Public health modeling and populations at risk to sexually transmitted diseases

Creating public awareness of the new wave of sexually transmitted diseases masks the fact that gonorrhea continues to be the major communicable infection related to sexual activity. This report evaluates public health models that focus on the carriers of gonorrhea. Data pertaining to patients who were examined and treated at a public health clinic are discussed in light of the prevailing models of populations at risk to sexually transmitted diseases.     

Public health requirements for rapid progress in global health

Abstract

Effective public health interventions can save hundreds of millions of lives in developing countries, as well as create broad social and economic benefits. Unfortunately, public health approaches and solutions applied in developed countries are often assumed to be inappropriate or unattainable in developing countries. This has sometimes forestalled effective interventions in parts of the world where they are most needed, despite conditions that now facilitate lasting solutions to both long-standing and emerging global public health problems. Core public health functions are similar regardless of a country's income level. Although some resource-intensive approaches from industrialised nations are inappropriate in less developed countries, many basic public health measures achieved decades ago in developed countries are urgently needed, highly appropriate, extremely cost-effective and eminently attainable in developing countries today. About half of the disease burden in low and middle-income countries is now from non-communicable diseases, but non-communicable disease epidemics that will otherwise increase rapidly in the developing world can be avoided or reversed. Progress of public health in developing countries is possible, but will require sufficient funding and human resources; improved physical plant and information systems; effective programme implementation and regulatory capacity; and, most importantly, political will at the highest levels of government.     

Religious affiliation and disparities in risk of non-communicable diseases and health behaviours: Findings from the fourth Thai National Health Examination Survey

This study aims to compare the health-related behaviours and risk of non-communicable diseases (NCDs) between Muslims and non-Muslims in Thailand, a predominantly Buddhist country in which Muslims are the second largest religious group. Data from the fourth Thai National Health Examination Survey (NHES IV) conducted in 2009 were used to run multivariate survey logistic regression models with adjustment for age, gender and socio-economic status indicators. Data from 20,450 respondents, of whom 807 (3.9%) were Muslims, were included in the study. Muslims were significantly more likely to have daily consumption of deep-fried food (adjusted odds ratio [OR] = 1.35; 95% confidence interval [CI] = 1.15?1.58) and packaged snacks (adjusted OR = 1.55; 95% CI = 1.30?1.86), and have inadequate control of hypercholesterolemia (adjusted OR = 2.95; 95% CI = 1.30?6.68). In conclusion, we found disparity in the majority of risk factors for NCDs between Muslim and non-Muslim Thais.     

Tackling the emerging pandemic of non-communicable diseases in sub-Saharan Africa: the essential NCD health intervention project

There is evidence that the prevalence of certain non-communicable diseases, such as diabetes and hypertension, is increasing rapidly in parts of sub-Saharan Africa. Others, such as asthma and epilepsy, are known to be common but to be poorly managed. This paper describes a project, funded by the Department for International Development of the British Government, which aims to provide costed and evaluated treatment packages for use at primary health care level, methods and materials for evaluating the quality of non-communicable disease care, and a protocol for the assessment for national opportunities for the prevention of hypertension, heart disease and diabetes. Methods are being developed and piloted in urban and rural Tanzania and Cameroon.     

Public health metaphors in Australian policy on asylum seekers

Objective : To analyse the way in which a public health metaphor has been incorporated into Australian political practice to justify the exclusion or mistreatment of unwelcome non-citizens, giving particular attention to recent asylum seekers.
Approach : Starting with a personal experience of working in an immigration detention centre and then drawing on media reports and published scholarship, I critique political rhetoric and policy on asylum seekers, arguing that the significance of a public health metaphor lies in its effectiveness in persuading the public that refugees and asylum seekers are a moral contaminant that threatens the nation and has to be contained.
Conclusion : Acceptance of the metaphor sanctions humanly degrading inferences, policies and actions. Public health professionals therefore have a responsibility to challenge the political use of public health and associated metaphors.
Implications : Substituting the existing metaphor for one that is more morally acceptable could help to redefine refugees and asylum seekers more positively and promote compassion in political leaders and the community.     

Public health management: Time for a new start?

One of the themes of health care reform Is a renewed focus onhealth rather than health care. The role of the purchaser isdirected towards health gain rather than merely the maintenanceof health care services. This goal can only be achieved if publichealth specialists and health services managers work togetherand share skills. There is a need for public health physicians,non-clinical public health specialists and health service managersto find an intellectual focus for joint working since theirrespective skills are complementary. Whereas public health haslooked outwards towards the health needs of the population,health care management has focused inwards on the organizationof health services. The concept of public health managementoffers a unifying focus. It centres on the mobilization of society'sresources, including those of the health service sector, toimprove the health of populations through whatever means ismost appropriate. Public health has suffered from a tensionbetween knowledge and action. Public health management seeksto resolve this tension. The paper explores the concept of publichealth management, analyses the skills required for its successfulpractice and considers the training programmes required to developpublic health managers. The authors call on European organizationsto champion the concept of public health management.     

