Organizing, educating, and advocating for health and human rights in Vieques, Puerto Rico

I briefly review the process of community organization, education, and advocacy activities that ended the harmful military practices in the island-municipality of Vieques, Puerto Rico, while drawing attention to the intersection of human rights and social justice in the context of local and global implications. The Viequense experience was one of building an organization based on people's experiences and strengths, educating people to increase individual and collective efficacy and power, and advocating for policy change with an assertive cohesive action. Public health practitioners must continue supporting community-led interventions in the restoration of the island's environment and other resources vital for people's health and well-being.     

What is evidence-based public health?

Evidence based Public Health is the execution and evaluation of the efficiency of interventions, plans, programs, projects and politics in public health through the application of the scientific principles of reasoning, including the systematic use of information and information systems. Evidence based public health involves the use of methodologies similar to those applied in evidence-based clinical medicine, but differs in its contents. In public health two types of evidence are described. The type I evidence in which a strong relation exists between the preventable risk and disease, and type II evidence in which there exists a relative effectivity of the public health interventions. In evidence based Public Health research designs more appropriate for the social sciences are used, as the observational and quasi-experimental studies. Likewise the decisions are more of interdisciplinary teams.     

Proposals for the reform of public health services in Catalonia

In the year 2004 the government of Catalonia undertook a process to reform its public health services. In this context, it created a working groupinvolving experts from diverse backgrounds to analyse the reforms to be undertaken, the Scientific Committee for the Reform of Public Health in Catalonia. Its members produced eight documents on specific aspects of public health, from which a global report of the Committee was compiled by the end of 2005. This paper makes a synthesis of their production, and includes as an annex their recommendations and proposals. Public health policies should be structured around three main goal: the reduction of health inequalities, the control and removal of social and environmental risks, and effective improvements in quality of life. To reach them, common criteria are defined as main directions. These are based in favouring decentralization of public health services and their administration, linking public health activities with health care services, designing interventions with a population perspective, and reinforcing cross-sectional implications of public health. The work of this Committee is produced in the context of an international debate on the future of public health services and the disproportion between its contribution to health and well being and its resources and visibility. The Committee produced proposals and recommendations which can he grouped in five facets: consolidating a solid and coherent system, developing an organizational reform, defining a port-folio of services, adopting improvements in management, and taking into account cross sectional aspects relating to public health.     

Being global in public health practice and research: complementary competencies are needed

Different sets of competencies in public health, global health and research have recently emerged, including the Core Competencies for Public Health in Canada (CCPHC). Within this context, we believe it is important to articulate competencies for globalhealth practitioners-educators and researchers that are in addition to those outlined in the CCPHC. In global health, we require knowledge and skills regarding: north-south power dynamics, linkages between local and global health problems, and the roles of international organizations. We must be able to work responsibly in low-resource settings, foster self-determination in a world rife with power differentials, and engage in dialogue with stakeholders globally. Skills in cross-cultural communication and the ability to critically self-reflect on one's own social location within the global context are essential. Those in global health must be committed to improving health equity through global systems changes and be willing to be mentored and to mentor others across borders. We call for dialogue on these competencies and for development of ways to assess both their demonstration in academic settings and their performance in global health practice and research.     

How is health-related “deservingness” reckoned? Perspectives from unauthorized im/migrants in Tel Aviv

Do unauthorized im/migrants have a right to health? Do they deserve health care, or health protection, or access to the social determinants of good health? Are they party to prevailing social contracts, or does their exclusion from mainstream systems of health promotion, prevention, and care “make sense”? Questions like these, which generate considerable attention in multiple spheres of scholarship, policy, and public debate, revolve around an issue that merits substantially greater consideration among social scientists of health: health-related “deservingness.” In addition to putting the issue of health-related deservingness squarely on the map as an object of analysis, this article further argues that we cannot focus solely on those with power, influence, and public voice. Rather, we also must investigate how deservingness is reckoned in relation to – and, furthermore, from the perspectives of – unauthorized im/migrants and members of other groups commonly constructed in public and policy discourse as undeserving. Additionally, we must consider the complicated relationship between universalizing juridical arguments about formal entitlement to health rights, on one hand, and situationally specific, vernacular moral arguments about deservingness, on the other.     

