The impact of global health initiatives on the health system in Angola

We assessed the impact of global health initiatives (GHIs) on the health care system of Angola, as a contribution to documenting how GHIs, such as the Global Fund, GAVI and PEPFAR, influence the planning and delivery of health services in low-income countries and how national systems respond. We collected the views of national and sub-national key informants through 42 semi-structured interviews between April 2009 and May 2011 (12 at the national level and 30 at the sub-national level). We used a snowball technique to identify respondents from government, donors and non-governmental organisations. GHIs stimulated the formulation of a health policy and of plans and strategies, but the country has yet to decide on its priorities for health. At the regional level, managers lack knowledge of how GHIs’ function, but they assess the effects of external funds as positive as they increased training opportunities, and augment the number of workers engaged in HIV or other specific disease programmes. However, GHIs did not address the challenge of attraction and retention of qualified personnel in provinces. Since Angola is not entirely dependent on external funding, national strategic programmes and the interventions of GHIs co-habit well, in contrast to countries such as Mozambique, which heavily depend on external aid.     

The public health impact of global climate change

Accurate predictions of the public health impact of global climatic changes are hampered by the absence of a dose-response relationship between climate change and human health and imprecise, often conflicting, meteorological models of climate change. Public health officials are obligated to educate policy makers and the public about the significant threats posed to population health and quality of life by the inexorable progression of global climate change. Only an enlightened public consciousness can muster the political will required to press for policy changes and to support new technologies to conserve energy and to protect the environment from manmade agents of destruction.     

The global impact of glaucoma.

Although glaucoma is a major global cause of blindness, the lack of a uniform definition of the disease in its different forms makes it difficult to assess its public health impact. By considering the common features of glaucoma, we have analysed available data on the three main forms of the disease: congenital/hereditary glaucoma, primary open-angle, and primary angle-closure glaucoma. A simple model was then developed to estimate the extent of glaucoma on a regional basis, taking into account demographic data, e.g., age distribution, gender and ethnic groups. Overall, the results demonstrate that glaucoma is responsible for approximately 5.2 million blind (15% of the total burden of world blindness).     

The World Bank's perspective on global health

Over the next 25 years, as populations age and tobacco consumption increases, most developing regions will likely see noncommunicable diseases become the leading causes of disability and premature mortality. The already existing problems of malnutrition and infectious diseases will remain. In this context, the World Bank is examining its role and contribution to global health. From a small start approximately 25 years ago, the Bank has greatly expanded its role in international health, population, and nutrition to become the largest single external financier of health activities in low- and middle-income countries. Many other Bank-supported activities affect health, including poverty reduction, housing, water and sanitation, and the education of girls. The Bank is also increasingly active in health policy debates, publishing numerous studies annually. Most of these studies focus upon specific countries, but some address key issues of concern to many developing countries. This article explains why the Bank continues to expand its resources devoted to health and the rationale for the changing emphasis of its activities in the field.     

氟化物对作业工人健康危害的研究

目的探讨氟化氢对作业人员健康的影响, 提出早期预防措施和对策.方法对69名氟作业工人和60名非氟作业人员进行了10年动态对比观察,分析了氟化物对作业人员健康的影响.结果与非氟作业人员比较,氟作业人员尿氟、发氟增高(P＜0.01或P＜0.05);生化指标、心电图、骨骼发生改变,并伴有神经衰弱症候群、四肢麻木、腰背痛、胃痛、咽部充血、牙龈肿胀等症状体征.结论①工业性氟中毒是以骨骼损害为主的全身性疾病;②尿氟、发氟增高、骨前相、心电图、生化指标及典型临床表现等可作为早期诊断的指标.     

The impact of weather on human health

The impact of weather on human health is a well-known fact, yet, alas, neglected in the past. Bioclimatology, a vast field of medical knowledge, has only been developed in the past few years. It shows that the air we breathe has a profound influence on our well-being. Electrical charges of the air, such as ions, spherics and electrofields can affect our endocrine, vegetative and autonomous nerve system. It may even be responsible for post-operative thromboembolism. The present article describes weather reactions, electric radiations, climate rhythm, medical aspects of weather changes, and their effect on health and disease. Special devotion is also given to the manifestations of evil winds.     

