Associations between alcohol outlets and emergency department injury presentations: effects of distance from the central business district

Objective : To examine the effects of licensed outlets and sales on levels of alcohol‐related injuries presenting to emergency departments (EDs) in the Inner, Middle and Outer postcode zones of Perth, Australia. Methods : Using panel data (2002–2010), a surrogate measure (based on day of week and time of day of presentation) was used to identify alcohol‐related injuries presenting at EDs. Postcodes were grouped according to their distance from the central business district (CBD). Numbers of alcohol outlets and their sales were the primary explanatory variables. Data were analysed using negative binomial regression with random effects. Results : In the Inner and Outer postcode zones, counts of on‐site outlets were positively associated with alcohol‐related injury (IRR: 1.008; 95%CI 1.003–1.013 and IRR: 1.021; 95%CI 1.013–1.030 respectively). An additional off‐site outlet was associated with 6.8% fewer alcohol‐related injuries (95%CI 0.887–0.980). In the Middle postcode zone, mean off‐site sales were positively associated with injury (IRR: 1.024; 95%CI 1.003–1.044). Conclusions : Associations between alcohol availability variables and injury differed by outlet type and distance from the CBD. Implications : These findings provide further evidence to support stronger controls on liquor licensing, and indicate the need for different controls according to the location and type of licence.     

Cost-effective public health guidance: asking questions from the decision-maker's viewpoint

In February 2004, in his assessment of the long-term financial viability of the NHS, Derek Wanless recommended the use of 'a consistent framework, such as the methodology developed by NICE, to evaluate the cost-effectiveness of interventions and initiatives across health care and public health'. One year later public health was added to NICE's remit and the new National Institute for Health and Clinical Excellence (NICE) was established, with amended statutory instruments to permit consideration of broader public sector costs when developing cost-effective guidance for public health.With the principle of 'a consistent framework' put forward by Wanless as the starting point, this paper provides an insight into the most challenging aspects of applying the principles of cost-effectiveness analysis in the public health context from the policymaker's perspective. It reflects on the long-term consequences of taking on responsibility for producing public health guidance on the Institute's overall approach to guidance development and describes the tension between striving for consistency and cross-evaluation comparability while ensuring that the methodological tools used are fit for the purpose of developing public health guidance.     

Brazil and access to HIV/AIDS drugs: a question of human rights and public health

I explore the relationship between public health and human rights by examining the Brazilian government's policy of free and universal access to anti-retroviral medicines for people with HIV/AIDS. The Brazilian government's management of the HIV/AIDS epidemic arose from initiatives in both civil society and the governmental sector following the democratization of the country. The dismantling of authoritarian rule in Brazil was accompanied by a strong orientation toward human rights, which formed the sociopolitical framework of Brazil's response to the HIV/AIDS epidemic. Even if the Brazilian experience cannot be easily transferred to other countries, the model of the Brazilian government's response may nonetheless serve as inspiration for finding appropriate and lifesaving solutions in other national contexts.     

Healthcare-associated infections: challenges to public health in Brazil

This study presents a critical evaluation of the scientific literature related to this subject, aiming to assess the policies and administrative issues regarding the prevention and magnitude of healthcare-associated infections and discuss the challenges for their prevention in Brazil. The topics discussed included historical and administrative issues, challenges imposed by the characteristics of the healthcare system and the territorial dimension, laboratorial support limitations, costs, institutional culture, professional qualification, and patient engagement. It is urgent to hold a nationwide discussion among government representatives, institutions, and healthcare workers and users to overcome these challenges.     

Australian television news coverage of alcohol,health and related policies, 2005 to 2010: implications for alcohol policy advocates

Objective: To describe television news coverage between 2005 and 2010 of alcohol, health and relevant alcohol‐control policies, with a view to informing policy advocacy. Methods: A content analysis of all alcohol stories archived by the Australian Health News Research Collaboration. We recorded what triggered a news item, the main topics covered, whether risks to health were communicated, whether alcohol‐control policies were featured and which news‐actors appeared. Results: We identified 612 stories, where 69.2% were triggered by a particular newsworthy incident or the release of new findings. The most frequently reported alcohol stories were focused on associated harms (30.2%) and ‘binge drinking’ (19.0%). A majority (75.3%) reported a variety of positive and negative health effects, yet mainly focused on short‐term consequences. Combined, 63% mentioned an alcohol‐control policy, yet no one particular policy was featured in more than 10% of all stories. The most commonly featured news‐actors included public‐health professionals (50.0%), members of affected communities (28.4%) and government representatives (24.3%) Conclusions: Problems related to alcohol were well‐established foci of news attention and reportage and covered a broad spectrum of issues related to public health goals, yet less coverage centred on long‐term health consequences or effective policy solutions. Implications: Future policy advocacy could focus on moving the debate away from simple problem definition to better communication of long‐term health risks, existing policies, and evidence of their effectiveness and arguments for their adoption. Future research might consider audience understanding of the information.     

