Physical Activity Information Seeking and Advertising Recall

The purposes of this research were to examine the characteristics of those who look for physical activity-related information, where they find it, and to examine what types of physical activity-related advertisements are recalled (i.e., publicly funded or commercial). These purposes were tested using secondary data analyses from two population health surveys. Results from the first survey (n = 1211) showed gender, age, education, and activity-level differences in who is more likely to search for physical activity-related information. Adding the goal of being active into the model made age and activity level no longer significant but gender and education remained significant factors. The Internet was the most often cited source of physical activity information. The second survey (n = 1600) showed that adults 55 years of age or older and participants with the least amount of education were more than twice as likely to name commercial advertisements than were participants aged 18–54 years or those with more education. These results help further our understanding of how publicly funded promotional campaigns fare against commercial advertising and also highlight the need to understand physical activity information-seeking behavior on the Internet and its implications for health promotion.     

Physical activity information seeking and advertising recall

The purposes of this research were to examine the characteristics of those who look for physical activity-related information, where they find it, and to examine what types of physical activity-related advertisements are recalled (i.e., publicly funded or commercial). These purposes were tested using secondary data analyses from two population health surveys. Results from the first survey (n=1211) showed gender, age, education, and activity-level differences in who is more likely to search for physical activity-related information. Adding the goal of being active into the model made age and activity level no longer significant but gender and education remained significant factors. The Internet was the most often cited source of physical activity information. The second survey (n=1600) showed that adults 55 years of age or older and participants with the least amount of education were more than twice as likely to name commercial advertisements than were participants aged 18-54 years or those with more education. These results help further our understanding of how publicly funded promotional campaigns fare against commercial advertising and also highlight the need to understand physical activity information-seeking behavior on the Internet and its implications for health promotion.     

Health insurance and private providers: A study of the civil servants' medical benefit scheme in bangkok,Thailand

Compulsory health insurance schemes have received attention recently as a means of creating a reliable extra-budgetary source of health care funding. Yet, the full implications of such schemes in a developing country context are unclear; in particular, the impact on and relationship with private sector providers has infrequently been explored. This study examines patterns of public and private sector utilization under the Civil Servants' Medical Benefit Scheme (CSMBS) in Bangkok, Thailand. The CSMBS currently provides limited reimbursement for private inpatient care, but recent proposals suggest increasing benefit levels for care sought in the private sector. The study shows that despite high level of cost recovery in the public sector, charges were much lower than those in the private sector. Different patterns of diagnosis in the two sectors were found with private hospitals tending to treat a less complex case mix. Within the private sector, there was a limited tendency to specialize in certain types of care. It is concluded that under the current payment mechanism of fee-for-service reimbursement, measures to enhance access to private sector care should be approached with caution. In the long run, the scheme should merge with the recently established social security scheme.     

Historic day for Malaysian consumers

The Malaysian Medical Association, the Malaysian Dental Association, the Malaysian Pharmaceutical Society, and the Federation of Malaysian Consumer Associations have introduced and endorsed the Charter for Patient Rights. The Charter recognized that health care is a basic human right, regardless of race, religion, social status, and ability to pay. Further, consumers have the right to seek medical care in both the public and private sectors. The Charter also includes the right to a second opinion, one's own medical records, and explanation before receiving any medical treatment and concerning the risks of treatment, compensation for negligence, and adequate information. Malaysia is the second Asian country to have such a charter, South Korea being the first. The UK also has a Patients Charter. The rest of Europe is also moving to adopt such a charter. The private sector, which serves only those who can afford them, provides most health care services in developing countries. Thus, a large private sector threatens the elderly, unemployed, rural poor, and the mentally ill in these countries. The supply of these services is a marketable commodity which physicians and health care professionals own and sell. The medical community has planned, formulated, implemented, and monitored health services in most of these countries. Therefore, the private sector is a major obstacle to health for all. The Charter helps to break down the barrier by informing both physicians and their patients of their rights and responsibilities.     