Public health medicine: the constant dilemma

There is a well-known quotation by the nineteenth-century sociologist Virchow (quoted in Ref. 1) that aptly captures the dilemma that has confronted public health medicine since the specialty was created as a discrete entity in 1848. Virchow said: 'Medicine is politics and social medicine is politics writ large!' What does this mean in relation to effective public health medicine practice and how is it likely to affect its future? There is increasingly limited freedom of expression within the current context of political correctness, central control and a rapidly burgeoning litigious climate. The purpose of this paper is to explore these issues and to propose a means of maintaining public health medicine integrity within a working environment where action is becoming rapidly constrained by political rigidity. An additional factor to be included in the dialogue is the current context within which public health physicians work. Because the majority of public health doctors are employed within the National Health Service (NHS), they are finding themselves being expected to take on tasks and responsibilities marginal to their essential purpose and function. For example, public health physicians spend a great deal of time involved in detailed deliberations about health service provision. Although there is a great deal of evidence to show that good quality health care provision positively affects the health of the individual, there is no evidence to show that this activity has any effect on the population's health status. The essence of public health medicine practice is the prevention of ill-health and the promotion of the health of the population and, consequently, attention needs to be focused on the root causes of disease. However, as these are outside the aegis of the NHS, public health medicine involvement in such issues as education, nutrition, housing, transport and poverty is regarded as marginal to the NHS corporate agenda.     

Meeting the challenge of epidemic infectious disease outbreaks: an agenda for research

Challenges arising from epidemic infectious disease outbreaks can be more effectively met if traditional public health is enhanced by sociology. The focus is normally on biomedical aspects, the surveillance and sentinel systems for infectious diseases, and what needs to be done to bring outbreaks under control quickly. Social factors associated with infectious disease outbreaks are often neglected and the aftermath is ignored. These factors can affect outbreak severity, its rate and extent of spread, influencing the welfare of victims, their families, and their communities. We propose an agenda for research to meet the challenges of infectious disease outbreaks. What social factors led to the outbreak? What social factors affected its severity and rate and extent of spread? How did individuals, social groups, and the state react to it? What are the short- and long-term effects on individuals, social groups, and the larger society? What programs can be put in place to help victims, their families, and affected communities to cope with the consequences--impaired mental and physical health, economic losses, and disrupted communities? Although current research on infectious disease outbreaks pays attention to social factors related to causation, severity, rate and extent of spread, those dealing with the "social chaos" arising from outbreaks are usually neglected. Inclusion, by combining traditional public health with sociological analysis, will enrich public health theory and understanding of infectious disease outbreaks. Our approach will help develop better programs to combat outbreaks and equally important, to help survivors, their families, and their communities cope better with the aftermath.     

FUTURE COOPERATION BETWEEN THE AMERICAN RED CROSS AND PUBLIC HEALTH AGENCIES

Since the cessation of hostilities in Europe health officers have been asking "What is the Red Cross going to do in Public Health?" Dr. Farrand here assures the public health profession that the Red Cross proposes to be a co?perative agency and not unless circumstances seem to demand it, an operative one.     

Complicating nursing's views on religion and politics in healthcare

Nursing, with its socially embedded theory and practice, inevitably operates in the realm of power and politics. One of these political sites is that of religion, which to varying degrees continues to shape beliefs about health and illness, the delivery of healthcare services and the nurse–patient encounter. In this paper, I attempt to complicate nursing's views on religion and politics in healthcare, with the intent of thinking critically and philosophically about questions that arise at the intersection of religion, politics and nursing/healthcare. These questions include the following: What is the domain of religion and politics? How (non)religious are the contemporary societies in which nurses practice? What are the variations and implications of secularism? How is religion entangled with other intersecting social relations of power? How does a political reading of religion and politics matter to the concerns of nursing?     

Limiting the consumption of sugar sweetened beverages in Mexico's obesogenic environment: a qualitative policy review and stakeholder analysis

Mexico is building a legal framework to address its childhood obesity epidemic. Sugar sweetened beverages (SSB) in the school environment represent a major policy challenge. We addressed the following questions: What barriers inhibit political attention to SSB and childhood obesity? What political instruments, international and national, exist to guide agenda setting in Mexico? What opportunities exist for policy adoption? We conducted a systematic review of international and national legal instruments concerned with SSB consumption. We traced process, conducting interviews with key informants. Thematic analysis helped us identify barriers and opportunities for public health interventions. We found 11 national policy instruments, but detected implementation gaps and weak fiscal policies on SSB consumption in schools: limited drinking water infrastructure, SSB industry interests, and regulatory ambiguities addressing reduction of sugar in beverages. Public policy should target marketing practices and taxation. The school environment remains a promising target for policy. Access to safe drinking water must complement comprehensive and multi-sector policy approaches to reduce access to SSB.     

