The health status of Cuba: recommendations for epidemiologic investigation and public health policy

The health status of Cuba is described in comparison with Costa Rica and, in some instances, the United States. Recommendations are made for epidemiologic studies and for specific health policies to lower death rates from diarrhea and enteritis, cardiovascular disease, cancer, and injuries. Rapid expansion of training and research in epidemiology and biostatistics is emphasized, and specific goals for health outcomes for the year 2000 are suggested.     

Improving indoor environmental quality for public health: impediments and policy recommendations

BACKGROUND: People in modern societies spend more than 90% of their time indoors. Hence, indoor environmental quality (IEQ) has a significant impact on public health. In this article we describe health risks associated with indoor environments, illuminate barriers to overcoming these risks, and provide policy recommendations to achieve healthier indoor environments. OBJECTIVES: The weight of evidence suggests that indoor environmental contaminants pose significant public health risks, particularly among children and the poor, and the societal costs of illnesses related to indoor environments are considerable. Despite the evidence of harm to human health, poor indoor environments are generally difficult to regulate and not of sufficient concern to the general public. We discuss several reasons for this lack of concern about IEQ, focusing specifically on home environments. DISCUSSION: Economics plays a large role both in political inaction and individual-level indifference. Because little effort has been made to quantify the value of the societal and individual costs of poor housing quality, as well as the benefits achievable by simple interventions, policymakers lack motivation to act on IEQ. Similarly, individual homeowners lack the incentive to remediate homes, as other problems may be more pressing than home environmental quality. CONCLUSIONS: Although the problem of IEQ involves multiple stakeholders and multiple levels of governance, it is possible to establish economic incentives that would set the wheels in motion for action at all levels to achieve healthy home environments. Also important are education and information dissemination on the public health risks associated with indoor environments. These recommendations are intended for all decision makers who have an influence in developing policy to improve indoor environmental quality.     

Communicating exposure and health effects results to study subjects, the community and the public: strategies and challenges

The Mickey Leland National Urban Air Toxics Research Center sponsored a Symposium in August 2002 that focused on the communication of health effects results from community studies involving exposure to hazardous substances in the environment. Some of the audiences identified for presentation of study results were the study subjects, the community, and the general public. Principles and approaches to communicating findings were discussed, as were the challenges that may confront researchers in developing and implementing a communication plan. The Symposium included four sessions. The first was an overview session where Timothy McDaniels (University of British Columbia) described risk communication as a decision-aiding process. In the second session, case studies were presented by Timothy Buckley (Johns Hopkins University), Jane Hoppin (National Institute of Environmental Health Sciences), and Anne-Marie Nicol (University of British Columbia). Approaches and strategies used by different stakeholders to communicate study results was the topic for a panel discussion at the third session. Panelists included: James Collins (The Dow Chemical Company), Mary White (Agency for Toxic Substances and Disease Registry), Richard Clapp (Boston University), Valerie Zartarian (Environmental Protection Agency), Pamela Williams (Chemrisk), and Tina Bahadori (American Chemistry Council). The final session was a summary presentation on lessons learned given by Rebecca Parkin of George Washington University, in which she synthesized the preceding presentations and formulated guidelines for effective risk communication in community research studies.     

Trade policy and health: from conflicting interests to policy coherence

Policy incoherence at the interface between trade policy and health can take many forms, such as international trade commitments that strengthen protection of pharmaceutical patents, or promotion of health tourism that exacerbates the shortage of physicians in rural areas. Focusing on the national policy-making process, we make recommendations regarding five conditions that are necessary, but not sufficient, to ensure that international trade policies are coherent with national health objectives. These conditions are: space for dialogue and joint fact-finding; leadership by ministries of health; institutional mechanisms for coordination; meaningful engagement with stakeholders; and a strong evidence base.     

The human right to adequate housing: a tool for promoting and protecting individual and community health

The human right to adequate housing is enshrined in international law. The right to adequate housing can be traced to the Universal Declaration of Human Rights, which was unanimously adopted by the world community in 1948. Since that time, the right to adequate housing has been reaffirmed on numerous occasions and further defined and elaborated. A key component of this right is habitability of housing, which should comply with health and safety standards. Therefore, the right to adequate housing provides an additional tool for advocates and others interested in promoting healthful housing and living conditions and thereby protecting individual and community health.     

