Garnering Partnerships to Bridge Gaps Among Mental Health,Health Care,and Public Health

Integrating mental health and public health chronic disease programs requires partnerships at all government levels. Four examples illustrate this approach: 1) a federal partnership to implement mental health and mental illness modules in the Behavioral Risk Factor Surveillance System; 2) a state partnership to improve diabetes health outcomes for people with mental illness; 3) a community-level example of a partnership with local aging and disability agencies to modify a home health service to reduce depression and improve quality of life among isolated, chronically ill seniors; and 4) a second community-level example of a partnership to promote depression screening and management and secure coverage in primary care settings. Integration of mental health and chronic disease public health programs is a challenging but essential and achievable task in protecting Americans'' health.     

Enhancing Health Knowledge,Health Beliefs,and Health Behavior in Poland through a Health Promoting Television Program Series

This study examined the impact of a health promoting television program series on health knowledge and the key factors of the health belief model (HBM) that have led people to engage in healthy behavior (exercising, losing weight, changing eating habits, and not smoking/quitting smoking). Using data from a posttest comparison field study with 151 viewers and 146 nonviewers in Poland, we found that hierarchical regression analysis showed stronger support for the HBM factors of efficacy, susceptibility, seriousness, and salience in their contribution toward health behavior among television viewers compared with nonviewers. Cues to action variables (including television viewing) and health knowledge boosted efficacy among viewers. Without the advantage of receiving health information from the television series, nonviewers relied on their basic disease fears on one hand, and interest in good health on the other to take steps toward becoming healthier. A health promoting television series can increase health knowledge and enhance health beliefs, which in turn contribute to healthy behaviors.     

Free Library of Health: Consumer Health Information,Health Literacy,and Library Programming in Philadelphia

In 2016, the Free Library of Philadelphia reopened the newly renovated South Philadelphia Library. This full-service neighborhood library is co-located with pediatric primary care services, a city-run health center, and a recreation center in a first-of-its-kind facility called the Community Health and Literacy Center. The South Philadelphia Library aims to improve health literacy in the community through the provision of consumer health information and health programming, and the co-location with health care and recreation services provides unique opportunities to partner and offer health-based library services. A community health librarian certified in consumer health information assists customers with accessing reliable health information, and health programming covers many areas of interest. Partnerships with nearby health organizations also allow the library to connect customers with vetted neighborhood services. By combining health services with traditional library programming, customers are able to increase their health literacy when they visit the library.     

Managed Care, School Health Programs, and Adolescent Health Services: Opportunities for Health Promotion

ABSTRACT: The rapid expansion of managed care creates opportunities and dilemmas for those involved in school health and adolescent health promotion. Managed care organizations (MCOs), public health agencies, and school and adolescent health providers share certain common goals and priorities including an emphasis on prevention, cost-effectiveness, and quality of care — and a willingness to explore innovative approaches to health promotion and disease prevention. However, MCOs often face conflicting challenges, balancing the goals of cost containment and investment in prevention. In considering support for school health programs, MCOs will be interested in evidence about the effectiveness of services in improving health and/or reducing medical expenditures. Mechanisms for improving prevention efforts within MCOs include quality assurance systems to monitor the performance of health plans, practice guidelines from professional organizations, and the contracting process between payers and health care providers. Development of partnerships between MCOs and schools will be a challenge given competing priorities, variation in managed care arrangements, structural differences between MCOs and schools, and variability in services provided by school health programs     

Class, Health, and Justice

Class inequalities in health are intuitively unjust. Although the link between social class and health status has been fully documented, the precise nature of the injustice has not been made clear. Four alternative views are presented, corresponding to four goals: (1) maximizing the sum total of health; (2) equalizing the health status of higher and lower social classes; (3) maximizing the health status of the lowest social class; and (4) maximizing the health status of the sickest individuals in society. The nature of the injustice is further obscured by several theoretical and empirical questions, like the degree and significance of personal responsibility for illness and the relation of the degree of economic inequality to sum total of health.     

Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient-Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools—accountability measures and payment designs—to improve access to and quality of care for patients with behavioral health needs.     