The impact of moderate and major workplace expansion and downsizing on the psychosocial and physical work environment and income in Sweden

AIMS: To describe the effect of organizational change (moderate and major expansion and downsizing) on psychosocial work characteristics, physical hazards, and income in a representative sample of larger workplaces in Sweden. METHODS: Annual changes in workforce size for the years 1991-1996 were derived from tax registry data. Work environment characteristics were measured in a sub-set of participants from the biennial Swedish Work Environment Surveys for 1991, 1993, and 1995. Income data were derived from national registries. RESULTS: Not all organizational change resulted in a poorer work environment. The number of beneficial outcomes associated with moderate downsizing and moderate expansion in the public sector outweighed the number of adverse outcomes. However, in the private sector the overall effect of moderate organizational change was a poorer work environment. Major downsizing was associated with a better psychosocial work environment for private-sector men and major expansion with a poorer environment for public-sector women and private-sector men. Otherwise, associations between major organizational change and the psychosocial work environment were mixed across sex and sector, although major organizational change was consistently associated with a greater risk of physical hazards. Low income was associated exclusively with organizational downsizing in the private sector. CONCLUSIONS: More research is needed to determine whether the work environment can explain observed associations between organizational change and health. Data limitations prevented the authors from examining this in the present study. Their findings indicate that future research on the work environment should pay more attention to physical hazards.     

Caught in the competitive crossfire: safety-net providers balance margin and mission in a profit-driven health care market

This paper describes how intensifying competitive pressures in the health system are simultaneously driving increased demand for safety-net care and taxing safety-net providers' ability to maintain the mission of serving all, regardless of ability to pay. Although safety-net providers adapted to previous challenges arising from managed care, health system pressures have been more intense and more generalized across different sectors in recent years than in the past. Providers are adopting some of the same strategies being used in the private sector to attract higher-paying patients and changing their "image" as a safety-net provider.     

The political process and the private health sector's role in Vietnam

Vietnam has experienced a period of economic and political transition from a command economy to one of market socialism. This transition has precipitated a shift in the policies concerning the private sector, as well as increased demand for services from the private health sector. The private sector has evolved, though more rapidly in the Ho Chi Minh City area, with the passing of laws and regulations concerning private practice. The policy maker's concern is to maintain the equity gains realized under the public health system while using the private sector growth to make improvements in the system's efficiency. The political process enabling expansion of the private health sector has been slow, and will continue to be measured as it seeks to create a national health system with a rational integration of the public and private sectors.     

Food advertising targeted at school-age children: a content analysis

OBJECTIVE: To determine whether the contents of food and beverage advertisements are associated with physical activity and athletic ability more often than those for toys and games, and to describe persuasive techniques used in advertising food and beverages to children. DESIGN: A content analysis of advertisements during 31 hours of school-age children's television programming. ANALYSIS: Chi-square tests were used to examine differences in depictions of physical activity. Types of persuasive techniques were tabulated and, within each advertisement, categorized as implicit or explicit. RESULTS: Food and beverage ads depicted children engaged in physical activity and associated the advertised product with athletic ability significantly more than toy and game ads. Food was most often associated with fun and good times (75%), pleasant taste (54.1%), being hip or cool (43.2%), and feelings of happiness (43.2%). IMPLICATIONS FOR RESEARCH AND PRACTICE: These findings raise concern that greater levels of physical activity and athletic ability in food advertising, in which the product is frequently associated with fun, may promote overconsumption, especially of calorie-dense, nutrient-poor foods. Further research would elucidate whether this concern is warranted. On the other hand, since food advertisements are presumably effective, health educators can use these techniques to formulate messages for nutritious foods. This concept should be tested with well-designed interventions.     

The impact of public employment on health and health inequalities: evidence from China

Because the public and private sectors often operate with different goals, individuals employed by the two sectors may receive different levels of welfare. This can potentially lead to different health status. As such, employment sector offers an important perspective for understanding labor market outcomes. Using micro-level data from a recent Chinese household survey, this study empirically evaluated the impact of employment sector on health and within-sector health inequalities. It found that public sector employment generated better health outcomes than private sector employment, controlling for individual characteristics. The provision of more job security explained an important part of the association between public sector employment and better health. The study also found less health inequality by social class within the public sector. These findings suggest that policymakers should think critically about the "conventional wisdom" that private ownership is almost always superior, and should adjust their labor market policies accordingly.     