Exposure to brominated flame retardants,perfluorinated compounds,phthalates and phenols in European birth cohorts: ENRIECO evaluation,first human biomonitoring results,and recommendations

There are emerging concerns about potential effects on child health and development of early-life exposure to substances such as brominated flame retardants (BFRs), perfluorinated compounds (PFCs), phthalates and phenols (including bisphenol A (BPA)); pregnancy and birth cohort studies are ideally designed to study such concerns prospectively. As part of the ENRIECO project, we evaluated existing human biomonitoring data for these substances in European birth cohorts and develop recommendations for more harmonized methods that will enable combination and comparison of cohort data in the future. The ENRIECO inventory shows that 20 European birth cohorts have measured or are measuring BFRs (N = 10), PFCs (N = 11), phthalates (N = 16) or phenols (N = 8). Generally, samples were collected prenatally or at birth and measurements involved few subjects in each cohort (a few hundred maximum). Biological matrices, timing, and analytical methods of the measurements varied between cohorts. Few cohorts have measured at multiple time points or in children. In European cohorts, levels of BFRs were very low and at least 10-fold lower than in US; levels of PFCs and phthalates have decreased over the last decade since the phasing out of certain of these compounds; concentrations of phenols are comparable to those in the US. Although there is little published data in the cohorts now, many measurements are ongoing and we recommend that cohorts start working towards combined and comparison studies. Specific recommendations for use of existing data include the development of conversion models for the different media used for measurement of persistent chemicals, and inter-laboratory comparisons and calibrations. Recommendations for further data collection include more evaluation of exposure to these chemicals in children; repeated measurements of non-persistent chemicals; validation and harmonisation of questionnaires; and the development of mechanisms for fast European birth cohort response for the detection and prioritisation of new chemicals of concern.     

Diet modelling: How it can inform the development of dietary recommendations and public health policy

With the global population expected to increase to 9 billion by 2050 coupled with concerns about food security in relation to climate change and increasing prosperity in many parts of the world causing desire for a less monotonous diet, efficient use of resources such as food becomes ever more important. While the prevalence of obesity is a cause for concern in many parts of the world, many people still go to bed hungry, and in many communities, obesity co‐exists with poor diet quality. The result is a series of complex and challenging nutrition problems, such as the access to nutritionally adequate and affordable diets and the development of dietary recommendations. Diet modelling is a useful tool to help identify solutions to such complex questions and this paper summarises a session on this topic at the International Congress of Nutrition that took place in September 2013.     

Foreword: Public health, public policy, politics and policing

ABSTRACT: Reducing harm from drug use lies at the intersection of public health, public policy, politics and policing. In an ideal world, evidence of public health gains achievable through new approaches or technologies should inform public policy, should help shape political agendas in support of policy change, which should translate into law and regulations - and then to their application. The goal of this transformative process should be to yield the highest attainable health benefits to vulnerable individuals and communities and to society as a whole.     

Cigarette smoking in China: public health, science, and policy

Throughout the world, cigarette smoking is a habit that causes serious health, economic, and social problems. Therefore, many countries have taken an active role to control and to ban smoking. The chronic smoking problem in China is particularly acute because China has the largest population of smokers in the world, over 300 million currently. If 30% of these smokers were to die of smoke-related diseases in the next 20 years, the impact from the more than 90 million premature deaths could be damaging to China. In addition, numerous non-smokers also experience health problems from exposure to environmental tobacco smoke. China's efforts to reduce or to ban smoking in certain public places have not been well-coordinated or enforced compared with those in other countries. Therefore, success has been minimal. Consequently, leaders in China should not be complacent about combating the serious national health problem. A multiprong approach in combination with the MPOWER policy from the World Health Organization that targets different levels of acquisition of the smoking habit must be used. Examples may include the government's reduced reliance on profits from the sale of cigarettes, the elimination of advertisements that encourage smoking among young individuals, the presentation of more graphic illustration of harmful effects from smoking on every pack of cigarettes, higher taxes/prices on cigarettes, and the implementation of enforceable bans on smoking in public places. As shown in other countries, such coordinated effort can be highly effective in the reduction of smoking and can have healthy consequences.     