Priority access to health care: Evidence from an exogenous policy shock

Access to care is an important issue in public health care systems. Unlike private systems, in which price equilibrates supply and demand, public systems often ration medical services through wait times. Access that is given on a first come, first served basis might not yield an allocation of resources that maximizes the health of a population, potentially creating suboptimal heterogeneity in wait times. In this study, we examine an access disparity between two groups of patients—established patients and new patients. We exploit an exogenous policy change—implemented by the U.S. Veterans Health Administration—that removed the disparity and homogenized the wait time. We find strong evidence that without such a policy, established patients have priority access over new patients. We discuss whether this is a suboptimal allocation of resources. We additionally find that established patient priority access is an important determinant of access for new patients; accounting for it increased the explanatory power of our statistical model of new patient wait times by a factor of five. The findings imply that policy and management decisions may be more effective in achieving the optimal distribution of access if access heterogeneity is recognized and accounted for explicitly.     

The post‐2015 landscape: vested interests,corporate social responsibility and public health advocacy

This paper explores the tensions between UN calls for private sector engagement in the post‐2015 landscape and public health opposition to those ‘harm industries’ that are ‘corporate vectors of disease’ for the mounting global non‐communicable disease burden. The UN's support for public‐private partnership has provided industries with ‘vested interests’ in the propagation of unhealthy behaviours with new opportunities for the strategic alignment of their corporate social responsibility (CSR) endeavours with the post‐2015 sustainable development agenda. This has galvanised public health advocates to place pressure on the World Health Organisation to formalise their ambiguous stance towards private sector involvement in public policy formation and the resultant ‘conflicts of interest’. This paper critically examines the ‘gathering storm’ between this ‘anti‐corporate movement’ and the alcohol industry in the increasingly politicised domain of CSR. Drawing on the example of SABMiller's Tavern Intervention Program, the paper argues that CSR represents a profound threat to the sanctity and moral authority of the public health worldview. Questions therefore need to be asked about whether the public health‐led path of industry non‐association will necessarily result in health improvements or just a further retrenchment of the ideological faultlines explored in the paper.     

Social capital and access to primary health care in developing countries: Evidence from Sub-Saharan Africa

We test for a causal role of social capital, as measured by self-reported trust, in determining access to basic health facilities in Sub-Saharan Africa. To skirt the reverse-causality problems between social capital and basic health, we rely on instrumental-variable (IV) estimates. A one standard-deviation increase in trust is predicted to lead to a 0.22 standard-deviation fall in doctor absenteeism, a 0.31 standard-deviation fall in waiting time and a 0.30 standard-deviation fall in bribes. As a robustness check, we also use a different database regarding a different health issue, access to clean water. We find that a one standard-deviation rise in trust leads to a 0.33 standard-deviation rise in access to clean water. The variety of public goods considered provides insights about the possible channels through which social capital is converted into health improvements.     

Welfare consequences of access to health insurance for rural households: Evidence from the New Cooperative Medical Scheme in China

This study evaluates the welfare benefits of the New Cooperative Medical Scheme (NCMS), the main public health insurance plan for the rural population in China. The findings show that the value of the NCMS to recipients is slightly lower than the government's costs of implementation, ranging from 0.79 to 0.97 per RMB of the resource cost of the NCMS. The estimated moral hazard costs are low compared with the total benefits. It is also estimated that the benefits originating from the NCMS's insurance function only constitute 20% of the total benefits, suggesting a need for higher generosity levels among rural households. Our results shed new light on the welfare effects of access health insurance among low‐ and middle‐income households.     

Co-ordination, collaboration and health promotion: lessons and issues from an alcohol education programme

This article draws upon the evaluation of an alcohol educationprogramme in South West England to develop a discussion abouthow to improve co-ordination and collaboration in health promotionbetween different professionals. The importance of collaborationis frequently recognized but research evidence suggests thatit is very hard to achieve. Three main issues are addressed.First, the article considers how the national funders of regionalprogrammes can improve their relationship with local agencies.Second, the district co-ordination model of the South West programmeis assessed as a possible model for co-ordination across a rangeof health topics. Third, the tactics of professional networkdevelopment at the local level are explored.     