Self-Esteem, Health Locus of Control, and Health Attitudes Among Native American Children

Self-esteem and health locus of control have been postulated as predictors of attitudes and behaviors related to child health. The association among these variables has not been assessed adequately among Native American children. This study measured the relationship among self-esteem, health locus of control, and health attitudes of Native American fourth, fifth, and sixth grade students. A statistically significant relationship was found between self-esteem and positive attitudes toward health. Self-esteem was a modest predictor of health attitudes and health behavioral intentions among Navajo and Pueblo children.     

Health Literacy,Cognitive Ability,and Functional Health Status among Older Adults

Objective

To investigate whether previously noted associations between health literacy and functional health status might be explained by cognitive function.

Data Sources/Study Setting

Health Literacy and Cognition in Older Adults (“LitCog,” prospective study funded by National Institute on Aging). Data presented are from interviews conducted among 784 adults, ages 55–74 years receiving care at an academic general medicine clinic or one of four federally qualified health centers in Chicago from 2008 to 2010.

Study Design

Study participants completed structured, in-person interviews administered by trained research assistants.

Data Collection

Health literacy was measured using the Test of Functional Health Literacy in Adults, Rapid Estimate of Adult Literacy in Medicine, and Newest Vital Sign. Cognitive function was assessed using measures of long-term and working memory, processing speed, reasoning, and verbal ability. Functional health was assessed with SF-36 physical health summary scale and Patient Reported Outcomes Measurement Information System short form subscales for depression and anxiety.

Principal Findings

All health literacy measures were significantly correlated with all cognitive domains. In multivariable analyses, inadequate health literacy was associated with worse physical health and more depressive symptoms. After adjusting for cognitive abilities, associations between health literacy, physical health, and depressive symptoms were attenuated and no longer significant.

Conclusions

Cognitive function explains a significant proportion of the associations between health literacy, physical health, and depression among older adults. Interventions to reduce literacy disparities in health care should minimize the cognitive burden in behaviors patients must adopt to manage personal health.     

健康、亚健康与疾病

健康、亚健康与疾病，是人体生命过程中常见的三种不同状态。正确认识人体健康、亚健康与疾病的实质，对维护、巩固和促进人体健康十分重要。本文叙述了人体健康、亚健康与疾病的定义，健康指标，亚健康分类、诱因及主要危害，疾病的基本特征及转归。     

实施健康管理积极维护、巩固和促进健康

实施健康管理，是维护、巩固和促进健康的重要措施。本文着重叙述了健康管理的形成和发展，健康管理工作的层次和分类，强调了个人知己健康管理的重要性。     

Mobile Health in China: A Review of Research and Programs in Medical Care,Health Education,and Public Health

There are nearly 1 billion mobile phone subscribers in China. Health care providers, telecommunications companies, technology firms, and Chinese governmental organizations use existing mobile technology and social networks to improve patient–provider communication, promote health education and awareness, add efficiency to administrative practices, and enhance public health campaigns. This review of mobile health in China summarizes existing clinical research and public health text messaging campaigns while highlighting potential future areas of research and program implementation. Databases and search engines served as the primary means of gathering relevant resources. Included material largely consists of scientific articles and official reports that met predefined inclusion criteria. This review includes 10 reports of controlled studies that assessed the use of mobile technology in health care settings and 17 official reports of public health awareness campaigns that used text messaging. All source material was published between 2006 and 2011. The controlled studies suggested that mobile technology interventions significantly improved an array of health care outcomes. However, additional efforts are needed to refine mobile health research and better understand the applicability of mobile technology in China's health care settings. A vast potential exists for the expansion of mobile health in China, especially as costs decrease and increasingly sophisticated technology becomes more widespread.     

Families,Transitions, and Health

This paper critically reviews the Caroff-Mailick classification of families seen around health care crises, and of reciprocal roles suggested for health social workers depending on severity and trajectory of illness and on family's functioning levels. As balance, transitional crisis theory, holistic health concepts, and team approaches to the mobilized family as the nit of caregiver attention are discussed. Newer alternative family styles are reviewed which challenge middle class caregiver mores and practices. Family forces which may prejudice worker assessment are reviewed, and the need to mitigate unhealthy and constricting environmental conditions is stressed.     