The impact of gender roles on health

The present research focused on a sample of Spanish undergraduate women and men to evaluate whether gender was related to substance use and chronic illness. This research examined the associations of conformity to masculine norms for men and conformity to feminine norms for women with substance use in chronic illnesses. Spanish male (n = 226) and female (n = 234) college undergraduates completed measures of chronic diseases, alcohol and tobacco consumption, and conformity to gender norms. Multivariable regression analyses demonstrated that being female was related to lower alcohol and cigarette consumption but a greater rate of chronic illnesses. Although masculinity did not explain the rate of chronic illnesses, specific feminine and masculine gender norms were related to alcohol and tobacco use and prevalence of chronic diseases. The present study provides insights for further cross-cultural psychological studies on the mediating effect of self-reported conformity to gender norms (rather than only sex) on health. Limitations and implications are discussed.     

The impact of a health campaign on health social capital

Referring to literature in sociology, mass communication, and public health, we conceptualize and operationally define "health social capital" and "individual health social capital" and then posit and test a model for its development in response to a public health media campaign. The campaign evaluated here was designed to stimulate behaviors that would provide a more supportive social environment for children and youth, an environment which we consider to be richer in aggregate health social capital. The association model of advertising was employed to explain the development of individual health social capital measures of awareness, attitude, and behavior. With cross-sectional data (1998, n = 614; 1999, n = 1087; 2000, n = 1388), we examine the results for changes in awareness, attitude, and behavior over time and the significant links between these dependent variables and media campaign exposure. The results show significant increases in awareness and attitude, but not in behavior. Structural equation modeling revealed different patterns of influence for newspaper and TV campaign exposure.     

The impact of global budgeting on treatment intensity and outcomes

This paper investigates the effects of global budgets on the amount of resources devoted to cardio-cerebrovascular disease patients by hospitals of different ownership types and these patients’ outcomes. Theoretical models predict that hospitals have financial incentives to increase the quantity of treatments applied to patients. This is especially true for for-profit hospitals. If that’s the case, it is important to examine whether the increase in treatment quantity is translated into better treatment outcomes. Our analyses take advantage of the National Health Insurance of Taiwan’s implementation of global budgets for hospitals in 2002. Our data come from the National Health Insurance’s claim records, covering the universe of hospitalized patients suffering acute myocardial infarction, ischemic heart disease, hemorrhagic stroke, and ischemic stroke. Regression analyses are carried out separately for government, private not-for-profit and for-profit hospitals. We find that for-profit hospitals and private not-for-profit hospitals did increase their treatment intensity for cardio-cerebrovascular disease patients after the 2002 implementation of global budgets. However, this was not accompanied by an improvement in these patients’ mortality rates. This reveals a waste of medical resources and implies that aggregate expenditure caps should be supplemented by other designs to prevent resources misallocation.     

The impact of micro health insurance on Rwandan health centre costs

While the implications of payment mechanisms for provider behaviour and cost have been amply explored in industrialized countries, there is little empirical evidence from developing countries. This study exploits the opportunities created by a pilot study of micro health insurance with capitation in Rwanda to address this issue. Using cross-sectional data collected in 52 health centres, the paper employs an econometric cost function with payer-specific outputs to assess the cost impact of two provider payment mechanisms: (1) user fees for care paid by the uninsured, and (2) capitation payment paid by informal insurance schemes for the insured. The cost function allows payer-specific marginal and average costs and scale measures to be calculated. Findings point to significant differences in cost between the two payment forms. These may be due to the incentives embodied in the capitation provider payment or the less severe case-mix among insured patients arising from improved access to care for this group, or both. For both payment types there are important short-run economies of scale, which could be exploited through more intensive use of idle resources in health centres.