The consequences of health service privatisation for equality and equity in health care in South Africa

The trend towards the privatisation of health services in South Africa reflects a growing use of private sources of finance and the growing proportion of privately owned fee-for-service providers and facilities. Fee-for-service methods of reimbursement aggravate the geographical maldistribution of personnel and facilities, and the competition for scarce personnel resources aggravates the difference in the quality of the public and private services. Thus the growth in demand for these types of providers may be expected to increase inequality of access in these two respects. The potential expansion of medical scheme coverage is shown to be limited to well under 50% of the population, leaving the majority of the population without access to private sector health care. Even for members of the medical schemes, benefits are linked to income, thus clashing with the principle of equal care for equal need. The public funds needed to overcome financial obstacles to access to private providers could be more efficiently deployed by financing publicly owned and controlled health services directly. Taxation also offers the most equitable method of financing health services. Finally, attention is drawn to the dilemma resulting from the strengthening of the private health sector; while in the short term this can offer better care to more people on a racially non-discriminatory basis, in the long term, health care for the population as a whole may become more unequal and for those dependent on the public sector it may even deteriorate.     

PPP医疗项目关键成功因素分析

随着政府与社会资本合作模式(PPP)在中国的推广运用,越来越多的社会资本参与到公共设施的融资、设计、建造和运营中来。然而,由于PPP本身的复杂性和合同义务的长期性,PPP项目要实现落地并不容易。目前,部分PPP医疗项目在吸引社会资本进入和提供服务上遇到困难。本文通过文献综述和专家咨询获得中国医疗领域PPP的18个关键成功因素(CSF),包括收益分配合理、政府政策稳定、风险分担合理、职责划分明确等,并通过近期财政部PPP中心综合信息平台项目库的公开资料来验证中国PPP关键成功因素体系,为促进PPP成功达成协议提供参考。     

A cautious approach to privatization in Papua New Guinea

Health services in Papua New Guinea have historically been providedpredominantly by the public sector, in close partnership withthe churches, which are largely subsidized by government andconsequently tend to be considered as part of the public healthsector. There is a small, but growing private health sectorabout which little is known and which until recently had developedwithout involvement by the government. Indeed, little interestwas shown by health officials, apart from the occasional animosityof hospital staff to in-patients of private doctors, until thelate 1980s when attention was brought to the high levels ofattrition of doctors from the public to the private sector.Budgetary constraints felt by the health sector in 1986, asa result of a change in governmental policy, emphasized theneed to improve the financial information available to enablepolicy makers to optimize the use of the limited resources andseek alternative financing sources. One alternative, which hassince been the suject of greater interest, has been the potentialfor sharing the responsibility for health care provision withthe private sector. This paper draws together what is knownabout the private health care sector in Papua New Guinea anddiscusses the implications of private sector growth for furtherhealth planning and policy formulation.     

Nine out of 10 food advertisements shown during Saturday morning children's television programming are for foods high in fat, sodium, or added sugars, or low in nutrients

A 2005 review by the Institute of Medicine of the National Academies concluded that food marketing influences children's food preferences, consumption, and health. Given the powerful influence of marketing on children's diets, this cross-sectional study examined the types of foods, the nutritional quality of those foods, and the marketing techniques and messages used in food advertising during Saturday morning children's television programming. During 27.5 hours of programming in May 2005, 49% of advertisements shown were for food (281 food advertisements out of 572 total advertisements). The most commonly advertised food categories were ready-to-eat breakfast cereal and cereal bars (27% of all food advertisements), restaurants (19% of food advertisements), and snack foods (18% of food advertisements). Ninety-one percent of food advertisements were for foods or beverages high in fat, sodium, or added sugars or were low in nutrients. Cartoon characters were used in 74% of food advertisements, and toy or other giveaways were used in 26% of food advertisements. About half of food advertisements contained health/nutrition or physical activity messages and 86% of food advertisements contained emotional appeals. This study provides food and nutrition professionals with information about the amount and types of food children are encouraged to eat during Saturday morning television programming. The findings can help food and nutrition professionals counsel children about healthful eating and/or develop programs or policies to balance those advertisements with healthful eating messages.     