Public health at a crossroads: assessing teaching on economic globalization as a social determinant of health

This article examines how public health faculty prepare students to respond to economic globalization, and more broadly considers the response of public health academics to structural challenges that fall within the realm of global economics, politics, and policy. At this moment, public health is at a crossroads of formalizing its education through graduate competencies and certifications. This research undertook in-depth interviews with public health faculty from across the US to explore how students are prepared to critically consider root causes and respond to political and economic trends shaping health. These interviews reveal a general dearth of attention to globalization, as well as several factors shaping public health academic knowledge production. These include the deep influence and shortcomings of funding resources; a general lack of critical perspective in public health; and both methodological and faculty competence deficiencies. Interviewees also discuss political influences and conflicting student demands, as well the strength of public health as an interdisciplinary profession and potential opportunities for improving public health's responsiveness. Interestingly, while there was near unanimity regarding public health's role and obligation to advocate for change on these issues, there was also uncertainty about how to appropriately model and teach advocacy skills, and tension over public health's role in politics and policy. While public health has a rich history of addressing structural and political factors shaping health, this research reveals an ongoing need to define public health's role in contemporary politics and policy, and in advocating for change at the global policy level.     

社区公共卫生和临床医学整合模式的研究与实践

该文分析了宁波市构建社区公共卫生和临床医学整合模式的实践措施及其特点,提出了加强区域卫生资源整合,构建大协作组织网络．加强卫生应急能力建设,构建一体化卫生信息体系;加强社区健康管理．构建慢性病综合防治模式;加强医学教育改革,培养防治结合型卫生人才等四个方面措施,并进行了进一步实践运用,取得了较好成效,值得推广应用。     

Challenges and opportunities for surveillance data to inform public health policy on chronic non-communicable diseases: Canadian perspectives

A number of major challenges face surveillance systems in the field of chronic disease. The complex interplay of risk factors and determinants that result in chronic disease is calling into question traditional surveillance systems in terms of what is collected to inform policy decisions. At the same time, the complexity presents an opportunity to broaden the evidence base on which arguments can be based for chronic disease intervention to increase their potential to influence policy makers. This article describes some initiatives in Canada to enhance the capacity and utility of surveillance systems and their associated data to inform policy making in the field of chronic disease.     

Access to medicines and domestic compulsory licensing: Learning from Canada and Thailand

Abstract

Within the array of measures for improving medicines access for the world's neediest populations, governments of many countries have turned to compulsory licensing, a statutory mechanism to enable third parties to manufacture a product or process still under patent. In this paper, we focus on a historic case example from Canada and the present example of Thailand's use of domestic compulsory licenses as a policy tool for ensuring public access to affordable medicines. The overarching objective is to draw out policy and legislative insights that may be of value for countries with pharmaceutical manufacturing capacity and which are considering better access to patented medicines for their populations under the current global intellectual property regime. From these cases, it is apparent that although compulsory licensing is not a novel remedy, even in a post-Trade Related Aspects of Intellectual Property Rights environment, it remains a powerful policy tool in improving access to medicines in a variety of domestic settings.     

Innovation and participation for healthy public policy: the first National Health Assembly in Thailand

Aim This paper aims to describe and disseminate the process and initial outcomes of the first National Health Assembly (NHA) in Thailand, as an innovative example of health policy making. Setting The first NHA, held in December 2008 in Bangkok, brought together over 1500 people from government agencies, academia, civil society, health professionals and the private sector to discuss key health issues and produce resolutions to guide policy making. It adapted the approach used at the World Health Assembly of the World Health Organization. Method Findings are derived from a literature review, document analysis, and the views and experiences of the authors, two of whom contributed to the organization of the NHA and two of whom were invited external observers. Results Fourteen agenda items were discussed and resolutions passed. Potential early impacts on policy making have included an increase in the 2010 public budget for Thailand’s universal health coverage scheme as total public expenditure has decreased; cabinet endorsement of proposed Strategies for Universal Access to Medicines for Thai People; and establishment of National Commissions on Health Impact Assessment and Trade and Health. Discussion The NHA was successful in bringing together various actors and sectors involved in the social production of health, including groups often marginalized in policy making. It provides an innovative model of how governments may be able to increase public participation and intersectoral collaboration that could be adapted in other contexts. Significant challenges remain in ensuring full participation of interested groups and in implementing, and monitoring the impact of, the resolutions passed.     

