Housing and health—Current issues and implications for research and programs

This article provides an overview of the ways in which the home environment can affect human health, describes how specific health hazards in housing are related, and considers implications of these concerns for research and programs to address the health-housing connection. The widespread availability of decent housing has contributed greatly to improvements in health status in developed countries through, for example, provision of safe drinking water, proper sewage disposal, and protection from the elements. However, a lack of decent housing and homelessness among a significant number of Americans remains a significant public health concern. In addition, a number of specific health hazards can be found even in housing that is in good condition and provides all basic amenities. Specific health hazards related to housing include unintentional injuries, exposure to lead, exposure to allergens that may cause or worsen asthma, moisture and fungi (mold), rodent and insect pests, pesticide residues, and indoor air pollution. A number of these specific hazards share underlying causes, such as excess moisture, and all may be influenced by factors in the community environment or by occupant behaviors. We make recommendations for developing programs and research efforts that address multiple housing problems in an integrated way, rather than categorically, and for closer collaboration between housing and public health programs. The views expressed in this article are those of the authors and do not necessarily reflect official policies of the US Centers for Disease Control and Prevention or the US Department of Housing and Urban Development.     

and biology

有一个富翁,带了许多金银财宝,到很远的地方去寻找快乐。但他走过了千山万水,到过了无数的地方,却始终没有找到快乐。一天,正当他沮丧地坐在山道旁休息时,见一位农夫背着一大捆柴草快乐地唱着山歌从山上下来,富翁急忙上前向农夫问道:“我是个令人羡慕的富翁,为什么却总是找不到     

Brominated Indoles and Phenols in Marine Sediment and Water Extracts from the North and Baltic Seas–Concentrations and Effects

This work presents results from analytical as well as ecotoxicologic investigations of sediment and water samples from the North and Baltic Seas. A bioassay-directed procedure was used to investigate cause–effect relationships between observed effects in acute laboratory bioassays (luminescent bacteria assay with Vibrio fischeri and embryo test with Danio rerio) and analyte concentrations in extracted samples. Brominated phenols and indoles—including 4-bromophenol; 2,4-dibromophenol; 4- and 6-bromoindole; 3,4-, 4,6-, and 3,6-dibromoindole; and tribrominated compounds—were identified in partly remarkable concentrations (up to 40,000 ng g⁻¹ total organic carbon TOC for 4-bromophenol) in North Sea sediment samples and water samples (913 ng L⁻¹ 3,6-dibromoindole) from the German Bight. The toxicity of some of the identified brominated substances was low, with median effect concentration levels (EC₅₀) ranging from 0.08 to 21.7 mg/L for V. fischeri and 4.3 to 46.3 mg/L for D. rerio. Comparison of the concentrations of analytes with ECs showed a toxicity contribution of brominated phenols and indoles to overall toxicity of the fraction. In the case of one water sample from the German Bight, brominated phenols and indoles accounted for the observed toxicity. Brominated phenols and indoles, which are assumed to be of biogenic origin, have rarely been discussed so far in the context of ecotoxicologic effects in marine ecosystems.     

Comparing objective and subjective status: Gender and space (and environmental justice?)

The environmental justice literature has described differential health effects of environmental toxins and pollutants on people of different socio-economic status (SES) that may not always reflect differing levels of exposure. We offer four questions or contentions that together may contribute to understanding this conundrum and then present an empirical exploration of one of these questions: Does the relationship between SES and self-perceived status vary in space? Utilizing data from an original questionnaire survey of randomly selected adults conducted in twenty-five communities in British Columbia, Canada, a supplementary data set containing demographic and socio-economic characteristics of the communities themselves, and multilevel modelling techniques, this article describes relationships between objective and subjective measures of social status, by gender and in space. Our analysis contributes to the development of innovative environmental justice models by bringing some spatial sensitivity to interrelationships among these aspects of status.     

Burns and Nutrition

In adults, burns of 40％ total body surface areas(TBSA)or greater were virtually unsurvivable but a few decades ago.Now, more than half of the adult patients with a 70％ TBSA burn survive. In children, the size of the survivable injury has increased so much that it is now possible to save a child with burns exceeding 95％ TBSA full thickness.The decrease in mortality and morbidity related to major thermal burn injuries noted in the past decade is primarily due to improvements in four major areas.     

Do Adolescent Sexual and Reproductive Attitudes and Knowledge Predict Men and Women's Adult Sexual Partnerships?