Delivery of rural and remote health care via a broadband Internet Protocol network - views of potential users

We asked the views of potential users of a proposed Canadian broadband Internet Protocol (IP) network for health, the Alberta SuperNet. The three user groups were drawn from the public, provider and private sectors. In all, 35 health-sector participants were selected (17 government, nine health-care organizations, five providers/practitioners and four private sector). The questionnaire was Web-based, semistructured and self-administered. It consisted of four major areas: value, readiness, effect on usual care and limitations. A total of 28 (80%) individuals responded to the questionnaire: 21 (81%) were from the public sector (three provincial, nine regional and nine organizational), three (60%) were from the provider sector and four (100%) were from the private sector. Overall, the items related to health services and health human resources were considered to be the most valuable to rural communities. Respondents identified the expansion of telehealth services as the most important, except those from the private sector, who ranked this a close second. The health system's move to the use of electronic health records was ranked second in importance by all respondents. The private-sector respondents viewed all user groups to be generally less ready (mean score 2.5 on a seven-point scale from 1 = not ready to 7 = ready), while the public-sector respondents were the most optimistic (mean score 4.0). Specific socioeconomic impact data were limited. The top-ranked disadvantage of the 10 suggested was that 'Changes in health-service delivery practices and/or processes will be required'.     

The World Health Organization's Framework Convention on Tobacco Control: implications for global epidemics of food-related deaths and disease

This paper reviews the major elements of the WHO Framework Convention on Tobacco Control and considers those that can be applied to diet and nutrition. Tobacco and food policy have important differences: the two commodities have distinctly different health impacts, and food companies may be more responsive to public concerns than the tobacco industry. Nevertheless, both food and tobacco policy address public health issues surrounding legal products. Both require comprehensive and multi-sector approaches at global and national levels. The degree of flexibility possible in interacting and partnering with the private sector and food and related industries and the related implications for regulations and laws are reasons for a more nuanced approach to diet and physical activity policy.     

Risks and benefits of private health care: exploring physicians' views on private health care in Ho Chi Minh City, Vietnam

As in a number of other low- and middle-income countries, the health sector in Vietnam is transforming with a rapid shift from fully state run and financed health care towards more private financing and delivery of health care. This development has been particularly noticeable in the largest city in the country, Ho Chi Minh City, where a majority of physicians now are practising in private clinics and where the private health care sector is an increasingly popular option for people. While the private sector is an important part of the health care system in Vietnam, few data are available on the characteristics and quality of private health care services. This case study describes some aspects of the re-emerging private health care sector in Ho Chi Minh City, Vietnam, from the view of 27 private and non-private physicians. The paper explores physicians' reasons for going private, physicians' notions of patients' health care preferences, and physicians' views on potential influence of financial incentives on characteristics of private health care. The characteristics of private health care are discussed in relation to a context of private health care characterised by a fully patient-financed fee-for-service payment system, weak regulatory mechanisms, and a public health care system (government-run and-financed health care) that operates under resource constraints. Issues to consider when attempting to steer private health care in Vietnam in a direction where it can optimally contribute to public health, are discussed while considering the interplay between authorised private practitioners, private pharmacies, the informal private sector, and the public health care sector.     

Pathways to obesity: identifying local, modifiable determinants of physical activity and diet

Many studies document small area inequalities in morbidity and mortality and show associations between area deprivation and health. However, few studies unpack the "black box" of area deprivation to show which specific local social and physical environmental characteristics impact upon health, and might be amenable to modification. We theorised a model of the potential causal pathways to obesity and employed path analysis using a rich data set from national studies in England and Scotland to test the model empirically. Significant associations between obesity and neighbourhood disorder and access to local high street facilities (local shops, financial services and health-related stores found in a typical small UK town) were found. There was a tendency for lower levels of obesity in areas with more swimming pools and supermarkets. In turn, policing levels, physical dereliction and recorded violent crime were associated with neighbourhood disorder. The analysis identifies several factors that are associated with (and are probably determinants of) obesity and which are outside the standard remit of the healthcare sector. They highlight the role that public and private sector organisations have in promoting the nation's health. Public health professionals should seek to work alongside or within these organisations to capitalise on opportunities to improve health.     

