Public health genetics--potential for public health?

Although it is well understood that the disciplines of medicineand public health are different in their goals and practices,in the context of genomics this difference is even more pronounced.While medical genetics concerns the clinical decision made bya doctor to use genomic knowledge for the benefit of the patient,public health genetics may be defined as the systematic integrationof genomics into public health research, policy and practice.¹     

Wither? Public health in a changing Europe

Large parts of the population of the wealthier countries havenot enjoyed the health benefits of their more fortunate citizens.We have not reached the limits of what we can achieve in healthby any means.¹ The conditions and determinants of population health have changedmarkedly over the last decades, and so has the context of publichealth. We are living in a globalized world. Health is seenas a major driving force for economic and social development.The public     

Public health. Too much to handle?

Organisations involved in public health welcome primary care trusts' role in the reorganised service and the establishment of public health networks. But there are concerns about shortage of specialist expertise. They believe PCTs have not yet developed their public health role. The public health role of strategic health authorities is seen as unclear. There are concerns about inequities in the distribution of public health resources to PCTs.     

Public health strategies for M?ori.

When the New Zealand Department of Public Health was established in 1900, Ma?ri health status was compromised to the extent that survival itself was threatened. The remarkable turnaround was unexpected and owes much to pioneer Ma?ri professionals, especially the first Ma?ri medical practitioner, Dr. Maui Pomare, who graduated in the United States in 1899. As "Medical Officer to the Ma?ris," and later as Minister of Health, he made major changes through a five-part strategy: recognizing Ma?ri community leaders as leaders in health, improving access to societal goods and services (especially housing and education), appealing to cultural practices that were linked to good health, wise use of political power, and developing a skilled Maori health workforce to complement community leadership. Although mental health disorders and lifestyle illnesses have largely replaced infectious diseases, malnutrition, and tuberculosis, Pomare's strategy has continuing relevance and warrants serious consideration as a model for health promotion.     

Public health policies: a Scandinavian model?

AIM: To identify how public health problems are identified, explained, and addressed in Scandinavian public health programmes. METHODS: Recent public health white papers from Denmark, Norway, and Sweden have been studied asking the following questions. How are policies and activities justified? Which problems and causes are identified? What is to be done? To what extent are the interpretations and suggested interventions in accordance with liberal or social democratic political ideals? RESULTS: The programmes studied give similar reasons for dealing with public health, namely the wish to create good lives for citizens and to improve the economy of society. The health problems identified are almost the same: cancer, heart disease, diabetes, musculoskeletal diseases, and mental illness. The Danish programme differs from its Norwegian and Swedish counterparts with regard to explanations and suggested solutions to the problems. It may be characterized as more liberal. While the Danish programme stresses the importance of individual behaviour, responsibility, and autonomy, the two others emphasize social relations, living conditions, and participation in addition to behavioural factors. Political responsibility for the health of the population is emphasized in the Norwegian and Swedish programmes. The Swedish programme, in particular, stresses common values such as equality and equal rights, and the significance of the welfare state. The Norwegian programme underlines the importance of empowering the individual, an ambition that could also be seen as a social liberal ambition to increase the self-determination of citizens. CONCLUSION: There is not one Scandinavian model in public health policy but several: a Danish model mainly adhering to liberal ideals, a Norwegian one that could tentatively be labelled social liberal, and a Swedish model adhering to more social democratic ideals.     

Public health preparedness: evolution or revolution?

The recent emphasis on preparedness has created heightened expectations and has raised questions about the extent to which U.S. public health systems have evolved in recent years. This paper describes how public health preparedness is transforming public health agencies. Key signs of change include new partnerships, changes in the workforce, new technologies, and evolving organizational structures. Each of these elements has had some positive impact on public health; however, integration of preparedness with other public health functions remains challenging. The preparedness mission has also raised challenges in the areas of leadership, governance, quality, and accountability.     

Public health research: between science and action?

In this text, we first propose a concept of public health research as a multidisciplinary endeavor whose aim is to identify the main determinants of people's health status, analyzed at the collective level. The public's health is thus envisioned as a socially determined reality, in which risk factors include biological phenomena as well as a given community's social and economic environment. Second, we argue that public health research should be applicable research, i.e. that it should be useful to decision-makers. But since the relationship between science and action is conflicting, it is necessary to invent mediatory practices to facilitate interaction between researchers and decision-makers.     

Too small for concern? Public health and nanotechnology

While advances in nanotechnology promise to deliver significant benefits to many aspects of health care, there is increasing concern that regulatory regimes do not adequately capture the potential risks associated with this new technology. Concerns have arisen due to preliminary evidence suggesting that some engineered nanoparticles may display undesirable toxicological properties, presenting potential risks to human and environmental health and safety. Within this context, the role of Australia's National Industrial Chemicals and Assessment Scheme and the Therapeutic Goods Administration in regulating nano-based substances is explored. Drawing on earlier regulatory failures, combined with the scientific uncertainty surrounding nanotechnology, this article recommends that Australia adopt a proactive regulatory approach to nanotechnology through amendments to present legislative regimes. The approach articulated in this article strikes a balance between the current approach and that of the European Union's comprehensive new chemicals regime. Immediate regulatory change is called for in order to ensure that the health of the Australian public is adequately protected over the coming years.     

Public health and health administration: collaboration or competition? An Australian perspective

The Review of Postgraduate Public Health Training in Australia 1988, commissioned by the Australian Public Health Association, identified as a major issue the degree of collaboration between independent postgraduate courses in health administration and courses in public health. This paper suggests that the two fields share the common goal of health service education, which they pursue by the respective pathways of effectiveness and efficiency. We argue that the identity and the complementarity of the disciplines are best served by a collaborative model and discuss ways to encourage and achieve this aim.     

Public trust in health care: a performance indicator?

PURPOSE: If public trust in health care is to be used as a performance indicator for health care systems, its measurement has to be sensitive to changes in the health care system. For this purpose, this study has monitored public trust in health care in The Netherlands over an eight-year period, from 1997 to 2004. The study expected to find a decrease in public trust, with a low point in 2002. DESIGN/METHODOLOGY/APPROACH: Since 1997, public trust in health care was measured through postal questionnaires to the "health care consumer panel". This panel consists of approximately 1500 households and forms a representative sample of the Dutch population. FINDINGS: Trust in health care and trust in hospitals did not show any significant trend. Trust in medical specialists displayed an upward trend. Trust in future health care, trust in five out of six dimensions of health care and trust in general practitioners actually did show a decrease. However, only for trust in macro level policies and trust in professional expertise this trend continued. For the remaining trust objects, after 1999 or 2000, an upward trend set in. RESEARCH IMPLICATIONS/LIMITATIONS: No support was found for our overall assumption. Explanations for the fact that trust did increase after 1999 or 2000 are difficult to find. On the basis of these findings the study questions whether the measure of public trust is sensitive enough to provide information on the performance of the health care system. ORIGINALITY/VALUE: The aim of this research is to study public trust in health care on its abilities to be used as a performance indicator for health care systems.