PurposeAdolescence is a key stage for forming knowledge and attitudes about sex and reproduction that may have long-term implications for adult sexual behaviors. Gender differences in experiences and socialization processes may affect the links between adolescent characteristics and adult behaviors.MethodsBy following adolescent virgins aged 15 years and older from wave I through wave IV of the National Longitudinal Study of Adolescent to Adult Health (n = 4,152), we test whether adolescent boys' and girls' knowledge about, and attitudes toward, sex and reproduction influence the number of lifetime different-sex sexual partners and the likelihood of having concurrent sexual partners in adulthood, using negative binomial regression and logistic regression, respectively. Models are run separately by gender.ResultsMen and women who reported greater physical benefits of sex as adolescents reported more lifetime different-sex sexual partners and were more likely to have concurrent sexual partners in adulthood. For women, adolescent perceptions of more social costs to sex were linked to fewer lifetime sexual partners, whereas greater birth control confidence was linked to more sexual partners. Women who more strongly felt that avoiding sexually transmitted infections was a hassle during adolescence were less likely to have concurrent sexual partners as adults, and men who were more knowledgeable about condoms during adolescence were more likely to have concurrent sexual partners.ConclusionsAdolescent knowledge and attitudes about sex, contraception, and reproduction have implications for adult sexual behavior, but different aspects emerge as salient for men and women.     

非政府组织(NGO)艾滋病防治工作在转型期的可持续发展

随着国际社会逐渐减少对中国的艾滋病防治工作提供经费支持,云南省防艾工作已逐步进入转型期。在转型期,非政府组织(NGO)防艾工作面临一系列挑战,如:如何继续获得参与的平台;如何促进NGO参与的管理方式、理念转化为政府的工作机制等。为使NGO防艾工作可持续发展,首先应开展一些独立的活动,如技术资料和人力资源及工作网络的整理与利用、经济资源投入促动行动、培训政府相关部门的艾滋病工作管理人员等,以推动目前NGO参与的产出进一步扩大、增值和继续发挥其作用;其次应创造条件,促进政府的认可,扩大NGO自己的生存空间;第三应从服务领域、服务层次、筹资渠道、志愿者发展、组织网络建设等方面努力提高自身专业能力的建构和财政的自主性,谋求长远发展。     

The potential of health sector non-governmental organizations: policy options

Non-governmental organizations (NGOs) have increasingly been promoted as alternative health care providers to the state, furthering the same goals but less hampered by government inefficiencies and resource constraints. However, the reality of NGO health care provision is more complex. Not only is the distinction between government and NGO providers sometimes difficult to determine because of their operational integration, but NGOs may also suffer from resource constraionts and management inefficiencies similar to those of government providers. Some registered NGOs operate as for-profit providers in practice. Policy development must reflect the strengths and weaknesses of NGOs in particular settings and should be built on NGO advantages over government in terms of resource mobilization, efficiency and/or quality. Policy development will always require a strong government presence in co-ordinating and regulating health care provision, and an NGO sector responsive to the policy goals of government.     

Context matters in NGO-government contracting for health service delivery: a case study from Pakistan

Contracting non-governmental organizations (NGOs) for health service provision is gaining increasing importance in low- and middle-income countries. However, the role of the wider context in influencing the effectiveness of contracting is not well studied and is of relevance given that contracting has produced mixed results so far. This paper applies a policy analysis approach to examine the influence of policy and political factors on contracting origin, design and implementation. Evidence is drawn from a country case study of Pakistan involving extensive NGO contracting for human immunodeficiency virus (HIV) prevention services supported by international donor agencies. A multilevel study was conducted using 84 in-depth interviews, 22 semi-structured interviews, document review and direct observation to examine the national policy design, provincial management of contracting and local contract implementation. There were three main findings. First, contracting origin and implementation was an inherently political process affected by the wider policy context. Although in Pakistan a combination of situational events successfully managed to introduce extensive and sophisticated contracting, it ran into difficulties during implementation due to ownership and capacity issues within government. Second, wide-scale contracting was mis-matched with the capacity of local NGOs, which resulted in sub-optimal contract implementation challenging the reliance on market simulation through contracting. Third, we found that contracting can have unintended knock-on effects on both providers and purchasers. As a result of public sector contracts, NGOs became more distanced from their grounded attributes. Effects on government purchasers were more unpredictable, with greater identification with contracting in supportive governance contexts and further distancing in unsupportive contexts. A careful approach is needed in government contracting of NGOs, taking into account acceptance of contracting NGOs, local NGO capacities and potential distancing of NGOs from their traditional attributes under contracts. Political factors and knock-on effects are likely to be heightened in the sudden and aggressive use of contracting in unprepared settings.     

