期望寿命及健康寿命应用分析

目的　对居民期望寿命和健康寿命的应用进行分析。　方法　采用宁波市城乡 2 0 0 0年居民病伤死因年报表和 2 0 0 1年宁波市城市居民慢性病调查数据 ,分析全死因、去死因期望寿命及健康寿命。　结果　全死因、去死因期望寿命分布均表现为女性高于男性 ,城市高于农村。宁波市 35岁以上城市居民不健康寿命平均为 9.2 1岁 ,占期望寿命的比例各年龄组从 4 3.4 3%到 6 9.88%不等 ,随年龄增长比例逐渐下降。各年龄组健康寿命女性均高于男性 ,平均高 3.0 8岁。　结论　健康寿命是评价人群健康状况的有用指标     

Patient choice and equity in the British National Health Service: towards developing an alternative framework

Choice and competition have been phased into many public health systems with the aim of achieving various and potentially exclusive goals such as improving efficiency, quality and responsiveness to users’ needs. Yet their use to promote equity of access as evidenced recently in the British National Health Service (the NHS) is unprecedented. Giving users the power of exit over unresponsive providers is meant to address the failures of previous policies. This paper shows that there is a potential conflict between choice and equity, in terms of both the values and the outcomes each policy is likely to produce. Using a multidisciplinary and multidimensional framework, drawn from Bourdieusian sociology, feminist theory and economics, the study highlights the implications of the simplistic and one‐sided conception of individual patient choice in relation to equity. It also uses the existing evidence on the impact of market competition and choice, in the UK and elsewhere, to emphasise the importance of socio‐economic and psycho‐social factors, which are left out of current policy considerations.     

Health Disparities,Transportation Equity and Complete Streets: a Case Study of a Policy Development Process through the Lens of Critical Race Theory

Historic disinvestment in transportation infrastructure is directly related to adverse social conditions underlying health disparities in low-income communities of color. Complete Streets policies offer a strategy to address inequities and subsequent public health outcomes. This case study examines the potential for an equity-focused policy process to address systemic barriers and identify potential measures to track progress toward equity outcomes. Critical race theory provided the analytical framework to examine grant reports, task force notes, community workshop/outreach activities, digital stories, and stakeholder interviews. Analysis showed that transportation inequities are entrenched in historically rooted disparities that are perpetuated in ongoing decision-making processes. Intentional efforts to incorporate equity into discussions with community members and representatives contributed to explicit equity language being included in the final policy. The potential to achieve equity outcomes will depend upon policy implementation. Concrete strategies to engage community members and focus city decision-making practices on marginalized and disenfranchised communities are identified.     

The development of a national HIV Plan in Belgium: Achieving consensus despite institutional complexity

BackgroundThe development of a national HIV Plan poses serious challenges to countries with a complex distribution of legal powers such as Belgium. This article explores how the Belgian national HIV Plan 2014–2019 was developed.MethodsApplying the policy streams model of John Kingdon, the analysis of the HIV Plan development process was based on published government statements, parliamentary documents, and websites of stakeholders.ResultsThe Federal Ministry of Health initiative to achieve the HIV Plan was characterized by a coordinating role with a participatory approach towards the other Belgian governments and stakeholders. The 2013 protocol agreement of the Belgian governments committed them to principles, actions, and cooperation, but not to budgets, priorities, or target figures.DiscussionThe Federal government followed a successful strategy to create momentum and commitment to a common national vision on HIV/AIDS. The window of opportunity was not sufficient to create an implementation plan prior to the 2014 elections, and major challenges were left to the subsequent governments, including financing.ConclusionThe country of Belgium represents an example of a consensus strategy to achieve a national HIV Plan with its achievements and limits within institutional complexity and limited Federal legal powers.     

Comprehensive Transgender Healthcare: The Gender Affirming Clinical and Public Health Model of Fenway Health

This report describes the evolution of a Boston community health center’s multidisciplinary model of transgender healthcare, research, education, and dissemination of best practices. This process began with the development of a community-based approach to care that has been refined over almost 20 years where transgender patients have received tailored services through the Transgender Health Program. The program began as a response to unmet clinical needs and has grown through recognition that our local culturally responsive approach that links clinical care with biobehavioral and health services research, education, training, and advocacy promotes social justice and health equity for transgender people. Fenway Health’s holistic public health efforts recognize the key role of gender affirmation in the care and well-being of transgender people worldwide.     

