Multisector partnerships in population health improvement

Many new initiatives for population health improvement feature partnerships of leaders and organizations across multiple sectors of society. The purpose of this article is to review 1) the rationale for such partnerships as an important, if not essential, tool for population health improvement; 2) key organizational and contextual factors that appear to be associated with effective multisector partnerships; and 3) the limited evidence regarding the effect of such partnerships on population health outcomes. We conclude that systems thinking - accounting for the collective effect of many actors and actions - is essential to organizing and sustaining efforts to improve population health, and to evaluating them. More research is needed to understand how and why multisector partnerships are formed and sustained and the conditions under which multisector partnerships are necessary or more effective than other strategies for population health improvement. Research on and evaluation of multisector partnerships also need to incorporate more standard measures of partnership contexts, characteristics, and strategies and adopt longitudinal and prospective designs to accelerate social learning in this area. Finally, studies of multisector partnerships must be alert to the value of such initiatives to individuals and communities apart from any direct and measurable impact on population health.     

Systems approach to population health improvement

Managed care organizations (MCOs) are uniquely well positioned to implement population health initiatives. In an MCO setting, populations may be clearly defined. Health care may be provided via integrated clinical care delivery systems. Centralized services such as information systems, community relations, health promotion and disease prevention support, and marketing campaigns may aid in the achievement of population health improvement objectives. However, in order to sustain population health improvement efforts long-term, continued support and allocation of critical resources are needed. For this to occur, efforts need to be integrated with the personal, social, economic, regulatory, and business objectives of all key stakeholders involved in this process. Furthermore, the process needs to continuously generate deliverables in order to allow for ongoing feedback, evaluation, accountability, relationship building and maintaining, and continuous quality improvement to occur. Hence, specific strategies may be considered from a systems perspective. The present article describes a systems approach in which a population health cycle generates health improvement outcomes that are used to provide the rationale for continued allocation of resources.     

An aging population — Some demographic and health trends

This article reports information on the demographic changes that have occurred in England and Wales in this century, with particular emphasis on aspects related to the elderly. What is known about the major diseases killing the elderly and trends in these diseases is also reported. Projections of the elderly population over the next 40 years and attempts to identify the possible degree of handicap in these elderly are discussed. Since the beginning of the century the population of England and Wales has grown from about 32.5 million to over 49 million. Age-specific mortality trends throughout the century indicate that there has been an appreciable decline at younger ages, but less of a decrease with advancing age in males. The fluctuation in the birth rate, different trends in the age-specific mortality, and differences between mortality for the sexes has resulted in a change in the age structure of the population. The main cause of death in the age range 60-84 years for both males and females is ischaemic heart disease--responsible for 1/3 of all deaths in males and 1/4 of all deaths in females. As with mortality, the statistics for hospital in-patient care show a marked rise with advancing age. About 8% of the male and 11% of the female population aged 75 years and over were receiving care from health and welfare service facilities day by day during 1981. In the oldest age group of 90 years and over, there are at present about 25 males for every 100 females; by 2023 this is projected to increase to about 35 males for every 100 females. What is not clear from the basic projection is whether the improvement in mortality is associated with an increasing number of healthy survivors, or an increasing number of survivors who have a chronic disease.     

Application of demographic methods in population planning

Although demographic methods help population program planning by providing quantitative formulas, the validity of the projections depend on the assumptions made and the quality of input data. Particularly in the case of reproductive performance, which is independently influenced by a variety of factors, projections present problems. In order to develop effective population programs planners must recognize all dimensions of population change.     

Medical and demographic assessment of human health under conditions of radiation and toxic exposures

Medical and demographic assessments of the impact of a complex of man-made and radiation exposures on the population of the Altai territory revealed that the use of retrospective diagnosis of radiation exposures of Semipalatinsk ground testing and the account of additional exposures to combined effects of dioxines, heavy metals, rocket fluel components (heptyl, etc.), which are observed in specially identified former administrative areas of this territory in causing specific changes in the health status of neonates, pregnant females, and able bodied individuals are of priority in sociosanitary monitoring of sanitary and epidemiological service.     

透过学分审验探讨继续医学教育存在的问题及改进对策

笔者通过近2年来参与管理医院继续医学教育工作和学分审验工作,针对一些存在的问题做进行探讨。     

新生患儿治疗中的医学伦理、法律与医疗保障等问题的探讨

WHO将新生儿死亡率作为衡量一个国家卫生事业发展水平的标志。文章从管理学角度出发,从新生儿放弃治疗的伦理正当性、NICU病房里的医学人本主义、新生儿医学的立法问题、危重新生儿的医疗保障和医疗公平、建立新生儿合理医疗保障制度、建立儿童伦理委员会、新生儿安乐死等7个方面探讨了新生儿医学的医疗伦理、法律和医疗保障等几个问题。