Doing implementation research on health governance: a frontline researcher’s reflexive account of field-level challenges and their management

Background

Implementation Research (IR) in and around health systems comes with unique challenges for researchers including implementation, multi-layer governance, and ethical issues. Partnerships between researchers, implementers, policy makers and community members are central to IR and come with additional challenges. In this paper, we elaborate on the challenges faced by frontline field researchers, drawing from experience with an IR study on Village Health Sanitation and Nutrition Committees (VHSNCs).

Methods

The IR on VHSNC took place in one state/province in India over an 18-month research period. The IR study had twin components; intervention and in-depth research. The intervention sought to strengthen the VHSNC functioning, and concurrently the research arm sought to understand the contextual factors, pathways and mechanism affecting VHSNC functions. Frontline researchers were employed for data collection and a research assistant was living in the study sites. The frontline research assistant experienced a range of challenges, while collecting data from the study sites, which were documented as field memos and analysed using inductive content analysis approach.

Results

Due to the relational nature of IR, the challenges coalesced around two sets of relationships (a) between the community and frontline researchers and (b) between implementers and frontline researchers. In the community, the frontline researcher was viewed as the supervisor of the intervention and was perceived by the community to have power to bring about beneficial changes with public services and facilities. Implementers expected help from the frontline researcher in problem-solving in VHSNCs, and feedback on community mobilization to improve their approaches. A concerted effort was undertaken by the whole research team to clarify and dispel concerns among the community and implementers through careful and constant communication. The strategies employed were both managerial, relational and reflexive in nature.

Conclusion

Frontline researchers through their experiences shape the research process and its outcome and they play a central role in the research. It demonstrates that frontline researcher resilience is very crucial when conducting health policy and systems research.

     

What can transaction costs tell us about governance in the delivery of large scale HIV prevention programmes in southern India?

This paper aims to understand the transaction costs implications of two different governance modes for large scale contracting of HIV prevention services to non-governmental organisations (NGOs) in 2 states in India as part of the National AIDS Control Programme between 2001 and 2003. Interviews at purposively selected case study NGOs, contracting agencies and key informants as well as document review were used to compile qualitative data and make comparisons between the states on five themes theoretically proposed to shape transaction costs: institutional environment, informational problems, opportunism, scale of activity and asset specificity (the degree to which investments made specifically for the contract have value elsewhere). The State AIDS Control Society (SACS) in state Y used a management agency to manage the NGO contracts whereas the SACS in state X contracted directly with the NGOs. A high level of uncertainty, endemic corruption and weak information systems served to weaken the contractual relationships in both states. The management agency in state Y enabled the development of a strong NGO network, greater transparency and control over corrupt practises than the contract model in state X. State X's contractual process was further weakened by inadequate human resources. The application of the transaction cost framework to contracting out public services to NGOs identified the key costs associated with the governance of HIV prevention services through NGO contracts in India. A more successful form of relational contract evolved within the network of the contract management agency and the NGOs. This led to improved flows of information and perceived quality, and limited corrupt practises. It is unlikely that the SACS on its own, with broader responsibilities and limited autonomy can achieve the same ends. The management agency approach therefore appears to be both transaction cost reducing and better able to cope with the large scale of these contracting programmes.     

Engagement of non-government organisations and community care workers in collaborative TB/HIV activities including prevention of mother to child transmission in South Africa: Opportunities and challenges

ABSTRACT: BACKGROUND: The implementation of collaborative TB/HIV activities requires interventions beyond facility fences in order to mitigate the impact of the dual epidemic on patients and communities at large. Engagement of Community Care Workers (CCWs) in delivery of integrated TB/HIV services is a potential avenue to enhance universal coverage and treatment outcomes and address human resource for health crisis in sub-Saharan Africa. In South Africa, CCWs are employed by nongovernmental organization (NGO) with Health Department contracts funded by government to provide various TB/ HIV community based activities. Using South Africa as a case, we report on engagement of NGOs and CCWs in the implementation of collaborative TB/HIV/PMTCT activities in rural South Africa, including extent of participation and constraints and opportunities to enhance effective participation. Our mixed method study in Sisonke district, KwaZulu-Natal included facility and NGO audits, a household survey (n=3867), 33 key informants with provincial, district and facility managers, NGOs managers and six CCW focus group discussions. Results: The findings indicate that most contracted NGOs were providing TB or HIV support and care with little support for PMTCT. Only 11% of TB and HIV patients needing care and support at the community level were receiving support from CCWs, while 2% of pregnant women were counseled by CCWs on infant feeding options and HIV testing. Most facilities (83%) did not have referral mechanisms or any linkage with NGOs. Major constraints identified were system-related: structural, organizational and managerial constraints; inadequate CCW training and supervision; limited scope of CCW practice, inadequate funding, and inconsistency in supplies and equipment. Individual and community factors such as lack of disclosure and stigma related to HIV; and cultural beliefs were also identified as constraints. Conclusions: We conclude that sub-optimal NGO/CCW engagement exists in implementation of collaborative TB/HIV/PMTCT activities, despite its potential benefits to enhance provision of integrated TB/HIV/PMTCT services at community level. Effective interventions that address contextual and health systems challenges are required and these interventions should combine systematic skills-building and consistent CCW supervision with a reliable referral and M&E system. Policy review to harmonise and expand the scope of CCW practice with task shifting to include home-based HIV counseling and testing is vital.     

