Influencing public health policy: to what extent can public action defining the policy concerns of government?

Aim  

The aim of this paper is to provide a discussion on how the public health policy process can be influenced by both civil society groups and by public health practitioners.     

Do individuals’ health preferences validate the decentralisation of the public health system in Spain?

The objective of this paper is to estimate individuals’ preferences about public health services in two Spanish regions, the Basque Country (BC) and Canary Islands (CI) and analyse whether they differ. This work was motivated by the actual economic situation, where it is necessary to obtain equilibrium between the needed health services and limited economic resources. With this limitation in mind, politicians have tried to design health policies that maximise individuals’ welfare. Based on the theory of decentralisation, the devolution of public expenditure decisions and management to regional government maximises individuals’ welfare more when individual preferences differ among regions. A discrete choice experiment was implemented with a survey designed to obtain data about individuals’ choices. Using this data and discrete choice models, individual preferences for health services were estimated. Our findings indicate that these preferences differ among regions, so, for reasons of efficiency, decentralising decisions and management of public health policies to regional governments would be recommended. Once health policies are decentralised, our results provide a tool for identifying the health services most valued by the individuals in each region. This information would be useful policymakers designing health policies.     

Can public health and medicine partner in the public interest?

The dominant issues for health and health care today can be effectively engaged only if public health and medicine work together as better partners. Yet historical, professional, organizational, operational, and financial barriers exist to closer relationships. Fostering the necessary collaboration will require changes for both public health and medicine in leadership styles, professional education, practice incentives, accountability measures, and financing structures.     

Who does the work of public health?

Frequently, we take the "public" out of public health and allow the practice to become extremely narrow, limited to experts telling the public what's best for them.     

Prospects for the elimination of leprosy as a public health problem in the State of Paraná, Brazil

Leprosy, an endemic contagious/infectious disease, is still a public health problem in most States of Brazil, despite an important decrease in the prevalence rate in recent years. The current study aims to analyze the prospects for the elimination of leprosy in the State of Paraná, based on detection and prevalence rates for the years 2000 to 2005, in addition to data on gender, age, clinical form, operational classification, and number of skin lesions. Data were obtained from the Reportable Diseases Information System (SINAN) and the Tabnet software. Leprosy detection and prevalence rates in Paraná remained unaltered during the study period. The leprosy detection rates were high or very high in the majority of the health districts in the State. In terms of prevalence, eight health districts had reached the goal of eliminating the disease. In conclusion, the State of Paraná is close to reaching the goal of eliminating leprosy. Based on the study results, actions are recommended to eliminate the disease as a public health problem.     

“Human trafficking,public health and the law”: a comprehensive analysis of intersections

Aim

The extraordinary topic of “Human Trafficking, Public Health and the Law” was subject of an interdisciplinary and international Spring School that took place in March 2013 in Italy. The aim of the meeting was a comprehensive examination of the human trafficking issue.

Subject and methods

In collaboration with seven expert lecturers, a group of students particularized the issues and claims related to human trafficking and public health from the angles of all relevant disciplines. Past legal decisions were evaluated in order to recommend future solutions in the common interest with respect to human dignity.

Results

The main outcome of the two weeks of lectures, group work and a field trip are practical approaches and the document: Siena Principles on Human Trafficking and Public Health.

Conclusion

The costs for society that arise due to the adverse effects of human trafficking encompass the degradation of human rights, poor public health, weakened social development, and disturbed communities. Human trafficking therefore is a critical health issue with serious social implications that requires both medical and legal attention.     

Intergenerational photovoice perspectives of place and health in public housing: Participatory coding,theming, and mapping in/of the “structure struggle”

This paper details an intergenerational photovoice project exploring spatial and perceptual differences of “place” and health among adult and youth public housing residents in a small urban rustbelt city in the Midwestern United States. It specifically highlights the value of fully participatory photovoice processes—participatory narrative-coding and digital web-based photo-mapping—in furthering conceptual and analytical understanding of “place” and health. Results indicate the critical import of accounting for non-residential locations (i.e. activity spaces), and the significance of engaging the generationally- and spatially-specific social and physical landscapes of residents’ lived “place” to improve health opportunities within place-based strategies involving public housing.     

Are schools of public health needed to address public health workforce development in Canada for the 21st century?

In addition to establishing Canadian federal institutions for public health to work in cooperation with provincial and local health authorities, the infrastructure of public health for the future depends on a multi-disciplinary and well-prepared workforce. Traditionally, Canada trained its public health workforce in schools of public health (or hygiene), but in recent decades this has been carried out in departments and centres primarily within medical faculties. Recent public health crises in Canada have led to some new federal institutions and reorganization of public health activities as well as other reforms. This commentary proposes re-examination of the context of public health workforce training and especially for schools of public health as independent faculties within universities as in the United States or, as developed more recently in Europe, semi-independent schools within medical faculties. The multi-disciplinary nature of public health professionals and the complex challenges of the "New Public Health" call for a new debate on this vital issue of public health workforce development. Public health needs a new image and higher profile of training, research and service to meet provincial and national needs, based on international standards of accreditation and recognition.     

More physicians in public health: less public health work?

AIM: The object was to assess changes in work priorities in local public health medicine in Norway over the period from 1994 to 1999. METHODS: Two cross-sectional studies were undertaken of physicians working in local public health medicine in all Norwegian municipalities, using a postal questionnaire. RESULTS: Half of the physicians working in public health in 1999 were recruited after 1994. Although the number of physicians working in public health increased from 505 in 1994 to 555 in 1999 (10%) an estimation of the total weekly hours worked decreased by 3.7% from 8,715 hours in 1994 to 8,386 hours in 1999. The vast majority of physicians worked in combined posts (87%), and they reduced their engagement in public health by 2.6 hours on average from 1994 to 1999. The reduction depended on remuneration model, speciality in community medicine, and municipality size. CONCLUSIONS: Local public health in Norway was under pressure in the 1990s. For public health physicians, preventive medicine lost out to clinical work. No promising signals of change in the professional or political framework or in incentives for public health work are seen.     

Lifeworld-led care: Is it relevant for well-being and the fifth wave of public health action?

A recent paper has made the case for a “fifth wave” of public health action. The paper articulated the first four waves as focusing on civil engineering, the germ theory of disease, welfare reforms and lifestyle issues. This article will focus on well-being and will expand on the authors’ articulation of a current need to “discover a new image of what it is to be human” to begin to address the challenges of promoting well-being. This article will consider an alternative way of viewing human beings within a “caring” context and how this alternative view may aid this potential fifth wave of public health action. This alternative view has emerged from the work of Husserl who suggested that any human view of the world without subjectivity has excluded its basic foundation. The phenomenological understanding of “lifeworld” is articulated through five elements, temporality, spaciality, intersubjectivity, embodiment and mood that are all discussed here in detail. A world of colours, sparkling stars, memories, happiness, joy, anger and sadness. It is this “lifeworld’ that when health care or as argued in this article as public health becomes overly focused on decontextualized goals, and measuring quality superficially can be neglected.