Aging minority women: issues in research and health policy

This paper presents an overview of current knowledge about the economic, psychosocial and cultural dimensions of the aging process among minority women in the U.S. Attention is directed to the shorter life span of minority women and its implication for understanding aging, the reality of the "quadruple jeopardy" hypothesis, and the adaptative advantages minority women may have in dealing with growing older. The need to consider cohort effects and ethnic diversity in future research on minority women is stressed.     

Ethical issues in social science research with special reference to sexual behaviour research

Social science research has long been concerned with ethical issues, but agencies that review and fund research are increasingly attentive to assuring that ethical considerations are being fully addressed. Research on sexual behavior, a topic that has generated much recent attention worldwide as scientists confront the epidemics of adolescent pregnancy, AIDS and STDs, raises ethical issues that are worthy of special attention. Beginning with the philosophical origin of ethical principles that guide research, this paper discusses the key ethical issues to be considered when designing and conducting social science research. Included are special precautions for research on adolescents, the purpose and properties of an informed consent procedure, and the formation and function of an ethical review committee.     

Public health policy research: making the case for a political science approach

The past few years have seen the emergence of claims that the political determinants of health do not get due consideration and a growing demand for better insights into public policy analysis in the health research field. Several public health and health promotion researchers are calling for better training and a stronger research culture in health policy. The development of these studies tends to be more advanced in health promotion than in other areas of public health research, but researchers are still commonly caught in a na?ve, idealistic and narrow view of public policy. This article argues that the political science discipline has developed a specific approach to public policy analysis that can help to open up unexplored levers of influence for public health research and practice and that can contribute to a better understanding of public policy as a determinant of health. It describes and critiques the public health model of policy analysis, analyzes political science's specific approach to public policy analysis, and discusses how the politics of research provides opportunities and barriers to the integration of political science's distinctive contributions to policy analysis in health promotion.     

PSRO: issues in health care policy

Enactment of the law regarding Professional Standards Review Organizations (PSROs) represents a major shift in health care policy in the United States. PSRO is an experiment in developing a national quality assurance system. It raises issues of quality versus cost control, professional versus public accountability, and confidentiality. These issues must be examined critically by social workers.     

Statistical science: a grammar for research

I greatly appreciate the invitation to give this lecture with its century long history. The title is a warning that the lecture is rather discursive and not highly focused and technical. The theme is simple. That statistical thinking provides a unifying set of general ideas and specific methods relevant whenever appreciable natural variation is present. To be most fruitful these ideas should merge seamlessly with subject-matter considerations. By contrast, there is sometimes a temptation to regard formal statistical analysis as a ritual to be added after the serious work has been done, a ritual to satisfy convention, referees, and regulatory agencies. I want implicitly to refute that idea.     

Statistical issues in health impact assessment at the state and local levels

In this work, we discuss the uncertainty in estimating the human health risk due to exposure to air pollution, including personal and population average exposure error, epidemiological designs, and methods of analysis. Different epidemiological models may lead to very different conclusions for the same set of data. Thus, evaluation of the assumptions made and sensitivity analysis are necessary. Short-term health impact indicators may be calculated using concentration–response (C-R) functions. We discuss different methods to combine C-R function estimates from a given locale and time period with the larger body of evidence from other locales and periods and with the literature. A shrunken method is recommended to combine C-R function estimates from multiple locales. This shrunken estimate includes information from the overall and the local estimates, and thus, it characterizes the estimated excess of risk due to heterogeneity between the different locations.     

Population health in Canada: issues and challenges for policy, practice and research

The population health movement has gained prominence in Canada and elsewhere with policy makers, program planners and researchers taking note that health is strongly influenced by factors that lie largely beyond the health-care system. The development of population health in Canada was the focus of the National Conference on Shared Responsibility for Health & Social Impact Assessments: Advancing the Agenda held May 2-3 1999 in Vancouver, Canada. A longer version of this paper was distributed to conference participants to provide some common knowledge and vocabulary. It also introduced and discussed definitional, normative, logistical, political, methodological, structural and resource considerations with respect to furthering the population health agenda in Canada.     

Social science and health research: growth at the National Institutes of Health

Programs within the National Institutes of Health (NIH) have recently taken steps to enhance social science contributions to health research. A June 2000 conference convened by the NIH Office of Behavioral and Social Sciences Research highlighted the role of the social sciences in health research and developed an agenda for advancing such research. The conference and agenda underscored the importance of research on basic social scientific concepts and constructs, basic social science research on the etiology of health and illness, and the application of basic social science constructs in health services, treatment, and prevention research. Recent activities at NIH suggest a growing commitment to social science research and its integration into interdisciplinary multilevel studies of health.     

Health workers at the core of the health system: framework and research issues

This paper presents a framework for the health system with health workers at the core. We review existing health-system frameworks and the role they assign to health workers. Earlier frameworks either do not include health workers as a central feature of system functioning or treat them as one among several components of equal importance. As every function of the health system is either undertaken by or mediated through the health worker, we place the health worker at the center of the health system. Our framework is useful for structuring research on the health workforce and for identifying health-worker research issues. We describe six research issues on the health workforce: metrics to measure the capacity of a health system to deliver healthcare; the contribution of public- vs. private-sector health workers in meeting healthcare needs and demands; the appropriate size, composition and distribution of the health workforce; approaches to achieving health-worker requirements; the adoption and adaption of treatments by health workers; and the training of health workers for horizontally vs. vertically structured health systems.     

Validity and reliability issues in published public health and social policy research

This paper reviews basic measurement concepts associated with objective instruments, argues for the importance of addressing the validity and reliability of instruments in articles reporting the results of empirical research, and discusses common measurement issues through examples observed in public health and social policy journals.     

Public health workforce: challenges and policy issues

This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that must be addressed in order to strengthen the public health workforce. The public health workforce is diverse and includes all those whose prime responsibility is the provision of core public health activities, irrespective of their organizational base. Although the public health workforce is central to the performance of health systems, very little is known about its composition, training or performance. The key policy question is: Should governments invest more in building and supporting the public health workforce and infrastructure to ensure the more effective functioning of health systems? Other questions concern: the nature of the public health workforce, including its size, composition, skills, training needs, current functions and performance; the appropriate roles of the workforce; and how the workforce can be strengthened to support new approaches to priority health problems.The available evidence to shed light on these policy issues is limited. The World Health Organization is supporting the development of evidence to inform discussion on the best approaches to strengthening public health capacity in developing countries. WHO's priorities are to build an evidence base on the size and structure of the public health workforce, beginning with ongoing data collection activities, and to map the current public health training programmes in developing countries and in Central and Eastern Europe. Other steps will include developing a consensus on the desired functions and activities of the public health workforce and developing a framework and methods for assisting countries to assess and enhance the performance of public health training institutions and of the public health workforce.