气候变化对儿童健康影响的研究进展

  目的   探讨福建省厦门市气象因素对流行性感冒的影响,为预警预测和防控提供理论依据。  方法   对2013年1月 — 2019年2月厦门市日均本站气压、日本站气压差、日均相对湿度、日均气温、日均气温差、日照时数等气象因素与日流行性感冒发病数进行相关性和分布滞后非线性模型分析。  结果   厦门市2013年1月 — 2019年2月共报告流行性感冒10 573例,男女性别比1.29 ∶ 1,4～岁组和0～岁组占比居前,依次为52.44 %和32.19 %。日均本站气压、日本站气压差与流行性感冒发病呈正相关（r > 0）,日均气温、日照时数与流行性感冒发病呈负相关（r < 0）。低气压（< 980 hPa）滞后0～5 d时是流行性感冒发病的危险因素,气压999 hPa滞后4 d发病风险最高（RR = 1.05,95 % CI = 1.01～1.11）。气压差 > 18 hPa对流行性感冒发病是危险因素,随气压差的增加而增加,< 3 hPa也是危险因素,总体呈现“U”型。气温 < 9 °C和 > 23 °C对流行性感冒发病是危险因素,呈现“U”型,日均气温1 °C滞后4 d时发病风险最高（RR = 2.40,95 % CI = 1.01～5.71）。日照1～5 h和11～13 h滞后1～15 d对流行性感冒发病是危险因素,日照13 h滞后15 d发病风险最高（RR = 8.79,95 % CI = 1.22～63.30）。低气压975 hPa经滞后0～15 d对4～岁组儿童累计效应有统计学意义（RR = 7.82,95 % CI = 6.40～9.55）;气压差5 hPa滞后0～15 d对60～岁组老年人流行性感冒发病累积效应最高 （RR = 3.69,95 % CI = 1.56～8.68）;低温1 °C和高温31 °C滞后0～15 d对13～岁组人群和4～岁组儿童均有显著性累积效应,前者较高（RR = 40.82,95 % CI = 3.53～554.19）;日照13 h滞后0～15 d对4～岁组儿童累积效应最为显著（RR = 20.41,95 % CI = 4.12～99.34）。  结论   日均本站气压、日本站气压差、日均气温、日照时数等气象因素影响厦门市流行性感冒发病,且具有一定的滞后性,可以考虑为预警预测和防控提供理论依据。     

Tobacco taxation and public health: ethical problems, policy responses

This article aims to describe the major ethical issues surrounding tobacco taxation, and to identify policy responses to minimise any ethical dilemmas. It uses the standard ethical framework for biomedicine (covering beneficence, non-maleficence, respect for autonomy and justice), in conjunction with relevant data on tobacco taxation from various developed countries. Tobacco taxation contributes substantial benefits at the population level by protecting health (i.e., by deterring the uptake of smoking by youth, by promoting quitting, and by reducing harm from exposure to second-hand smoke (SHS)). However, tobacco taxes can contribute to financial hardship among low-socioeconomic status populations where smoking persists. Such taxes can contribute to autonomy, by reducing SHS exposure to non-smokers, and by allowing freedom from nicotine-dependency for those who quit smoking or do not start regular smoking as a result of high tobacco prices. Furthermore, increases in tobacco taxation may reduce health inequalities and so contribute to justice. Nevertheless, the additional tax burden imposed on smokers who wish to continue to smoke, or are unable to quit, can be considered unjust. The autonomy of such smokers may be partly impaired. Although tobacco tax can be regarded as ethically justifiable because of its substantial overall benefit to society, there is substantial scope for policy changes to further reduce any harms and injustices for those populations who continue to smoke.     

An introduction to parks, recreation, and public health: collaborative frameworks for promoting physical activity

The purpose of parks and recreation as well as public health is to seek the highest possible quality of life for individuals and communities. Unfortunately, little discourse has occurred between the parks and recreation and public health professions. This missed opportunity has resulted in an incomplete understanding of the spectrum of issues shared by the fields, a slow transdisciplinary learning curve, and a dearth of knowledge-based linkages between science and practice. The goal of the 2006 Cooper Institute Conference on Parks, Recreation, and Public Health: Collaborative Frameworks for Promoting Physical Activity was to highlight opportunities and advance cooperation between parks, recreation, and public health researchers and practitioners that result in collaborations that influence public health decisions at the macro (agency) and micro (individual) levels. This article introduces the discussion on scientific and practice issues in parks, recreation, and public health. By establishing a baseline of frameworks for strengthening collaboration we hope to improve the health and quality of life through parks and recreation-based physical activity.     

Public health, not social warfare: a public health approach to illegal drug policy.

This article makes three major arguments: (I) the current War on Drugs undercuts public health values and premises, resulting in a war on the poor, disenfranchised, people of color, the homeless, and the unemployed; (2) drug problems should be addressed primarily within the realm of public health policy rather than criminal justice policy; and (3) to achieve a viable public health drug policy, the public health community needs to build grassroots support and become effective activists. The article reviews the history of past drug wars, analyzes recent trends in illegal drug use and problems, and critiques current policy initiatives and their consequences. It then outlines a comprehensive, public health approach to addressing illegal drug problems, and concludes with an analysis of what steps are needed to become effective in the public policy arena.