Earthquakes in El Salvador]

The Pan American Health Organization (PAHO) has 25 years of experience dealing with major natural disasters. This piece provides a preliminary review of the events taking place in the weeks following the major earthquakes in El Salvador on 13 January and 13 February 2001. It also describes the lessons that have been learned over the last 25 years and the impact that the El Salvador earthquakes and other disasters have had on the health of the affected populations. Topics covered include mass-casualties management, communicable diseases, water supply, managing donations and international assistance, damages to the health-facilities infrastructure, mental health, and PAHO's role in disasters.     

Welfare indicators and health: the selection and use of socioeconomic indicators for monitoring and evaluation

PAHO's plan of action for attaining the goal of health for all by 2000 calls for evaluating improvements in well-being--partly because health is included within the general framework of well-being and partly because nonhealth factors conditioning health status should be used to assess and explain health levels. Accordingly, the plan sets forth 8 indicators that, together with other appropriate indicators, can be used for such evaluations. These 8 indicators include demographic information (population classified according to age, sex, geographic distribution, and socioeconomic status); general fertility; illiteracy; unemployment; poverty; availability of calories and proteins; per capita gross domestic product and the structure of gross national product; and the proportion of the population living in marginal conditions. The purpose of this article is to examine each of these indicators, assess its value, and suggest how the data relating to it should be organized and broken down. Among other things, the author stresses the need to obtain demographic data of a socioeconomic nature; the importance of breaking down the information obtained in terms of population subgroups--by age, sex, geographic location, and socioeconomic status; and the need to go beyond average values, which tell little about overall welfare problems, so as to develop values for appropriate subgroups, which can indicate quite a lot. Other points noted include the need to group fertility data according to the mother's age and number of children; the ability of data on malnutrition to serve as an indicator of available calories and proteins; the possibility of equating 2 indicators (extreme poverty and marginal living conditions); the need to supplement data on unemployment rates with information about the duration of unemployment and the extent of underemployment; and the marginal utility of per capita gross domestic (or national) product information for the purpose of assessing deficiencies in public welfare. The piece also makes various points relating to research on the connections between health and nonhealth components of well-being. Specifically, it notes that socioeconomic information unrelated to health should not be reported by the health sector; that the mandatory socioeconomic indicators listed are sufficient for purposes envisaged; that any indicators added to those on the plan's list should bear a close relationship to health; that any research undertaken should be micro rather than macro in nature; that such research requires high quality statistical work; and that the value of this research for health policies will depend largely on how the results are presented to and interpreted by policymakers.     

Measles eradication: experience in the Americas

In 1994, the Ministers of Health from the Region of the Americas targeted measles for eradication from the Western Hemisphere by the year 2000. To achieve this goal, the Pan American Health Organization (PAHO) developed an enhanced measles eradication strategy. First, a one-time-only "catch-up" measles vaccination campaign is conducted among children aged 9 months to 14 years. Efforts are then made to vaccinate through routine health services ("keep-up") at least 95% of each newborn cohort at 12 months of age. Finally, to assure high population immunity among preschool-aged children, indiscriminate "follow-up" measles vaccination campaigns are conducted approximately every 4 years. These vaccination activities are accompanied by improvements in measles surveillance, including the laboratory testing of suspected measles cases. The implementation of the PAHO strategy has resulted in a marked reduction in measles incidence in all countries of the Americas. Indeed, in 1996 the all-time regional record low of 2109 measles cases was reported. There was a relative resurgence of measles in 1997 with over 20,000 cases, due to a large measles outbreak among infants, preschool-aged children and young adults in S?o Paulo, Brazil. Contributing factors for this outbreak included: low routine infant vaccination coverage, failure to conduct a "follow-up" campaign, presence of susceptible young adults, and the importation of measles virus, apparently from Europe. PAHO's strategy has been effective in interrupting measles virus circulation. This experience demonstrates that global measles eradication is an achievable goal using currently available measles vaccines.     

Maternal syphilis and congenital syphilis in Latin America: big problem, simple solution]

From the data submitted to the Pan American Health Organization (PAHO) by nationwide programs against sexually transmitted diseases (STD), HIV infection, and AIDS (2002), one can estimate the overall prevalence of syphilis among pregnant women to be 3.1% and to range from 1.00% in Peru to 6.21% in Paraguay. According to these data, the incidence of congenital syphilis ranges from 1.4 per 1000 live births in El Salvador to 12.0 per 1000 live births in Honduras. Among men who engage in sex with other men, who often classify themselves as heterosexual, as well as in female sex workers, the prevalence of syphilis ranged from 5% to 15%. Factors that determine the persistence of congenital syphilis as public health problem include a lack of awareness of the seriousness of the problem among politicians, health officials, and health care providers, difficult access to prenatal care, and screening services, a low demand for the test among users, and the stigma and discrimination that surround sexually transmitted diseases (STD). This paper seeks to focus the attention of health professionals on maternal and congenital syphilis so they will undertake actions, using an interprogrammatic approach, to eliminate congenital syphilis from Latin America and the Caribbean. Eliminating congenital syphilis will only become possible if interventions targeting vulnerable groups are also implemented. PAHO's role in eliminating congenital syphilis includes determining the baseline situation in the Region as a whole and in each country, developing communication and procurement strategies, supporting nationwide programs, promoting operational research, and facilitating interprogrammatic coordination.     