北京市居民健康期望寿命测算研究

目的：基于卫生系统现有数据测算北京市居民健康期望寿命,对该指标本土化研究与应用提出建议。资料与方法：利用2008年北京市年度人口和死亡资料,第四次国家卫生服务调查和第二次全国残疾人抽样调查资料,基于沙利文法测算常用健康期望寿命指标。结果：2008年北京市居民0岁自评健康期望寿命为72．75岁,男性71．22岁,女性73．89岁。0岁无失能期望寿命75．18岁,男性73．85岁,女性76．56岁。0岁无慢性病期望寿命62．73岁,男性61．87岁,女性63．75岁。北京居民健康期望寿命在期望寿命中的占比男性通常高于女性,但老年人口中,男性健康期望寿命在期望寿命中的占比低于女性。政策建议：使用健康期望寿命作为居民健康状况评价的重要指标,借鉴国外成熟经验建立本土化的数据报告和收集制度,推进居民全生命周期人口相关信息数据的整合与利用,重视老年人口的长期照护需求及其健康支持体系建设。     

The Impact of National Health Insurance on the Utilization of Health Care Services by Pregnant Women: The Case in Taiwan

Objectives: Substantially increased funding for health care services occurred in Taiwan after the implementation of a national health insurance plan in 1995. This study attempts to examine the impact of this national health insurance plan on the utilization of prenatal and intrapartum care services. Methods: Nationally representative surveys of all pregnant women in Taiwan in 1989 (1,662 participants) and in 1996 (3,626 participants) were included in the analysis. We first compared the distribution of birth characteristics between the two surveys. We then calculated the rate of utilization of various prenatal and intrapartum care services in the two surveys in the overall sample and in subsamples, stratified by maternal education, age, and parity. Results: The utilization of most prenatal and intrapartum care services, especially the complicated laboratory tests, increased in 1996 compared to 1989. For example, the proportion of women who received amniocentesis increased from 1.62% in 1989 to 5.60% in 1996 and German measles testing increased from 5.96% to 27.11%. By contrast, the proportion of women who received consultation services was stable over time, or for family planning, consultation declined from 33.21% to 27.00%. These changes in utilization over time were consistently observed across different maternal education, age, and parity groups. Conclusions: The utilization of prenatal and intrapartum care services, especially for the more expensive services, has substantially increased in Taiwan since the implementation of the national health insurance. For countries considering similar national health insurance plan, it may be helpful to consider cost-containing measures before the implementation of such a plan.     

The snakes and ladders of National Health Service management in England

This article explores managerial careers in the National Health Service (NHS) through the lens of talent management, particularly focusing on how managers view barriers (snakes) and facilitators (ladders) to career progression. There is a significant literature on enablers and barriers to career progression, but much of this focuses on specific groups such as black and minority ethnic and female workers, and there is relatively little material on the general workforce of the NHS. The research design is a mixed method quantitative (questionnaire) and qualitative (interview and focus group) approach consisting of a quasi‐probability element that focuses on a maximum variety sample and a purposive element that seeks policy views at central and strategic health authority level, and examines talent management in high‐performing NHS organisations. Ladders are identified as follows: volunteering, secondment, networking, mentoring, academic qualifications, development, good role models/managers and appraisal/personal development plan. Snakes are identified as managing expectations; identity and cognitive diversity; location; sector; NHS toxic and favouritism culture; poor talent spotting; credentialism; exclusive approach to talent; and sustainability. It concludes that while previous conceptual and empirical work is fairly clear on any ladders, it is less clear on snakes. Copyright © 2013 John Wiley & Sons, Ltd.     

Conducting the National Lesbian Health Care Survey: First of Its Kind

The authors of the National Lesbian Health Care Survey (NLHCS) describe the process, challenges, and experiences in planning and conducting the first and largest lesbian health survey, which helped define lesbian health and mental health issues. Challenges include lack of funding, lack of awareness that sexual orientation may affect access to care and health outcomes, sexism, homophobia, fear of AIDS, and lack of guidelines for conducting survey research with lesbians. The methodology was designed to reach a broad range of lesbians throughout the United States, including low-income lesbians, nonurban lesbians, lesbians of color, and lesbians with less formal education. Planning the survey took several years and helped frame how lesbians conceptualize health. Planning began in the late 1970s and data were collected during the fall of 1984 and spring of 1985, at a time when AIDS was emerging as a major focus for community services, research, and funding, and this is reflected in the history of conducting the survey. The process of questionnaire distribution and data collection made broad use of lesbian networks throughout the country, creating for respondents a sense of participation in a larger movement with special significance for lesbians. The National Lesbian Health Care Survey resulted in demographic, health, mental health, and community life experiences from 1925 lesbians from all 50 U.S. states and several territories, and is still the most extensive study of lesbians published to date.     