Obesity,Health at Every Size,and Public Health Policy

Obesity is associated with chronic diseases that may negatively affect individuals’ health and the sustainability of the health care system. Despite increasing emphasis on obesity as a major health care issue, little progress has been made in its treatment or prevention. Individual approaches to obesity treatment, largely composed of weight-loss dieting, have not proven effective. Little direct evidence supports the notion of reforms to the “obesogenic environment.” Both these individualistic and environmental approaches to obesity have important limitations and ethical implications. The low levels of success associated with these approaches may necessitate a new non–weight-centric public health strategy. Evidence is accumulating that a weight-neutral, nutrition- and physical activity–based, Health at Every Size (HAES) approach may be a promising chronic disease-prevention strategy.Obesity is defined as having a body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) in excess of 30. Obesity is associated with numerous chronic health conditions, including diabetes, hypertension, heart disease, and certain cancers.1 The directionality of such associations is largely unknown, confounding may be present, and causality has only definitely been assigned to obesity with respect to osteoarthritis and ovarian cancer.2 Despite these limitations, to counter the health effects of obesity-associated conditions, individuals frequently are encouraged to lose weight to improve individual and population health. However, diet-induced weight loss stimulates somatic and psychological ‘homeostatic pressures’ that induce weight regain.3 These mechanisms include hormonal alterations, reduced satiety and energy expenditure, and increased hunger.3,4 These adaptations stimulate weight regain in more than 90% of weight losers.5,6 In acknowledgment of the limited effectiveness of individual approaches to weight loss, increasing emphasis has been placed on environmental reforms. However, when weight loss is the key motivator of such changes, they are hindered by a limited evidence base and ethical difficulties. These concerns suggest public health would benefit from a shift in focus from weight loss to disease prevention for individuals of all ages and sizes, with a focus on health rather than weight-loss outcomes, and environmental reforms devoted to enhancing livability, accessibility, and equity. Evidence is accumulating that a weight-neutral, nutrition- and physical activity–based, Health at Every Size (HAES) approach may be a promising chronic-disease prevention, and overall well-being, strategy.     

Functions of Loneliness,Social Support,Health Behaviors,and Stress in Association With Poor Health

Prior research has established clear links between social support, loneliness, and various health outcomes. This study was designed to test several theoretically derived explanations for such associations. A survey of 265 adults ages 19–85 years was conducted with measures of social support, loneliness, stress, health behaviors, and general health. Results showed that loneliness was more strongly associated with number of close relationships than with sheer contact with social network members. Further, loneliness mediated the association between social support and better health. In addition, health behaviors, especially poor sleep and medical adherence, mediated the association between loneliness and poor health. These results provide confirmation of theoretical mechanisms postulated to explain why loneliness is associated with poor health.     

Health, technology, and medical care spending

The RAND Future Elderly Model illustrates important principles about the relation among medical technologies, health spending, and health. New technologies add to spending because the costs of the new technologies and the health care costs during the added years of life they bring outweigh reductions in annual spending from better health. Many technologies with a low cost per patient per year result in high aggregate costs because of an expanded population being treated. However, the jury is still out on whether a better health-risk profile among future sixty-five-year-olds could moderate health spending for the elderly.     

One Health,COVID-19, and a Right to Health for Human and Nonhuman Animals

COVID-19 is a reminder that human, nonhuman, and environmental health are linked, and so efforts to improve human, nonhuman, and environmental health should be linked as well. But current efforts to link these issues fall short by not doing enough for humans, not doing enough for nonhumans, and focusing narrowly on health instead of expansively on health, welfare, and rights. This paper surveys the case for respecting and promoting human and nonhuman welfare, health, and rights simultaneously. It then surveys the impacts of COVID-19 on human and nonhuman populations and proposes steps that humans can take to respect and promote human and nonhuman health, welfare, and rights ethically and effectively in this context.     