Students in the community: MAPP as a framework for academic-public health practice linkages.

The importance of establishing and sustaining academic-public health practice linkages has been a point of emphasis in the Institute of Medicine reports on public health in 1988 and in 2003. One likely barrier to fostering such linkages is the absence of a clear framework that matches academic requirements to practice realities. This article describes how an academic-public health practice collaborative has used MAPP in a health planning course for Master of Public Health students over a 3-year period, allowing students the opportunity to work in communities with public health practitioners. The specific focus for each of these 3 years has varied, but underlying the work has been a consistent approach to teaching and working in communities with MAPP as the frame of reference. The outcome of this work has been of value to students and faculty, to public health department staff, and, most important, to the communities where this work has taken place. This suggests that there is great potential for using MAPP as a framework for establishing and strengthening academic-public health practice linkages.     

An essay on 'health capital' and the Faustian bargains struck by workers in the globalised shipping industry

It has long been understood that work directly generates ill health and disability through injuries and occupational exposure to toxic and carcinogenic materials, but the more complex relationship between work and ill health that is seemingly mediated through psychological distress is more controversial. For example, the 'Karasek model', whereby high job demands coupled with limited latitude in decision making were thought to generate ill health, has not been supported in large-scale surveys. This paper postulates an alternative linking mechanism between work and health, namely Mildred Blaxter's concept of 'health capital', and specifically explores the value of the concept in understanding lay theorising about the links between labour intensification and self-perceived health: workers' perceptions that their work has become more effortful may be bracketed with their belief that their continuing employment is demanding accelerating expenditure of their health capital. The argument is illustrated by qualitative interviews with an international sample of seafarers, a proto-typically globalised labour force.     

家庭无酬照料劳动供给对中老年人健康的影响

伴随人口老龄化的加剧与三孩政策的放开,照料需求也不断增长。在有酬照料服务供给相对不足且质量欠佳,女性越来越多地进入劳动力市场的背景下,由中老年群体提供家庭照料成为了理性的选择。本文利用CHARLS数据库,构建面板数据固定效应模型,探究了家庭无酬照料劳动供给对中老年群体健康的影响。结果表明,提供家庭照料劳动对中老年群体的身体健康不存在显著性影响,但对其精神健康存在显著的负面冲击。提供家庭照料劳动对女性中老年人与农村中老年人精神健康的负面影响更强。中介效应分析表明,家庭照料劳动通过增加家庭总支出与减少花费在主要工作上的工作时间两种渠道对精神健康产生影响。文章最后从关注弱势群体精神健康、增加公共照料服务供给等角度提出了政策建议。     

Social work and health care = clinical social work competence and profile in an area that is hard to survey

From the very beginning professional social work has been involved in health care. However, in our post modern society this area of competence has to be improved, and in order to compete with new health professions, a clear distinction has to be made. This is shown in important points of modern social work: Society perspective (health behaviour and public health circumstances), WHO perspective (health promotion) and psycho-social perspective (health care in social services). Health care under most difficult conditions asks for specialised competence that is to be developed in Germany as "Klinische Sozialarbeit" referring to international clinical social work standards.     

Men's health promotion: a new frontier in Australia and the UK?

The field of men's health has grown markedly over the past few decades. Increased activity specifically relating to men's health promotion in both Australia and the UK has been noted during this period. There has, however, been a reticence to critically examine men's health promotion work within a broader discourse relating to gender and gender relations. Indeed, the vast majority of health-related gender discussion to date has been focused on women's health experiences and their health practices. In this paper, we argue that grounding men's health within this broad gender discourse is important for building an evidence base in, and advancing, men's health promotion work at a range of levels. We specifically explore the research, practice and policy contexts relating to men's health in Australia and the UK, and describe the facilitators for, and barriers to, promoting men's health. We conclude by suggesting that a critical gender lens ought to be applied to current men's health promotion work and provide strategies for researchers, practitioners and policy makers to move towards this new frontier.     