The Role of the National Rural Health Alliance

ABSTRACT: This paper outlines the history and subsequent development of the National Rural Health Alliance. The mission statement and objectives of the Alliance are presented. An outline of the role and function of the Alliance both now and in the future is given. Details are given of the rural associations who are members of this national rural body and key players in rural health in Australia.     

实现健康中国战略2030年人均预期寿命目标路径研究

目的：从健康社会决定因素角度,评估相关因素发展对中国人均预期寿命的影响,基于因素发展路径预测中国2030年人均预期寿命,分析健康中国战略2030年人均预期寿命目标的实现路径,提出政策建议。方法：利用1990—2017年跨国面板数据,采用个体固定效应模型分析人均预期寿命与健康社会决定因素相关性,基于因素发展路径模拟（高、中、低三种方案）预测中国2030年人均预期寿命,并与战略目标值比较分析。结果：人均GDP、受教育程度、卫生人力密度等与人均预期寿命正向相关,PM2.5、交通事故死亡率、个人现金卫生支出占比与人均预期寿命负向相关。按照中方案,中国2030年人均预期寿命可达79.22岁（95% CI：78.00~80.47）,可以实现健康中国战略2030年设定的79.0岁目标。在快速发展的情景下,高方案的预测值可达81.46岁（95% CI：80.23~82.70）;在发展受阻和疫情冲击的双重负向作用下,低方案的预测值仅为76.48岁（95% CI：75.21~77.77）,甚至低于2019年77.3岁历史值。结论：在推进健康中国建设过程中,应明确制定健康责任部门考核指标,推动健康融入所有政策落地;将短期发展与中长期发展相结合,分层分阶段实现发展目标;改善区域间人均预期寿命发展的不平衡,带动人均预期寿命整体提高。     

The National Rural Health Unit: The Consultation and Planning Phase

ABSTRACT: The National Rural Health Unit is Australia's peak body for rural and remote area health research. It has been established as a national network by a consortium led by the Monash University Centre for Rural Health in Moe, Victoria. During the consultation and planning phase, the Unit has sought input from interested individuals and organisations through a questionnaire survey and a national consultation and planning workshop. Priority issues identified by the survey were: rural health service policy and delivery; rural health workforce recruitment and retention: rural health workforce continuing education and professional development and Aboriginal health. The workshop brought together key opinion leaders with broad representation of the various health disciplines, geographic locations, health authorities, professional organisations and rural health research centres. From the workshop emerged recommendations for five-year and one-year goals of the Unit.     

The Americanization of the British National Health Service: A typological approach

There have been many different claims that the British National Health Service (NHS) is becoming ‘Americanized’. Focusing on the United Kingdom, this article critically analyses the “Americanization” of the NHS in three main sections. First, we explore the basic meanings of the term. Second, we examine the development of the discourse about Americanization. Third, we focus on one of many possible meanings of Americanization, namely system change. Focusing on this most demanding dimension of Americanization, we suggest that most changes have been ‘internal changes of levels’ (where there is a shift of levels in one or more dimensions but without changing the dominant form) or ‘internal system changes’ (where only one dimension changes its dominant form) rather than a ‘system change’ (from one ideal type to another).     

期望寿命相关指标的发展和应用

期望寿命相关指标是目前应用最为广泛的衡量人群总体健康水平或疾病负担的指标之一。随着长期随访的人群队列的增加,越来越多的研究开始探索此类指标的影响因素。本文将就期望寿命相关研究中较常采用的指标及其定义、计算的基本原理和在慢性病流行病学研究中的应用实例进行综述。     

从创建国家卫生城市看学校健康教育的开展效果

目的了解连云港市城、郊区学校健康教育开展情况及的存在问题,为有针对性地开展学校健康教育提供科学依据。方法对学校健康教育的工作部署、人员安排、授课情况及方法、形式等进行回顾与总结。结果通过创建国家卫生城市活动的推动和促进,连云港市学校健康教育工作有了长足的发展。毕业班健康教育开课率和控烟是学校健康教育的薄弱环节,大中专院校的健康教育、学校教职员工的健康教育和资料收集与归档工作没有得到应有的重视。结论应通过提高认识、建立目标责任制、加强制度化管理、充分发挥职能部门和校医的主导作用等途径,进一步促进学校健康教育工作的开展。     

