Community health planning from an interorganizational perspective.

Planning agencies do not have control over health care resources in the community. Resources are concentrated in a number of provider organizations, associations, and government agencies, which have common goals as well as a diversity of individual objectives, and therefore enter into networks of relationships to accomplish their overlapping service missions. Interorganizational research shows that it is important to enhance the interdependence and benefits of cooperation between organizations and at the same time maintain the identity and distinctive qualities of each organization. Thus, in addition to the important role to provide information for decisions, planners have a role to manage the interdependencies and identities among organizations in the health system. Research shows that in situations where only methods, data, and analysis were emphasized by health planners, they had less impact on community decisions than in situations where planners also emphasized the development of the interorganizational system of decision-making. In a neutral position with respect to competing forces, planners can more effectively use their leverage from their information processing role and from their regulatory powers to facilitate the balancing of interorganizational interests and to enhance cooperative benefits to the community.     

Discharge planning: an organizational perspective

Economic pressures and the advent of prospective payment systems have heightened the importance of effective discharge planning. In this examination of the organizational dimension of the discharge process, a conceptual approach for understanding complex organizations is outlined and strategies for negotiating multifaceted systems are presented.     

Population and family planning: an international perspective

Since the 1960s, the U.S. government has supported population and family planning programs in Third World countries, on the grounds that rapid population growth impairs the ability of those countries to develop economically; family planning programs contribute to fertility decline; and such programs help improve the health of mothers and children. Although the United States remains the largest single donor of funding for international population programs, its support has weakened during the eight years of the Reagan administration and patterns of funding for those programs have changed substantially. Since the 1960s, however, contraceptive use has increased in the Third World and fertility has fallen substantially. The decline has been uneven, though--considerable in some countries, moderate in others but very small in many. The performance of family planning programs around the world has varied widely, and questions remain as to what, if anything, can be done to increase success. For the future, three aspects of population and fertility control in developing countries merit special attention: the supply of contraceptive commodities going to family planning programs; the maintenance and strengthening of the family planning infrastructure; and the need to examine the policy implications of differing patterns of fertility and population growth for national development and individual well-being.     

Urban planning and public health at CDC

Urban planning, also called city and regional planning, is a multidisciplinary field in which professionals work to improve the welfare of persons and communities by creating more convenient, equitable, healthful, efficient, and attractive places now and for the future. The centerpiece of urban planning activities is a "master plan," which can take many forms, including comprehensive plans, neighborhood plans, community action plans, regulatory and incentive strategies, economic development plans, and disaster preparedness plans. Traditionally, these plans include assessing and planning for community needs in some or all of the following areas: transportation, housing, commercial/office buildings, natural resource utilization, environmental protection, and health-care infrastructure. Urban planning and public health share common missions and perspectives. Both aim to improve human well-being, emphasize needs assessment and service delivery, manage complex social systems, focus at the population level, and rely on community-based participatory methods. Both fields focus on the needs of vulnerable populations. Throughout their development, both fields have broadened their perspectives. Initially, public health most often used a biomedical model (examining normal/abnormal functioning of the human organism), and urban planning often relied on a geographic model (analysis of human needs or interactions in a spatial context). However, both fields have expanded their tools and perspectives, in part because of the influence of the other. Urban planning and public health have been intertwined for most of their histories. In 1854, British physician John Snow used geographic mapping of an outbreak of cholera in London to identify a public water pump as the outbreak's source. Geographic analysis is a key planning tool shared by urban planning and public health. In the mid-1800s, planners such as Frederick Law Olmsted bridged the gap between the fields by advancing the concept that community design contributes to physical and mental health; serving as President Lincoln's U.S. Sanitary Commission Secretary; and designing hundreds of places, including New York's Central Park. By 1872, the disciplines were so aligned that two of the seven founders of the American Public Health Association were urban designers (an architect and a housing specialist). In 1926, the U.S. Supreme Court, in validating zoning and land-use law as a legal government authority in Village of Euclid v. Ambler Realty, cited the protection of public health as part of its justification. Other connections have included 1) pioneering urbanist Jane Jacobs, who during the 1960s, called for community design that offered safe and convenient options for walking, biking, and impromptu social interaction; and 2) the Healthy Cities movement, which began in Europe and the United States during the 1980s and now includes projects in approximately 1,000 cities that in various ways highlight the role of health as much more than the presence of medical care.     

Exploring a public health perspective on pedestrian planning

A pedestrian plan is a public document that explains a community's vision and goals for future pedestrian activity. This study explored whether involvement by public health professionals in the development of pedestrian plans was associated with certain characteristics of the plan (vision, goals, identified programs, and evaluation). This study identified, collected, and analyzed content of all pedestrian plans in North Carolina through 2008. Among the 46 plans, 39% reported involvement by public health professionals in their development. Overall, 72% of pedestrian plans included a vision statement; health was mentioned four times and quality of life was mentioned five times. Slightly more than half (52%) of the plans included goals to improve public health. Plans that involved public health professionals more often included the type of physical activity, safety, or education program. Only 22% of all pedestrian plans included a proposal to evaluate their implementation. Plans that included public health professionals were less likely to include an evaluation proposal (11%) compared with those that did not involve public health professionals (21%). Public health professionals are encouraged to seek involvement in the pedestrian planning process, particularly in the areas of health program development, implementation, and evaluation.     