Retracted: Determinants of project success among HIV/AIDS nongovernmental organizations (NGOs) in Rakai,Uganda

The aim of the study was to identify the main determinants of grassroots project success among HIV/AIDS NGOs operating in Rakai, Uganda. It was a cross‐sectional study using face‐to‐face interviews in a mixed‐methods approach among community members and NGOs involved in providing HIV/AIDS and related health services. The study found that the success of grassroots projects of HIV/AIDS NGOs essentially relies on adequate financial resources, competent human resources, strong organizational leadership, and NGO networking. These data suggest that to increase grassroots project success, HIV and AIDS NGOs in Rakai need to improve not only the budget base and human capacities but as well decision‐making processes, organizational vision, mission and strategies, gender allocation in staffing, and beneficiary involvement. Copyright © 2010 John Wiley & Sons, Ltd.     

Translocal and gender dimensions of frame alignment: Community mobilization and recruitment processes among women community health workers in Mexico

The rise of working-class women's organizing, community work around health issues, and non-governmental organizations (NGOs) in Latin America has been attributed to structural and cultural factors. Yet these factors fall short in explaining how women are recruited into community health work and NGOs. In this paper the author argues that the frame alignment is the mediating process that stands between structural and cultural factors and individual women to make community activism in health possible. The frame alignment is an interactive process constituted by the life stories women bring into their activism and the NGO into which they are recruited. Further, the frame alignment is shaped by translocal actors such as state and international institutions as they put frames and financial resources in circulation throughout the Third World, particularly via NGOs. This argument is developd in a case study of women community workers members of a Mexican health-oriented NGO. The author relies on women's and the NGO's narratives to explore how the frame alignment takes place in and through the recruitment of working-class women into community health work within this NGO.     

中国全球健康相关非政府组织的发展策略浅析

国际非政府组织在全球健康治理中发挥了重要作用,也是各国发挥国际影响力的重要渠道,但中国非政府组织目前参与全球健康治理甚少。本文旨在分析中国非政府组织发展的社会政策环境、健康类非政府组织的发展现状并借鉴国外新兴的全球健康相关非政府组织的经验,为中国扶持非政府组织参与全球健康治理提供策略建议。本文发现,中国参与全球健康治理有较好国际机遇;国内社会组织发展环境趋势向好,但具有依附行政体系、政策定向发展等特点。因为专业性、公共服务属性以及与公共治理相关性小,非政府组织参与全球健康可以得到政府的全力支持。健康类非政府组织数量较少、基础较差、参与国际合作少。不同类型健康类社会组织各有长短,国际经验提示新兴机构主要依靠政府力量扶持非政府组织参与全球健康。建议我国政府采取"重点扶持,整体改善"的策略,制定中国全球健康发展战略,以政府附属与社会精英创办的大型非营利机构为重点扶持对象,引导和资助健康类非营利机构走向国际舞台。     

Does involvement of local NGOs enhance public service delivery? Cautionary evidence from a malaria‐prevention program in India

Partnerships between government and non‐state actors that aim to enhance the quality or efficiency of service delivery are increasingly common in today's development policy landscape. We investigate the impacts of such an approach using data from an experimental supportive intervention to India's malaria control program that leveraged local non‐state capacity in order to promote mosquito net usage and recommended fever care‐seeking patterns. The supportive activities were conducted simultaneously by 3 NGOs, contracted out by the Indian government, in 2 endemic districts in the state of Odisha. We find that program impact significantly varied by location. Examining 3 potential sources of this variation (differential population characteristics, differential health worker characteristics, and differential implementer characteristics), we provide evidence that both population and NGO characteristics significantly affected the success of the program. Specifically, the results suggest that the quality and effort of the local implementer played a key role in the differential effectiveness. We discuss these findings as they relate to the external validity of development policy evaluations and, specifically, for the ability of health and other service delivery systems to benefit from limited non‐state capacity in underresourced areas.