Public health job advertisements in Australia and New Zealand: a changing landscape

Objective : To describe available public health jobs in Australia and New Zealand by comparing recent job advertisements. Methods : We screened vacancies from 14 online job boards for public health jobs in late 2018. Data collected included information on job titles, sector, contract tenure, location and salary. We compared our findings with those of a job advertisements study from 2005. Results : We found 333 public health job advertisements in Australia and New Zealand. Common roles included project officers, researchers and managers. Nearly 40% of jobs asked for a ‘tertiary’ degree, with an additional 20% requiring a PhD degree. A qualification in public health was considered essential in 13% of job advertisements. Median annual salary range was $95,000–$111,365. Conclusions : There is not one specific public health job. Instead, such jobs are diverse in role, sector, qualification level required and the salary they confer. Implications for public health : There is a demand for skilled workers to perform increasingly complex public health functions, but this may eventually be outpaced by graduate supply. Furthermore, while salaries are considerable, long‐term positions are not, and this has implications for the sustainability of the public health workforce.     

Does federal health care policy influence switching between the public and private sectors in individuals?

OBJECTIVE: The aim of this study was to determine if changes in Australian Federal health policy have influenced individual behaviour regarding utilisation of private health insurance in Western Australia. METHOD: The WA Data Linkage System was used to extract all hospital morbidity records in Western Australia from 1980 to 2001. For each individual, episodes were grouped into hospital couplets classified according to the mix of public and privately insured events. Logistic regression was used to estimate the likelihood of switching towards or away from the private sector, according to the time between episodes in each of five health care policy eras. RESULTS: The odds of a switch away from the private sector increased by 29% with each additional year between episodes, while the odds of a switch towards the private sector increased by 15% per intra-couplet year. In those with a private first episode the odds of switching decreased approximately exponentially across the five eras whereas the odds of switching in those with a public first episode stabilised after 1985. In the last era (1999-2001) the odds of switching away from the private sector reduced substantially. CONCLUSION: Our analysis suggests that the recent policies supporting PHI (30% rebate and Lifetime Health Cover) appear to have been effective at modifying individual behaviour to reduce the drift away from the private sector. However, the reported increases in utilisation of PHI were only partially explained by switching of existing demand in patients who had been previously hospitalised as public patients, suggesting that the policy reforms had generated, rather than merely shifted, demand for health care. This finding has significant policy implications for Australia.     

Independent sector mental health care: a 1-day census of private and voluntary sector placements in seven Strategic Health Authority areas in England

The aims of this study were (i) to map the extent of all mental health placements in the independent sector, for adults of working age, and elderly people (excluding those with a diagnosis of dementia placed in Local Authority care homes), on a census date, across the areas in which the study was commissioned; (ii) to identify the characteristics of the population in placements; (iii) to explore some of the characteristics of the placements and the patterns of use within the private and voluntary sectors; and (iv) to identify the funding source of placements, and cost differences between the private and voluntary sector. The study took place in seven Strategic Health Authority areas, and information was sought from all Primary Care Trust and Social Services commissioners of mental health services, including regional secure commissioning teams, within those areas. A cross-sectional sample was used. Information was requested in relation to every individual meeting the inclusion criteria, placed in independent (private or voluntary) psychiatric hospitals, registered mental nursing homes and care homes on a specified study 'census date' of 28 June 2004 in six of the Strategic Health Authority areas, and 7 October 2004 in the seventh. Information was recorded on a standard questionnaire specifically designed for the study. Information was obtained on 3535 adults and 1623 elderly people in private or voluntary facilities. The largest groups of adults and elderly people had diagnoses of severe mental illnesses (42.1% and 30.5%, respectively), and placements were described as 'continuing care' or rehabilitation, with a 'niche' in specialist forensic care. Around four-fifths of units were in the private sector, which for adults was significantly more expensive than the voluntary sector. A large proportion of units (47.2% of adult placements and 59.3% of placements for elderly people) had only single placements from particular commissioning authorities, whilst others had large numbers, raising issues for effective commissioning. The distance of placements from patients' area of origin, is also an issue highlighted by the study. The study findings are discussed in relation to commissioning practice, and the development of the independent sector in mental health care.