Public health regulation and mortality: Evidence from early 20th century milk laws

In this paper, I estimate the impact of city-level public health regulations in the market for cow's milk on the mortality of infants and young children between 1900 and 1920. I find that the introduction of city-level dairy farm inspections reduced mortality from Diarrhea & Enteritis for one-year-old children by 1.3 annual deaths per thousand, a 14 percent effect relative to the baseline rate for this cause and a 3 percent effect relative to the baseline rate for all causes for this age group. Back-of-the-envelope calculations reveal that the benefits from these regulations exceeded costs by at least a factor of two.     

从鼠疫之殇到卫生之治:近代哈尔滨公共卫生法制的发展

目的 医疗卫生特别是疫病防治是重大的民生问题,随着近代哈尔滨的城市化发展,其卫生问题也逐渐凸显,溯源城市卫生法制的发展及其产生的影响具有积极的意义。方法 以法律史的视角和方法,以档案、市志、报纸等史料为基础,探究城市卫生法制的发展。结果 清末时期是近代哈尔滨公共卫生发展的初创阶段,并以鼠疫的爆发为契机,以防疫局的建立和防疫的制度化为起点开启了公共卫生事业的起步。民国时期,卫生行政机构的独立,卫生医疗机构的涌现,以及卫生立法的扩容进一步推动了公共卫生法制的发展,人们不良的卫生习惯也逐渐受到制度的约束,卫生意识从稚弱到成长。解放区时期,民主政权在为人民服务的思想下对卫生机构和从业人员进行了接管和改造,在保障人民健康和支援解放战争的宗旨下开展卫生立法,人民群众的卫生意识也在城市卫生管理的参与中得到了提高。结论 近代哈尔滨公共卫生法制发轫于清末、发展在民国、整合在解放区,其卫生法制的探索历程与实践经验也为后来解放的城市提供了可贵的借鉴。     

Access to health information on alcohol and tobacco among adolescents in Tanzania

Basic health information on alcohol and tobacco is usually availableto adolescents in industrialized countries, but this is notalways the case in developing countries. Alcohol and tobaccoconsumption are common in Tanzania, hence preventive strategies,including information dissemination, especially to adolescents,are essential. This study examines the access to informationon alcohol and tobacco among adolescents in Tanzania. A randomsample of 2869 pupils aged 10–18 years from fourth toseventh grades at 18 primary schools located in three regionswere studied. These pupils completed a questionnaire. Theirresponses indicated limited access to information on alcoholand tobacco, in particular among the girls and the younger pupils.For those who had received such information, their main sourceswere parents, health workers, religious leaders, schoolteachersand the media. These sources differed by age, gender, religionand residential area of the adolescents. The messages usuallyobtained were on health and social problems of drinking andsmoking. However, a few adolescents especially in the ruralareas had information on economic, medicinal and recreationalbenefits of alcohol or tobacco, or on how to produce these substances.These findings indicate a need for a national strategy for provisionof proper and equitable health information for preventing drinkingand smoking behaviours among adolescents in Tanzania.     

Private choices,public costs: Evaluating cost-shifting between private and public health sectors in New Zealand

New Zealand’s dual public-private health system allows individuals to purchase health services from the private sector rather than relying solely upon publicly-funded services. However, financial boundaries between the public and private sectors are not well defined and patients receiving privately-funded care may subsequently seek follow-up care within the public health system, in effect shifting costs to the public sector. This study evaluates this phenomenon, examining whether cost-shifting between the private and public hospital systems is a significant issue in New Zealand.We used inpatient discharge data from 2013/14 to identify private events with a subsequent admission to a public hospital within seven days of discharge. We examined the frequency of subsequent public admissions, the demographic and clinical characteristics of the patients and estimated the direct costs of inpatient care incurred by the public health system.Approximately 2% of private inpatient events had a subsequent admission to a public hospital. Overall, the costs to the public system amounted to NZ$11.5 million, with a median cost of NZ$2800. At least a third of subsequent admissions were related to complications of a medical procedure.Although only a small proportion of private events had a subsequent public admission, the public health system incurred significant costs, highlighting the need for greater understanding and discussion around the interface between the public and private health systems.