Globalization and workers' health

The global integration of economies worldwide has led to increased pressure for "labor flexibility". A notable aspect of this trend has been the rise in non-standard work arrangements, which include part-time work, temporary agency-based work, fixed-term contingent work, and independent contracting. Although non-standard work arrangements are convenient for employers, they are often associated with poor pay, absence of pension and health benefits, as well as lack of protection from unions and labor laws. Studies have begun to address the question of whether these "precarious" jobs pose a health hazard for workers. The challenge for causal inference is that precarious workers are likely to differ from non-precarious workers in a variety of characteristics that also influence health outcomes, i.e. there is confounding and selection bias. However, even after taking account of these biases--through propensity score-matched analysis--there is evidence to suggest that non-standard work may be damaging to workers' health. Policies modeled after the European Union's Directive on Part-Time Work may help to mitigate some of the health hazards associated with precarious work.     

The proper contributions of social workers in health practice

Current and potential future contributions of social workers to health practice are considered at the three levels of direct service to patients, influence on the processes and procedures of the health setting and influence on its future planning and service development. The capacity of U.S.A. and U.K. social work to contribute at these levels is compared in the light of their contrasting relationships to the health system. U.S.A. social work in health care is practised as employees of the health setting or as private practitioners and contains the majority of U.S.A. social workers. It remains a specialism that sustains a major body of published work, commitment to knowledge-building, standard setting and performance review, and a psycho-social orientation shared by a growing number of medical and nursing professionals. Its approach to the health system is that of the pursuit of professional credibility in the secondary setting by adopting the professional-technical practice model of the clinician. U.K. social work since the early 1970s has been committed to generic education and practice and to the development of its own primary setting in social services departments which now employ almost all U.K. social workers. Area team social work in these departments, typified by statutory work with the most deprived sections of the population, has become the dominant culture of British social work, with implications for the occupational identity and career prospects of those social workers who are outposted or attached to health settings but no longer employed by them. British social work and its management now approach the health system from a position of organizational independence which should strengthen their capacity to influence the health system. The cultural differences between social work and medicine, however, are experienced more keenly than ever as many social workers adopt a socio-political practice model that is at odds with the professional-technical model of the clinician. Provision of social work services to the health system has become a questionable priority and raises the issue of whether much of what is now termed "health care' could more appropriately be termed "social care' and provided in a primary social work setting to which medicine and nursing would make their "proper contributions'.     

Person/environment construct: positivist versus naturalist, dilemma or opportunity for health social work research and practice?

The purpose of this paper is to indicate that there is nothing fundamentally wrong with the social work purpose of simultaneous attention to persons in their contexts. In fact, the productive pull of both perspectives is what separates social work from other helping professions. Indeed, it is what separates health social work from other health professions. What has created difficulty, however, has been the predominant lens through which person and environment have been investigated, understood and manipulated. This paper compares two major models of knowledge building in an attempt to identify the consequences for research and practice in social work. Examples are provided from both research and practice that derive from these differing perspectives in an effort to clarify the choices social worker health professionals make when encountering a person-in situation.     

Health protection and promotion at work.

Official United Kingdom figures record annually 1400 deaths and 145,000 sufferers from chronic effects of occupational injury and disease. Evidence indicates that occupational disease directly due to work is underestimated. With more understanding of the multiple causes of disease, the concept of work related disorders has broadened to include four categories: work as a direct cause, a contributory cause, or an aggravating factor, and work offering easy access to potential dangers (alcohol). As an example, work factors that increase the risk of coronary heart disease are discussed. Evidence for work stress as a causal factor and the role of leadership are considered. Prevention depends on identifying risks, preferably before anyone is exposed, but more commonly through recognition of adverse effects on workers. The need for occupational health services to have health promotion programmes that include screening for disease and its precursors, counselling and education, is considered. The positive effects of work itself as a protector and promoter of health are discussed. Responsibility for improving health has to be shared by government, management, trade unions, health professionals, and the individual worker.     

Health protection and promotion at work

Official United Kingdom figures record annually 1400 deaths and 145,000 sufferers from chronic effects of occupational injury and disease. Evidence indicates that occupational disease directly due to work is underestimated. With more understanding of the multiple causes of disease, the concept of work related disorders has broadened to include four categories: work as a direct cause, a contributory cause, or an aggravating factor, and work offering easy access to potential dangers (alcohol). As an example, work factors that increase the risk of coronary heart disease are discussed. Evidence for work stress as a causal factor and the role of leadership are considered. Prevention depends on identifying risks, preferably before anyone is exposed, but more commonly through recognition of adverse effects on workers. The need for occupational health services to have health promotion programmes that include screening for disease and its precursors, counselling and education, is considered. The positive effects of work itself as a protector and promoter of health are discussed. Responsibility for improving health has to be shared by government, management, trade unions, health professionals, and the individual worker.     