Nursing and planning in health: management report as an instrument of health planning

The involvement of the future nurse in the construction of the Management Report of the Actions of Health of a city in the interior of Rio Grande do Sul was the main objective of this study. The methodological strategy consisted of meetings with coordinators and technicians responsible for the sanitary units, the General Director Group and planning team of the health of the city, participation in the collection of data and elaboration of the related report. The literature revision contemplated: politics of health, a management report as an instrument of health planning, continued education and the role of the nurse on SUS improvement. This work contributed to the improvement of the report of health management, with sights to the planning and implementation of resolute and effective actions.     

Primary health care: an international perspective

Five years have passed since the Alma Ata meeting, and with 17 years remaining in this century, one has to ponder whether the goal of health for all by the year 2000 through primary health care is achievable. This article explores the general situation of health and primary health care, especially in the developing world, where health problems are more acute. The slogan "health for all by the year 2000" has succeeded in creating an awareness of the problems throughout the world. The path toward this goal is not necessarily smooth or paved. Nevertheless, with goodwill and planned actions it can be achieved, though not necessarily by all nations or by the year 2000. This is the biggest challenge facing nations, professionals, international health organizations, and humanity. To achieve this goal they will need to improve and better use national resources, both physical and human. Developing physical resources entails comprehensive and integrated socioeconomic growth, improved health budgeting with multisectorial programming, the use of appropriate technology, and the adoption of scientific managerial processes; but what is even more important is the development of human resources at all levels.     

A joint urban planning and public health framework: contributions to health impact assessment

A joint urban planning and public health perspective is articulated here for use, in health impact assessment. Absent a blueprint for a coherent and supportive structure on which to test our thinking, we are bound to fall flat. Such a perspective is made necessary by the sheer number of people living in cities throughout the world, the need for explicit attention to land use and transportation systems as determinants of population health, and the dearth of useful indicators of the built environment for monitoring progress. If explicit attention is not paid to the overarching goals of equality and democracy, they have little if any chance of being realized in projects, programs, and policies that shape the built environment and therefore the public's health.     

A social-ecological perspective on health in urban environments

Human health in our cities is an expression of complex social and environmental interactions not previously faced in our long evolutionary history. In this paper, we present a social-ecological perspective on the complex nature of emerging public health problems in cities and identify some of the research questions emerging from this new view of the city. We argue that an integrative urban science agenda is needed not only to inform urban policy, planning and design, but also to alert people to the consequences of and trade-offs around their choices and behaviours.     

Geographic analysis of pertussis infection in an urban area: a tool for health services planning.

OBJECTIVE: This study examined whether incident cases of pertussis cluster in urban census tracts and identified community characteristics that predict high-incidence areas. METHODS: An ecological study design was used. The study population included all persons diagnosed with pertussis from January 1, 1986, through December 31, 1994. Maps of rates were constructed via a geographic information system and clustering was statistically confirmed. Associations between pertussis rates and community characteristics were tested. RESULTS: Mapping and statistical analysis revealed spatial clustering of pertussis. Higher age-adjusted rates of pertussis infection were associated with higher proportions of residents below poverty level. CONCLUSIONS: In urban areas pertussis infection clusters in areas of poverty.     

Taiwan's population and family planning efforts: an historical perspective

The unprecedented decline of Taiwan's natural population increase rate from 3% in 1963 to 1.9% in 1973, attributed primarily to an increasing use of contraception, brought universal attention to one of the first and most successful national family planning programs, at a time when successes were few. Taiwan met its goal of decreasing its natural increase rate despite its young population, increasing numbers of women of childbearing ages, a strong preference for sons and a per capita income at the outset in 1963 of less than U.S.$200. Recognition of this achievement brought thousands of professionals, particularly from developing countries, to study the program firsthand: more than 3,000 during 1970--73 alone. This was matched by an avalanche of publications about the program that appeared around the world, written by practitioners, academics and others. This article tells the story of this success.     

Prioritizing health services research: an economic perspective

Introduction

Given limited resources policymakers need to decide about how much and in what areas of health services research (HSR) to invest. The purpose of this study is to provide guidance for priority setting of HSR projects based on economic theory.

Methods

The conceptual analysis starts from the premise that competition in health care is valuable—a position that seems to predominate among Western policymakers. The principle of competition rests on economic theory and, in particular, its branch of welfare economics.

Results

Based on economic theory, the role of HSR is to detect and alleviate information asymmetry, negative externalities, and harm caused by competition and inappropriate incentives for competition. A hierarchy of HSR projects is provided; following the ethical principle of harm (‘do not harm’), the detection and prevention of harm would receive highest priority among HSR projects.

Conclusions

Agreeing that competition is valuable in achieving efficiency and quality of care (and therefore agreeing to the assumptions of economic theory) implies accepting the role of HSR in detecting market failure and the HSR hierarchy as suggested. Disagreement would require an alternative coherent concept of improving efficiency and quality of care.

     

Social determinants of health: an economic perspective

The World Health Organization has recently received the findings of its Commission on the Social Determinants of Health. The Commission's report offers a remarkable summary of the evidence, and makes a passionate case for government action to address the social determinants of health, especially as they relate to health inequity. This paper summarizes the ways in which economic analysis could strengthen policy under three headings: examining the causal impact of the determinants of health and of associated policies; prioritising actions; and determining the role of government in influencing behaviour. Copyright © 2009 John Wiley & Sons, Ltd.