 person-years were calculated by age at diagnosis and 5-year birth cohort (1950-1954, 1955-1959, 1960-1964, 1965-1969 and 1970-1974), and corrected for reporting delay. Incidence patterns were compared between birth cohorts and countries. For most countries the impact was greatest on the cohort born 1960-1964. Comparing incidence patterns in the 1965-1969 to 1960-1964 cohorts suggest the epidemic has plateaued at low to intermediate levels in Austria, Greece and the North-Western European countries, and at high levels in France, Italy and Switzerland. For most countries transmission amongst the 1970-1974 as compared to the 1965-1969 cohorts could not be assessed due to small numbers and short follow-up time. In Spain the epidemic was uncontrolled with a high incidence among recent birth cohorts. In Portugal the epidemic was still at an early and expanding phase. The APC analysis revealed large country differences in the dynamics of the HIV/AIDS epidemic among IDU. Full interpretation of these differences is dependent on information from other sources about the local public health response and trends in drug injecting behaviours. Earlier introduction of the virus and higher prevalence of injecting drug use may explain some of the generally higher incidence in Southern European countries, but the larger part of it is most likely explained by local characteristics of drug users, such as younger age and more frequent sharing of needles and syringes, and a less effective public health response.