Being out of Work and Health among Younger Japanese Men: A Panel Data Analysis

This paper examines the effect of being out of work, which is in a broader category of unemployment, on the physical and mental health of younger Japanese men using panel data. A fixed effects model, widely used to control for unobserved individual heterogeneity in panel data analysis, was used for this analysis. Using the first through the fifth waves of the Japanese Life Course Panel Survey, the first wave of which was conducted with people aged 20–40 yrs in 2007, it is found that being out of work has no observable effect on self-assessed physical health. However, being out of work has a negative effect on mental health as measured by the five-item version of the Mental Health Inventory. It is difficult to clearly distinguish the direction of causality even after controlling for individual heterogeneity that is constant over time. An analysis was done with a sub-sample to mitigate a possible reverse causality. The results consistently show that being out of work has a negative effect on mental health.     

The changing role of the social worker in the mental health system

The purpose of this paper is to discuss the role of the social work profession in the mental health service arena. It analyzes the changing mental health environment and the challenges facing social work. It stresses that the profession must adapt to the dramatic changes that have been taking place since the advent of deinstitutionalization and the need for community care for mentally ill persons. Historical analysis of the social work profession shows that its involvement in the mental health field has started during the early stages of the development of the profession. Psychiatric social work has been considered a prestigious area of practice within the profession. Historically, social workers in the mental health field rarely challenged the dominance of the psychiatric profession. This position seems to have restrained social work from providing its full potential contribution to this field of practice and to the population it served. Assessment of the continuing problems and current issues of the mental health system shows the potential central role of social work in this area. However, changes must take place in the practice of social workers in the mental health service system, as well as in the education and training of social workers. The paper discusses factors that facilitate or hinder the profession from appropriately adapting to the current service needs of the mentally ill persons, their families and communities, providing quality mental health and social services to this population and society as well.     

Serious crisis in the practice of international health by the World Health Organization: the Commission on Social Determinants of Health.

The Commission on Social Determinants of Health (CSDH) is the latest effort by the World Health Organization to improve health and narrow health inequalities through action on social determinants. The CSDH does not note that much work has already been done in this direction, does not make a sufficient attempt to analyze why earlier efforts failed to yield the desired results, and does not seem to have devised approaches to ensure that it will be more successful this time. The CSDH intends to complement the work of the earlier WHO Commission on Macroeconomics and Health, which has not had the desired impact, and it is unclear how the CSDH can complement work that suffers from such serious infirmities. Inadequacies of both commissions reflect a crisis in the practice of international health at the WHO, stemming from a combination of unsatisfactory administrative practices and lack of technical competence to provide insights into the problems afflicting the most needy countries. Often the WHO has ended up distorting the rudimentary health systems of the poor countries, by pressuring them into accepting health policies, plans, and programs that lack sound scientific bases. The WHO no longer seems to take into account historical and political factors when it sets out to improve the health situation in low-income countries--which is supposed to be the focus of the CSDH. An alternative approach is suggested.     

The corporatization of health care: an evaluation and an alternative.

The corporatization of health care organizations has become a significant international trend. This paper examines that trend, comparing the development of corporate health care in the USA with the impact of the New Zealand health reforms. The paper traces the evolution of the organizations of health care systems and explains the emergence of the corporate form. We argue that the corporate model of work organization is unsuited to the complex and ambiguous nature of the medical task as it ignores inherent interdependencies. An alternative is needed which addresses work practices rather than just participation in decision making and is based on a concept of mutual interdependence and support in the execution of work.     

Health benefits of primary care social work for adults with complex health and social needs: a systematic review

The prevalence of complex health and social needs in primary care patients is growing. Furthermore, recent research suggests that the impact of psychosocial distress on the significantly poorer health outcomes in this population may have been underestimated. The potential of social work in primary care settings has been extensively discussed in both health and social work literature and there is evidence that social work interventions in other settings are particularly effective in addressing psychosocial needs. However, the evidence base for specific improved health outcomes related to primary care social work is minimal. This review aimed to identify and synthesise the available evidence on the health benefits of social work interventions in primary care settings. Nine electronic databases were searched from 1990 to 2015 and seven primary research studies were retrieved. Due to the heterogeneity of studies, a narrative synthesis was conducted. Although there is no definitive evidence for effectiveness, results suggest a promising role for primary care social work interventions in improving health outcomes. These include subjective health measures and self‐management of long‐term conditions, reducing psychosocial morbidity and barriers to treatment and health maintenance. Although few rigorous study designs were found, the contextual detail and clinical settings of studies provide evidence of the practice applicability of social work intervention. Emerging policy on the integration of health and social care may provide an opportunity to develop this model of care.