Public health: politics help those who help themselves [in health services]

Poor countries health improves with the application of public health knowledge, but this requires from institutional capacity and political will, not automatically guaranteed by income growth alone. Generalized cost-benefit analysis, explicit establishment of priorities and even consensus (knowledge sharing) are suitable methods to select appropriate policies. Some problems, such as the increasing inequalities among countries or the global warming, may require a change of our institutions given than both market mechanisms and traditional policy intervention by nation-states may prove insufficient. could be the motto for the necessary conciliation between individual and collective actions on health. It has a similar importance to act upon the differences between individuals with similar exposures as diminishing the global risk of those social groups where misfortunes cluster. In a country such a Spain the aforementioned conciliation happens though a Welfare State capable of achieving social 'desirability' based upon democratic legitimacy and effective behavior, effectiveness that can not be obtained without the best combination of clinical and Public Health interventions.     

State health agencies and the legislative policy process.

A new era of health care reform places increasing pressure on public health leaders and agencies to participate in the public policy arena. Public health professionals have long been comfortable in providing the scientific knowledge base required in policy development. What has been more recent in its evolution, however, is recognition that they must also play an active role in leading and shaping the debate over policy. A profile of effective State legislative policy "entrepreneurs" and their strategies has been developed to assist health agencies in developing such a leadership position. Based on the experiences of State legislative liaison officers, specific strategies for dealing with State legislatures have been identified and are organized into five key areas--agency organization, staff skills, communications, negotiation, and active ongoing involvement. A public health agency must be organized effectively to participate in the legislative policy process. Typically, effective agencies centralize responsibility for policy activities and promote broad and coordinated participation throughout the organization. Playing a key role in the agency''s political interventions, the legislative liaison office should be staffed with persons possessing excellent interpersonal skills and a high degree of technical competence. Of central importance to effective legislative policy entrepreneurship is the ability to communicate the agency''s position clearly. This includes setting forward a focused policy agenda, documenting policy issues in a meaningful manner, and reaching legislators with the proper information. Once a matter is on the legislative agenda, the agency must be prepared to negotiate and build broad support for the measure. Finally, public health agencies must be active policy players.(ABSTRACT TRUNCATED AT 250 WORDS)     

Charting a health literacy journey--overview and outcomes from a stakeholder workshop

Through a combination of Personal, social, health and economic education (PSHE), Science, Healthy Schools and a range of other initiatives, we are increasingly preparing our children to understand key topics in health education. However, to what extent are we equipping them with a picture of a healthy, happy future and giving them the tools to access this? In June, The Royal Society for Public Health (RSPH) hosted a workshop entitled "Charting a Health Literacy Journey" to examine this. The workshop brought together a broad group of over 20 stakeholders from the health and education sectors. The aims of the day were to address the following six questions: What is health literacy? What does health literacy look like in action? What are the benefits of health literacy? How is health literacy reflected on the ground at present? How does health literacy fit with the current policy context? What are the options going forward? This report summarises the key findings of the workshop.     

Public health policies: a Scandinavian model?

AIM: To identify how public health problems are identified, explained, and addressed in Scandinavian public health programmes. METHODS: Recent public health white papers from Denmark, Norway, and Sweden have been studied asking the following questions. How are policies and activities justified? Which problems and causes are identified? What is to be done? To what extent are the interpretations and suggested interventions in accordance with liberal or social democratic political ideals? RESULTS: The programmes studied give similar reasons for dealing with public health, namely the wish to create good lives for citizens and to improve the economy of society. The health problems identified are almost the same: cancer, heart disease, diabetes, musculoskeletal diseases, and mental illness. The Danish programme differs from its Norwegian and Swedish counterparts with regard to explanations and suggested solutions to the problems. It may be characterized as more liberal. While the Danish programme stresses the importance of individual behaviour, responsibility, and autonomy, the two others emphasize social relations, living conditions, and participation in addition to behavioural factors. Political responsibility for the health of the population is emphasized in the Norwegian and Swedish programmes. The Swedish programme, in particular, stresses common values such as equality and equal rights, and the significance of the welfare state. The Norwegian programme underlines the importance of empowering the individual, an ambition that could also be seen as a social liberal ambition to increase the self-determination of citizens. CONCLUSION: There is not one Scandinavian model in public health policy but several: a Danish model mainly adhering to liberal ideals, a Norwegian one that could tentatively be labelled social liberal, and a Swedish model adhering to more social democratic ideals.     

