Socioeconomic inequalities in child mortality: comparisons across nine developing countries

This paper generates and analyses survey data on inequalities in mortality among infants and children aged under five years by consumption in Brazil, Côte d''Ivoire, Ghana, Nepal, Nicaragua, Pakistan, the Philippines, South Africa, and Viet Nam. The data were obtained from the Living Standards Measurement Study and the Cebu Longitudinal Health and Nutrition Survey. Mortality rates were estimated directly where complete fertility histories were available and indirectly otherwise. Mortality distributions were compared between countries by means of concentration curves and concentration indices: dominance checks were carried out for all pairwise intercountry comparisons; standard errors were calculated for the concentration indices; and tests of intercountry differences in inequality were performed.     

妇幼保健机构模式比较研究

目的 对我国现有的三种妇幼保健机构模式进行比较,总结不同模式的优缺点,探索最适合中国特色,符合妇女儿童健康需求的妇幼保健模式.方法 对妇幼保健政策环境、妇幼卫生事业发展状况等相关理论及研究成果进行系统地文献检索和数据查询,采取抽样调查的方法,确立三个省的省市县三级妇幼保健机构作为对比研究对象(在东部、西部和中部各选一个省,每个省选择一个有代表性的市,每个市选一个县).开展机构调查、服务对象调查及关键人员访谈.分析三种模式机构的职能和运行情况,对不同模式的妇幼保健机构运行效率进行对比,同时对服务对象调查资料进行对比分析.结果 中国妇幼保健机构存在三种模式,其运行效益存在差异.结论 医疗保健预防相结合的模式最适合妇幼保健事业发展,符合新时期妇女儿童医疗保健需求,有利于妇幼保健机构功能任务的实现,有利于提升妇幼保健机构的社会角色地位.这种模式可以使政府投入最少,运行效益最高,自身发展最好,市场竞争力最强,最受妇女儿童的欢迎.建议政府应该进一步支持推广这种医疗保健预防相结合的妇幼保健机构模式.     

国际卫生服务系统绩效评价框架与趋势比较研究

在大多数发达国家,卫生系统绩效改进已经成为一个主要的政策问题。为实现该目标,他们推动发起了各种测量卫生服务系统绩效的倡议。对国际组织及部分典型OECD国家卫生服务系统绩效评价框架体系进行概述,并从体制和运行机制方面对其进行比较分析,找出其建立的背景、特点及内在规律性,以期为我国卫生服务系统绩效评价框架体系的建立提供可借鉴的经验。     

Socioeconomic inequalities in homicide mortality: a population-based comparative study of 12 European countries

Recent research has suggested that violent mortality may be socially patterned and a potentially important source of health inequalities within and between countries. Against this background the current study assessed socioeconomic inequalities in homicide mortality across Europe. To do this, longitudinal and cross-sectional data were obtained from mortality registers and population censuses in 12 European countries. Educational level was used to indicate socioeconomic position. Age-standardized mortality rates were calculated for post, upper and lower secondary or less educational groups. The magnitude of inequalities was assessed using the relative and slope index of inequality. The analysis focused on the 35–64 age group. Educational inequalities in homicide mortality were present in all countries. Absolute inequalities in homicide mortality were larger in the eastern part of Europe and in Finland, consistent with their higher overall homicide rates. They contributed 2.5?% at most (in Estonia) to the inequalities in total mortality. Relative inequalities were high in the northern and eastern part of Europe, but were low in Belgium, Switzerland and Slovenia. Patterns were less consistent among women. Socioeconomic inequalities in homicide are thus a universal phenomenon in Europe. Wide-ranging social and inter-sectoral health policies are now needed to address the risk of violent victimization that target both potential offenders and victims.     

Health surveys in developing countries: the objectives and design of an international programme

There have been calls recently for a major international effort to collect epidemiological information in developing countries. One approach to a World Health Survey is considered, namely single-round retrospective interview surveys. Surveys can contribute to the improvement of national health information systems by providing person-based, rather than episode-based, measures related to health that apply to the entire population. A programme of health interview surveys could be used to ascertain patterns of morbidity and mortality, to measure access to and use of health services and to develop and disseminate methodologies for collecting and analysing health related data. Single-round surveys could not be used to evaluate the impact of investments on health and would be of limited use for improving our understanding of the determinants of ill health. Attention is drawn to a number of conceptual, technical and logistic issues to be considered in the design of a World Health Survey.     

山西省妇幼保健机构人力资源微观管理调查研究

目的通过调查了解山西省妇幼保健机构人力资源微观管理方面的情况。方法对全省12所妇幼保健机构663名在岗人员进行访谈和问卷调查。结果①山西省妇幼保健机构在人员招聘方面缺乏严格的准入制度;②机构内部人员培训方面存在诸多问题,如缺乏培训需求评估、培训内容与员工需求差距较大,实用性不强,培训形式较为单一等;③考核指标缺乏科学性,考核形式单一,考核与激励机制脱节,考核流于形式等。结论山西省妇幼保健机构应加强人力资源管理,围绕人员的培养、使用、评价、激励、保障等环节,建立符合妇幼卫生人才发展特点的人员管理制度,促进人力资源的良性开发和利用。     

Socioeconomic inequalities in mortality among women and among men: an international study

