Upstream Policy Changes to Improve Population Health and Health Equity: A Priority Agenda

Policy Points

• Upstream factors—social structures/systems, cultural factors, and public policy—are primary forces that drive downstream patterns and inequities in health that are observed across race and locations.
• A public policy agenda that aims to address inequities related to the well-being of children, creation and perpetuation of residential segregation, and racial segregation can address upstream factors.
• Past successes and failures provide a blueprint for addressing upstream health issues and inhibit health equity.

     

三城市公共卫生人员对气候变化健康影响的知识、态度、行为调查

目的了解我国公共卫生专业人员气候变化相关知识、态度和行为的现状。方法采用分层整群抽样的方法,抽取3个不同地理纬度城市28家公共卫生机构的795名业务科室工作人员作为调查对象,开展自我管理式问卷调查。结果气候变化知晓率84．4％,但对气候变化这一公共卫生问题的关注率仅为43．5％。69．1％可回答3项以上热浪期间慢病患者的注意事项;58．6％可回答5项及以上中暑发生的影响因素;71．1％可回答2项及以上中暑的急救措施。75％以上的调查对象对气候变化相关工作均持肯定态度,其中84．4％认为对公众开展适应气候变化的相关健康教育很重要,但仅38．5％调查对象曾经参加过适应气候变化保护人群健康的相关活动,55％曾在热浪期间宣传慢病防治知识。大众媒体是获取气候变化及健康影响相关知识的主要途径,专业培训及会议仅占35．8％。结论我国公共卫生人员在适应气候变化保护公众健康的能力方面亟待提高,适应气候变化保护人群健康方面的工作有待进一步加强。     

未来可能影响老年人口卫生费用的因素

随着人口的老龄化，老年人口的卫生费用在卫生总费用中的比例将会越来越高，本文对未来可能影响老年人口卫生费用的几个因素进行了分析，主要是医疗保障制度、老年人生活居住方式、医疗技术的发展和传播、疾病模式转变、公共政策的选择等。     

Lifecourse Health Development: Past, Present and Future

During the latter half of the twentieth century, an explosion of research elucidated a growing number of causes of disease and contributors to health. Biopsychosocial models that accounted for the wide range of factors influencing health began to replace outmoded and overly simplified biomedical models of disease causation. More recently, models of lifecourse health development (LCHD) have synthesized research from biological, behavioral and social science disciplines, defined health development as a dynamic process that begins before conception and continues throughout the lifespan, and paved the way for the creation of novel strategies aimed at optimization of individual and population health trajectories. As rapid advances in epigenetics and biological systems research continue to inform and refine LCHD models, our healthcare delivery system has struggled to keep pace, and the gulf between knowledge and practice has widened. This paper attempts to chart the evolution of the LCHD framework, and illustrate its potential to transform how the MCH system addresses social, psychological, biological, and genetic influences on health, eliminates health disparities, reduces chronic illness, and contains healthcare costs. The LCHD approach can serve to highlight the foundational importance of MCH, moving it from the margins of national debate to the forefront of healthcare reform efforts. The paper concludes with suggestions for innovations that could accelerate the translation of health development principles into MCH practice.     

U.S. Funding Is Insufficient to Address the Human Health Impacts of and Public Health Responses to Climate Variability and Change

Background

The need to identify and try to prevent adverse health impacts of climate change has risen to the forefront of climate change policy debates and become a top priority of the public health community. Given the observed and projected changes in climate and weather patterns, their current and anticipated health impacts, and the significant degree of regulatory discussion underway in the U.S. government, it is reasonable to determine the extent of federal investment in research to understand, avoid, prepare for, and respond to the human health impacts of climate change in the United States.

Objective

In this commentary we summarize the health risks of climate change in the United States and examine the extent of federal funding devoted to understanding, avoiding, preparing for, and responding to the human health risks of climate change.

Discussion

Future climate change is projected to exacerbate various current health problems, including heat-related mortality, diarrheal diseases, and diseases associated with exposure to ozone and aeroallergens. Demographic trends and geophysical and socioeconomic factors could increase overall vulnerability. Despite these risks, extramural federal funding of climate change and health research is estimated to be < $3 million per year.

Conclusions

Given the real risks that climate change poses for U.S. populations, the National Institutes of Health, Centers for Disease Control and Prevention, U.S. Environmental Protection Agency, and other agencies need to have robust intramural and extramural programs, with funding of > $200 million annually. Oversight of the size and priorities of these programs could be provided by a standing committee within the National Academy of Sciences.     

Critical race theory as theoretical framework and analysis tool for population health research

In population health research, it is important to consider socioecological perspectives that include cultural attitudes and beliefs which permeate all levels (intrapersonal, interpersonal, institutional/community, and structural/policy). Given the specificity of target populations centered on identity – ethnic and others – it is appropriate and warranted to centralize cultural studies theories into health determinant investigations. Cultural studies, which focus explicitly on identity exploration and impacts, have much to contribute to health research. In accordance with the transdisciplinary nature of population health and bearing in mind the significant role of ethnic identity in health outcomes, it is beneficial to utilize critical race theory (CRT) as a theoretical framework and analysis tool for population health research. This article will: (1) briefly overview a recent mental health study employing CRT, and a commentary that emphasizes how CRT can contribute to the sociology of mental health; and (2) propose ways CRT can be used in psychosocial health research.     