Assuring public health professionals are prepared for the future: the UAB public health integrated core curriculum

In response to calls to improve public health education and our own desire to provide a more relevant educational experience to our Master of Public Health students, the University of Alabama at Birmingham (UAB) School of Public Health designed, developed, and instituted a fully integrated public health core curriculum in the fall of 2001. This curriculum combines content from discipline-specific courses in biostatistics, environmental health, epidemiology, health administration, and the social and behavioral sciences, and delivers it in a 15 credit hour, team-taught course designed in modules covering such topics as tobacco, infectious diseases, and emergency preparedness. Weekly skills-building sessions increase student competence in data analysis and interpretation, communication, ethical decision-making, community-based interventions, and policy and program planning. Evaluations affirm that the integrated core is functioning as intended: as a means to provide critical content in the core disciplines in their applied context. As public health education continues to be debated, the UAB public health integrated core curriculum can serve as one model for providing quality instruction that is highly relevant to professional practice.     

浅谈突发公共卫生事件应对中健康促进工作的策略

突发公共卫生事件,是指一些突然发生的,可能或者已经造成社会重大传染病疫情、不明原因的群体性疾病或者造成大量人群食物中毒或者其他严重影响公众健康的紧急事件。在我国2003年颁布的《突发公共卫生事件紧急条例》中对其特征进行了定义:一是具有突发性;二是在公共卫生领域发生;三是严重危害公众健康。在面对突发公共卫生事件发生后,应该及时对事件进行分析、处置,开展广泛深入的健康教育和健康促进工作,可促进公众正确应对灾害,提高自我的防护意识和能力,可以对事件造成的损失进行补救,减少对社会、经济、政治和人民群众生命财产的损害,有利于维护公众健康和社会秩序。对于突发公共卫生事件,除了在发生之后及时应对以外,在平时要开展健康促进工作,对突发公共卫生事件进行预防,并且在其不可避免的发生时,将其危害降到最低。该文对突发公共卫生事件应对中健康促进工作进行探讨。     

Public Health Genomics

Which consequences can be drawn from genome-based knowledge and how can it be responsibly and timely translated into policies and practice? What are recent developments in genetics and molecular biology, what are the challenges, what are the risks of these developments? Which policies can provide an acceptable balance between providing strong protection of individuals'interests and needs while enabling society to benefit from the genomic advances and empowering individuals? How can molecular medicine contribute to more effective and efficient health care services, and what infrastructures and policies can already now be implemented to assure a benefit for population health? Thus, Public Health Genomics (PHG) tries to answer these challenging questions. This integration of genomics into the aims of public health is called Public Health Genomics (PHG) and is defined as "the responsible and effective translation of genome-based knowledge and technologies into public policy and health services for the benefit of population health".     

SUPPORT Tools for evidence-informed health Policymaking (STP) 15: Engaging the public in evidence-informed policymaking

This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers.In this article, we address strategies to inform and engage the public in policy development and implementation. The importance of engaging the public (both patients and citizens) at all levels of health systems is widely recognised. They are the ultimate recipients of the desirable and undesirable impacts of public policies, and many governments and organisations have acknowledged the value of engaging them in evidence-informed policy development. The potential benefits of doing this include the establishment of policies that include their ideas and address their concerns, the improved implementation of policies, improved health services, and better health. Public engagement can also be viewed as a goal in itself by encouraging participative democracy, public accountability and transparency. We suggest three questions that can be considered with regard to public participation strategies. These are: 1. What strategies can be used when working with the mass media to inform the public about policy development and implementation? 2. What strategies can be used when working with civil society groups to inform and engage them in policy development and implementation? 3. What methods can be used to involve consumers in policy development and implementation?     

An Ethics Framework for Public Health

More than 100 years ago, public health began as an organized discipline, its purpose being to improve the health of populations rather than of individuals. Given its population-based focus, however, public health perennially faces dilemmas concerning the appropriate extent of its reach and whether its activities infringe on individual liberties in ethically troublesome ways. In this article a framework for ethics analysis of public health programs is proposed. To advance traditional public health goals while maximizing individual liberties and furthering social justice, public health interventions should reduce morbidity or mortality; data must substantiate that a program (or the series of programs of which a program is a part) will reduce morbidity or mortality; burdens of the program must be identified and minimized; the program must be implemented fairly and must, at times, minimize preexisting social injustices; and fair procedures must be used to determine which burdens are acceptable to a community.