Non-communicable diseases and global health governance: enhancing global processes to improve health development

This paper assesses progress in the development of a global framework for responding to non-communicable diseases, as reflected in the policies and initiatives of the World Health Organization (WHO), World Bank and the UN: the institutions most capable of shaping a coherent global policy. Responding to the global burden of chronic disease requires a strategic assessment of the global processes that are likely to be most effective in generating commitment to policy change at country level, and in influencing industry behaviour. WHO has adopted a legal process with tobacco (the WHO Framework Convention on Tobacco Control), but a non-legal, advocacy-based approach with diet and physical activity (the Global Strategy on Diet, Physical Activity and Health).     

Clinical governance. Scope to improve

A survey of all 47 trusts in the West Midlands found that clinical governance had not been advanced beyond the production of strategies, establishing committees and appointing leads. There is little evidence of the cultural change clinical governance requires. Clinical governance has yet to make a real difference at the clinical workface.     

The need to improve health care in prisons

OBJECTIVE

To analyze physical structure, working conditions of health professionals and outline of the procedures established in prisons.

METHODS

We analyzed 34 provisional detention centers and 69 male and six female prison units in the state of Sao Paulo, Southeastern Brazil, in 2009. A self-applied instrument was developed to collect quantitative data on the characteristics of health care structure, equipment and personnel in prisons. Analysis of variance (ANOVA) or equivalent non-parametric tests and Chi-square or Fisher’s tests were used to compare categorical and continuous variables, respectively, between the groups.

RESULTS

The main problems were delays in the results of laboratory tests and imaging. With respect to the teams, it was observed that a large majority were in conditions close to those proposed by the Bipartite Commission 2013 but without improvement being reflected in the indicators. With respect to the process, more than 60.0% of prisons located in small towns do not have the structural conditions to ensure secondary or tertiary health care for the continuity of treatment.

CONCLUSIONS

This profile of prisons in the country can be used for planning and monitoring future actions for the continuous improvement of healthcare processes.     

The global health governance of antimicrobial effectiveness

Antimicrobial resistance is a growing threat to public health the world over. Global health governance strategies need to address the erosion of antimicrobial effectiveness on three levels. Firstly, mechanisms to provide incentives for the pharmaceutical industry to develop antimicrobials for diseases threatening the developing world need to be sought out. Secondly, responsible use of antimicrobials by both clinicians and the animal food growing industry needs to be encouraged and managed globally. And lastly, in-country and international monitoring of changes in antimicrobial effectiveness needs to be stepped up in the context of a global health governance strategy.     

Changing lifestyles to improve health

Lifestyle is the most important modifiable factor influencing health and illness today. It is difficult to stimulate the development of or change to a     

全球卫生法:全球卫生治理的新趋势

全球化对全球人口的健康产生了深刻影响.疾病全球化呼吁公共卫生治理的全球化.全球卫生治理与传统的国际卫生治理在治理主体、治理方式、治理结构及价值取向等方面存在区别.全球卫生治理的目标是让全世界人民获得可能的最高水平的健康标准.人人享有健康的美好理想只有通过全球卫生"善治"才能实现.而实现全球卫生"善治"的主要机制是国际卫...     

The complexities of multi-level governance in public health

This article reviews some of the challenges to developing national public health programs, focussing on the distribution of constitutional authority for public health and governance challenges that arise from this. Constitutional authority for public health resides primarily with the provinces. The federal government has obtained the authority to legislate in this area primarily through its power over criminal law. Challenges facing the establishment of national public health programs include the ambiguity over constitutional responsibility, challenges in managing externalities and spillovers, and issues related to funding and data ownership. Policy-making is also complicated by the importance of municipal and supranational governments in public health. National programs need to be structured in a way that balances the advantages of regional approaches to public health challenges with the benefits of a coordinated central response. To do so, policy-makers need to address unique challenges to public health governance.