Excessive Heat and Respiratory Hospitalizations in New York State: Estimating Current and Future Public Health Burden Related to Climate Change

Background: Although many climate-sensitive environmental exposures are related to mortality and morbidity, there is a paucity of estimates of the public health burden attributable to climate change.Objective: We estimated the excess current and future public health impacts related to respiratory hospitalizations attributable to extreme heat in summer in New York State (NYS) overall, its geographic regions, and across different demographic strata.Methods: On the basis of threshold temperature and percent risk changes identified from our study in NYS, we estimated recent and future attributable risks related to extreme heat due to climate change using the global climate model with various climate scenarios. We estimated effects of extreme high apparent temperature in summer on respiratory admissions, days hospitalized, direct hospitalization costs, and lost productivity from days hospitalized after adjusting for inflation.Results: The estimated respiratory disease burden attributable to extreme heat at baseline (1991–2004) in NYS was 100 hospital admissions, US$644,069 in direct hospitalization costs, and 616 days of hospitalization per year. Projections for 2080–2099 based on three different climate scenarios ranged from 206–607 excess hospital admissions, US$26–$76 million in hospitalization costs, and 1,299–3,744 days of hospitalization per year. Estimated impacts varied by geographic region and population demographics.Conclusions: We estimated that excess respiratory admissions in NYS due to excessive heat would be 2 to 6 times higher in 2080–2099 than in 1991–2004. When combined with other heat-associated diseases and mortality, the potential public health burden associated with global warming could be substantial.     

山西省流动人口基本公共卫生服务现状、问题及对策

目的 了解山西省流动人口基本公共卫生服务利用情况,探讨如何更好地让流动人口基本公共卫生服务均等化.方法 利用山西省2014年流动人口动态监测调查数据,分析山西省流动人口基本公共卫生服务利用情况.结果 山西省流动人口基本公共卫生服务利用水平低,健康教育普及率不高,医疗保险有重复参保现象,0~6岁儿童健康管理情况有待改善.结论 应提高流动人口对基本公共卫生服务的认识,搭建信息共享平台,实现流动人口医疗保险的有效衔接,同时有效整合卫生和计生资源,提高流动人口管理的效率,更好地为流动人口服务.     

Climate Change,Human Health,and Biomedical Research: Analysis of the National Institutes of Health Research Portfolio

Background: According to a wide variety of analyses and projections, the potential effects of global climate change on human health are large and diverse. The U.S. National Institutes of Health (NIH), through its basic, clinical, and population research portfolio of grants, has been increasing efforts to understand how the complex interrelationships among humans, ecosystems, climate, climate variability, and climate change affect domestic and global health.Objectives: In this commentary we present a systematic review and categorization of the fiscal year (FY) 2008 NIH climate and health research portfolio.Methods: A list of candidate climate and health projects funded from FY 2008 budget appropriations were identified and characterized based on their relevance to climate change and health and based on climate pathway, health impact, study type, and objective.Results: This analysis identified seven FY 2008 projects focused on climate change, 85 climate-related projects, and 706 projects that focused on disease areas associated with climate change but did not study those associations. Of the nearly 53,000 awards that NIH made in 2008, approximately 0.17% focused on or were related to climate.Conclusions: Given the nature and scale of the potential effects of climate change on human health and the degree of uncertainty that we have about these effects, we think that it is helpful for the NIH to engage in open discussions with science and policy communities about government-wide needs and opportunities in climate and health, and about how NIH’s strengths in human health research can contribute to understanding the health implications of global climate change. This internal review has been used to inform more recent initiatives by the NIH in climate and health.     

Preparing for Climate Change: A Perspective from Local Public Health Officers in California

Background

The most recent scientific findings show that even with significant emission reductions, some amount of climate change is likely inevitable. The magnitude of the climate changes will depend on future emissions and climate sensitivity. These changes will have local impacts, and a significant share of coping with these changes will fall on local governmental agencies. Public health is no exception, because local public health agencies are crucial providers of disease prevention, health care, and emergency preparedness services.

Methods

This article presents the results of a survey of California’s local pubic health officers conducted between August and October 2007. The survey gauged health officers’ concerns about the public health impacts of climate change, programs in place that could help to mitigate these health effects, and information and resource needs for better coping with a changing climate.

Results

The results of this survey show that most public health officers feel that climate change poses a serious threat to public health but that they do not feel well equipped in terms of either resources or information to cope with that threat. Nonetheless, public health agencies currently implement a number of programs that will help these agencies handle some of the challenges posed by a changing climate.

Conclusions

Overall, the results suggest that local public health agencies in California are likely in a better position than they perceive to address the threats associated with climate change but that there is a larger role for them to play in climate policy.