Employee Health in the Mental Health Workplace: Clinical,Administrative, and Organizational Perspectives

Issues of mental health and employee health have risen to increasing prominence in recent years. However, there have been few explorations of the clinical and administrative challenges that these issues raise, particularly in settings that are themselves mental health workplaces. In order to identify and understand such challenges, a brief case of acute employee illness in a mental health workplace is described followed by a discussion of salient clinical, administrative, and organizational considerations. The case raises questions about medicolegal responsibilities and relationships between clinicians and patients in mental health settings, illuminates tensions between clinical staff and human resources processes, and draws attention to the need for illness prevention and mental health promotion initiatives in the workplace. Increased awareness of these issues, complications, and potential solutions would benefit clinicians, administrators, and mental health institutions.     

Patients Utilizing a Free Clinic: Physical and Mental Health, Health Literacy, and Social Support

This cross sectional study assessed the physical and mental health, health literacy and social support of the uninsured utilizing a free clinic to develop intervention programs and research projects to improve the health of free clinic patients. Free clinics are nonprofit organizations that provide underserved and uninsured individuals access to a broad array of free or low cost healthcare services. English or Spanish speaking patients (N = 187) aged 18 years or older completed a self-administered survey. Physical, mental and oral health, health literacy, and social support were measured using standardized instruments. Eighty-two participants (45 US born and 37 non-US born) chose the English version of the survey (English speakers) while 105 participants (2 US born and 103 non-US born) chose the Spanish version (Spanish speakers). Overall, both the physical and mental health functioning of the participants was lower than that of the US general population. The participants reported being moderately depressed. US-born English speakers reported the poorest physical and mental health while Spanish speakers reported the best physical health and the lowest level of depression. A higher level of health literacy was associated with better physical health functioning, whereas reporting higher social support was associated with better mental health functioning and less severe depression. Because most free clinics have limited resources, developing services and programs that fit free clinics’ circumstances are needed. Our study finding indicates that health literacy education, mental health services, and social support are key services needed by free clinic patients to achieve better health.     

Health status, behavior, and care utilization in the Geneva Gay Men's Health Survey

BACKGROUND: Recent reviews and studies suggest distinctive health needs among gay men. METHODS: Swiss residents in the Geneva Gay Men's Health Survey (GGMHS, n=477) were matched with controls from the Swiss Health Survey (SHS, n=477) along sex, age, nationality, and region of residence and compared along standard indicators of health status, health behaviors, and health care utilization. Both health surveys were conducted in 2002 using probability sampling--i.e., time-space sampling (GGMHS) and household probability telephone sampling (SHS). RESULTS: Although gay men were significantly less likely to be overweight (adjusted odds ratio (AOR)=0.54), they reported significantly more and severe physical symptoms (AOR ranged from 1.72 to 9.21), short-term disability (AOR=2.56), risk factors for chronic disease--i.e., high cholesterol, high blood pressure, high glucose, and smoking (AOR ranged from 1.67 to 3.89), and greater health services utilization (AOR ranged from 1.62 to 4.28), even after adjustment for differences in socio-demographic characteristics and health behaviors. CONCLUSIONS: Evidence of greater morbidity among a community sample of gay men along standard health indicators underlines the relevance of sexual orientation as a socio-demographic indicator in public health in general and in the health inequalities discourse in particular.     

Breast Health Behavior Among Lesbians: The Role of Health Beliefs,Heterosexism, and Homophobia

ABSTRACT

The Health Belief Model was used as a conceptual framework for exploring how health beliefs and perceptions of heterosexism and homophobia in health care relate to lesbians' breast health behaviors, including use of breast exams and mammograms, visits to health care providers, and use of complementary/alternative care. A total of 173 exclusively homosexual women completed survey measures assessing health beliefs, experiences of heterosexism/homophobia, and health maintenance behaviors as these related to breast health. Findings indicated that women perceived heterosexism and homophobia from providers to influence the amount of discussion they had with providers and, to a lesser extent, care received, frequency of service use, and health outcomes. Perceptions of heterosexism and homophobia in health care settings significantly contributed, beyond routine health beliefs, to women's use of breast self-exams, visitation to health care providers, and use of complementary/alternative care. Implications for culturally competent care are discussed.