We carry history within us: Anti-Black racism and the legacy of lynchings on life expectancy in the U.S. South

The United States lags in life expectancy compared to most of the world's similarly wealthy nations, driven by pronounced regional disparities particularly between the South and the rest of the country. The U.S. South has a violent history of lynchings of Black Americans by White mobs after the ending of slavery and up to the Civil Rights Era. Building on critical race scholarship, the objective of this study was to determine whether there exists an association between historical lynchings and overall life expectancies in the U.S. South. We created a cross-sectional county-level data set with 1221 data points utilizing data from the Equal Justice Initiative and Robert Wood Johnson Foundation Country Health Rankings. The average life expectancy for 2019–2020 was 76.1 years, ranging from 68.2 years to 90.2 years. Overall life expectancy was found to be highest (76.6) in counties with no recorded lynchings, and lowest (75.5) in counties with the most lynchings (p < .001). In the spatially enabled regression model, the history of lynching along with other covariates explained 57.1% of the variance in life expectancies across the study area. Counties with a history of lynchings also score lower compared to the reference group in various socioeconomic indicators, including median household incomes and high school graduation rates. The findings suggest that lynchings were pivotal in creating the social and physical environment affecting health outcomes in the U.S. South today. We call for further public health research which acknowledges and explores this form of violent and institutional anti-Black racism as foundational to the nation's regional health disparities.     

National Health Insurance Scheme: An Assessment of Service Quality and Clients' Dissatisfaction

BackgroundHealth Insurance Scheme (NHIS), a medical package to start with a fraction of Nigerians at its inception, with the expectation of optimal services to all in the long The Nigerian government established National run. However, there are complaints and dissatisfaction of enrolees of the scheme. This study determined factors responsible for enrolees'' dissatisfaction of services in a general hospital within the federal capital territory, Abuja.MethodThree hundred enrolees of National Health Insurance Scheme at the Kubwa general hospital were enrolled. Semi structured questionnaires were used to obtain information on socio-demography, education, enrolee status, perception of the scheme and factors responsible for enrolees'' dissatisfaction. SPSS version 22 was used to analyse Data using percentage.ResultsMajority (66.3%) of the respondents were between 35 and 54 years while 28.5% were below 35years and 11.8% (32) were above 54years with the male to female ratio was 1.03:1. Sixty percent (179) of the respondents had a minimum of tertiary education with just 1.8% having primary education. Most (69.9% and 79.6%) respondents were principal enrolees and public servants respectively. Seventy percent of the respondents have been enrolled in NHIS for more than 3years and had a good perspective of the scheme. However, 30% of the respondents were not satisfied with NHIS services with 8.6% and 15.4% describing the services as substandard and below expectations respectively. Half (50.7%) of the respondents would consider an alternative to NHIS suggesting their dissatisfaction. The major factors responsible for dissatisfaction were billing system, long waiting hours and staff attitude accounting for 46.9%, 59.4% and 7.8% respectively.ConclusionThis study revealed that the level of clients'' dissatisfaction with NHIS services is high despite their acceptance of the scheme with the major areas of concern being the billing system, waiting time and staff attitude. Therefore, it is necessary for the providers to look more into these areas as targets for service delivery improvement.     

Universal Health Coverage in Italy: lights and shades of the Italian National Health Service which celebrated its 40th anniversary

The Italian National Health Service (I-NHS) was established in 1978 to guarantee universal access to healthcare. Prominent in international reports, the I-NHS has reached a satisfactory level of efficiency and excellent standards of care in many regions, in forty years. Along the years, I-NHS has developed a structural public-private partnership in health services delivery that in some regions contributes to the achievement of very high standards of healthcare quality. However, the I-NHS is currently facing some major challenges: (a) Italy is experiencing a remarkable aging of its population with increasing health needs; (b) the recent and constant cuts to public expenditures are reducing the budget for welfare. It is of utmost importance to ensure that on-going efforts to contain health system costs do not subsume health care quality. In addition, monitoring of the essential levels of care (Livelli Essenziali di Assistenza, LEA) highlights significant differences in healthcare delivery among Italian regions that, in turns, contribute to the burdensome migration of patients to best-performing regions. Therefore, a more consolidated and ambitious approach to quality monitoring and healthcare improvement at a system level is needed to guarantee its sustainability in the future.