OBJECTIVES: This study compared differences in total and cause-specific mortality by educational level among women with those among men in 7 countries: the United States, Finland, Norway, Italy, the Czech Republic, Hungary, and Estonia. METHODS: National data were obtained for the period ca. 1980 to ca. 1990. Age-adjusted rate ratios comparing a broad lower-educational group with a broad upper-educational group were calculated with Poisson regression analysis. RESULTS: Total mortality rate ratios among women ranged from 1.09 in the Czech Republic to 1.31 in the United States and Estonia. Higher mortality rates among lower-educated women were found for most causes of death, but not for neoplasms. Relative inequalities in total mortality tended to be smaller among women than among men. In the United States and Western Europe, but not in Central and Eastern Europe, this sex difference was largely due to differences between women and men in cause-of-death pattern. For specific causes of death, inequalities are usually larger among men. CONCLUSIONS: Further study of the interaction between socioeconomic factors, sex, and mortality may provide important clues to the explanation of inequalities in health.     

Bullying and symptoms among school-aged children: international comparative cross sectional study in 28 countries

BACKGROUND: There have been no large-scale international comparisons on bullying and health among adolescents. This study examined the association between bullying and physical and psychological symptoms among adolescents in 28 countries. METHODS: This international cross-sectional survey included 123,227 students 11, 13 and 15 years of age from a nationally representative sample of schools in 28 countries in Europe and North America in 1997-98.The main outcome measures were physical and psychological symptoms. RESULTS: The proportion of students being bullied varied enormously across countries. The lowest prevalence was observed among girls in Sweden (6.3%, 95% CI: 5.2-7.4), the highest among boys in Lithuania (41.4%, 95% CI 39.4-43.5). The risk of high symptom load increased with increasing exposure to bullying in all countries. In pooled analyses, with sex stratified multilevel logistic models adjusted for age, family affluence and country the odds ratios for symptoms among students who were bullied weekly ranged from 1.83 (95% CI 1.70-1.97) to 2.11 (95% CI 1.95-2.29) for physical symptoms (headache, stomach ache, backache, dizziness) and from 1.67 (95% CI 1.55-1.78) to 7.47 (95% CI 6.87-8.13) for psychological symptoms (bad temper, feeling nervous, feeling low, difficulties in getting to sleep, morning tiredness, feeling left out, loneliness, helplessness). CONCLUSION: There was a consistent, strong and graded association between bullying and each of 12 physical and psychological symptoms among adolescents in all 28 countries.     

Socioeconomic inequalities in the health of children and adolescents: A comparative study of the five Nordic countries

Background: Socioeconomic differences in health among adultsexist in the Nordic countries as well as in all other countrieswhere this has been examined. The present study examines whethersuch differences can also be found among children and adolescents,whether these differences vary between the Nordic countriesand whether they can be found in all age groups of childrenand adolescents. Methods: Questionnaires on health, well-beingand socioeconomic status (SES) were sent to parents of a randomsample of children aged 2–17 years, equally distributedbetween Denmark, Finland, Iceland, Norway and Sweden. The indicatorsof reported ill health were having one or more chronic diseases,frequent moderate or severe symptoms and short stature. Thesocioeconomic variables were education and occupation of bothparents and disposable family income. Logistic regression analysiswas used to measure the association between health and SES.Results: Parents in lower socioeconomic groups in all countriesreported more ill health for their children at all ages andtheir children more often belonged to the lowest decile in reportedheight. Sweden and Denmark on the whole showed larger inequalitiesthan the other three countries, but the difference between countrieswas small and varied according to the indicators of ill healthused. The size of the reported health inequalities did not varywith age: the differences were as marked among adolescents asamong younger children. Conclusions: Substantial inequalitiesin health according to SES can be found in childhood and adolescence,even in well-developed welfare states.     

Global health inequalities: an international comparison

OBJECTIVE: To study cross-national inequalities in mortality of adults and of children aged <5 years using a novel approach, with clustering techniques to stratify countries into mortality groups (better-off, worse-off, mid-level) and to examine risk factors associated with inequality. DESIGN, SETTING AND PARTICIPANTS: Analysis of data from the World Development Indicators 2003 database, compiled by the World Bank. MAIN OUTCOME MEASURES: Adult and child mortality among countries placed into distinct mortality categories by cluster analysis. RESULTS: 29 countries had a high adult mortality (mean 584/1000; range 460/1000 to 725/1000) and 23 had a high child mortality (mean 207/1000, range 160/1000 to 316/1000). All these countries were in western and sub-Saharan Africa and Afghanistan. Bivariate analyses showed that relative to countries with low child mortality, those with high child mortality had significantly higher rates of extreme poverty (p<0.001), populations living in rural areas (p<0.001) and female illiteracy (p<0.001), significantly lower per capita expenditure on healthcare (p<0.001), outpatient visits, hospital beds and doctors, and lower rates of access to improved water (p<0.001), sanitation (p<0.001) and immunisations. In multivariate analyses, countries with high adult mortality had a higher prevalence of HIV infection (odds ratio per 1% increase 18.6; 95% CI 0.3 to 1135.5). Between 1960 and 2000, adult male mortality in countries with high mortality increased at >4 times the rate in countries with low mortality. For child mortality, the worse-off group made slower progress in reducing <5 mortality than the better-off group. CONCLUSIONS: Inequalities in child and adult mortality are large, are growing, and are related to several economic, social and health sector variables. Global efforts to deal with this problem require attention to the worse-off countries, geographic concentrations, and adopt a multidimensional approach [corrected] to development.