Social network influences on reproductive health behaviors in urban northern Thailand

Prevention approaches for reproductive health have evolved from an emphasis on individually focused models of behavior change to a recognition that risk reduction occurs within a context of social norms. Prevention programs can be improved by understanding how social structure influences sexual behavior and using that understanding to develop strategies for positive change. In a dynamic, urban context, communities are better conceptualized as informal networks of ties. These network structures may help to protect, or conversely, expose members to reproductive risk behaviors. Using data from a study of social and sexual networks conducted in northern Thailand, this article describes partner relations and social structure in the modern, urban context, and illustrates the links between individual, relational and structural properties and reproductive risk behaviors. Triangulation of ethnographic, survey and social network data collection and analytic tools provide an opportunity to interpret individual behaviors, meanings of relationships and structural properties of networks. Intervention approaches should build on existing networks, and address the complex meanings of romantic and sexual partnerships.     

Human rights and political crisis in Brazil: Public health impacts and challenges

In 31 August 2016, Brazilian president Dilma Rousseff was impeached and replaced by her vice president Michel Temer. Herein, we examine how the conservative agenda of Mr Temer and his supporters is influencing key decisions in the human rights and public health arena in Brazil. The government’s austerity agenda includes severe cuts in critical areas such as health, education and science, jeopardising well-known strategies such as the Brazilian Public Health System (SUS) and nationwide cash transfer program, ‘Bolsa Familia’ – both benefited millions and were the largest of their kind in the world. Mr Temer’s decisions show not only severe cuts in critical areas but also a political agenda that clearly demonstrates a broad shift away from the progressivism and social agenda presented and supported by its predecessors. Most vulnerable groups such as the LGBTQ community, women, people who use drugs and disenfranchised communities have been severely affected. Mr Temer’s administration is putting Brazil far from its once nationwide goal to foster free and universal health care access and social equity for all its citizens. The near future for Brazil is unknown, but both national and international communities anticipate severe problems within the national human rights arena, if nothing changes.

Abbreviations: CCT: Conditional Cash Transfer; LGBTQ: Lesbian, Gay, Bisexual, Transgender and Queer (and/or Questioning); SUS: Brazilian Public Health System     

Public health responses to influenza in care homes: a questionnaire-based study of local Health Protection Units

BACKGROUND: Influenza virus infection poses a major threat to the elderly people in residential care. We sought to describe the extent to which local public health services in England were positioned to detect and respond effectively to influenza-like illness (ILI) in nursing homes. METHODS: A questionnaire-based survey was conducted in all 34 Health Protection Units (HPUs) regarding the 2004-05 influenza season. RESULTS: Of the 20 responses, half reported 24 outbreaks of ILI in care homes. The mean resident population attack rate was 41% (range 15-79) with 31 deaths. Staff ILI occurred in 23 of 24 outbreaks. Seven of 20 HPUs stated that a local policy for the management of ILI in nursing homes was in place, with only four specifying the use of neuraminidase inhibitors (NI) for treatment of cases and prophylaxis of residents. In the outbreaks reported, NIs were used for treatment and prophylaxis, respectively, in only 46 and 54% of instances. CONCLUSIONS: Given the availability of effective interventions for treatment and prophylaxis, there is potential to prevent substantial morbidity and mortality from influenza in at-risk populations. This study suggests that challenges remain in the effective response to influenza outbreaks in care homes and that there are wide variations in practice at local level.     

Politics and prospects for health promotion in England: mainstreamed or marginalised?

This paper critically examines the public policy environment that underpins the politics of health promotion in England. English health policy from the late 1970s to the mid 1990s was not receptive to health promotion. The new Labour government elected in 1997 claimed to embrace a ‘Third Way’ between the free market and socialism that would appear to embrace a community-centred approach to health promotion that would through partnership-building promote equity; perversely, however, the election of this government rhetorically committed to healthy public policy was accompanied by a crisis in health promotion delivery. Despite apparent commonalities between the Third Way and health promotion, the Third Way was in many respects a neoliberal ideology and so has contributed to the marginalisation of health promotion. Although some might argue that health promotion has been mainstreamed, it is argued here that in terms of the crucial National Health Service infrastructure underpinning the health promotion movement, that the organisational capacity for health promotion has been significantly weakened. Thus the question is how you revive a movement that has lost its way? The answer must include taking a historically informed approach to analysing the problem and identifying solutions. Wider systems issues in England include the emergence of multidisciplinary public health, the sequence of changes to national health promotion organisations and the wider marginalisation of the public health movement. It is only by critically analysing and addressing these systemic issues that the prospects for health promotion in England can be revived.