Addressing national and regional health needs: a framework for health planning

Completion of the first decade since the Alma-Ata Declaration of 'health for all' (1978) has led to numerous appraisals, in international forums, of progress achieved by the current primary health care strategy. Although this strategy appears to have contributed to improvements in selected health outcomes, changing circumstances in many developing countries may now require a more flexible and country-specific approach to health care programming. This article argues for the development of a pragmatic framework: to articulate problems which should be addressed in the development of national health programs; and, to organize concepts and methodologies to address these problems. Such a framework should enable an assessment of currently implicit value judgments, and enable strategies to be considered that assess several input and output variables simultaneously. Moreover, this framework would, we believe, further the goal of improved health delivery at a national level, and serve as a guide for further methodologic and conceptual development.     

Community indicators of child health

Summary Indicators of health in child populations are critically reviewed and the potential for routinely collected morbidity and life quality data discussed. A short list of currently available, routinely collected child health data is proposed which, if available for all European countries, would form the basis of a useable and comparable European child health data base. A European consensus group on child health indicators is proposed and further research into morbidity and life quality measures relevant to children recommended.

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Zusammenfassung Bestehende Indikatoren für Gesundheit bei Kindern werden kritisch überprüft und die Möglichkeiten für routinemässig erhobene Daten über Morbidität und Lebensqualität werden diskutiert. Eine kurze Liste von momentan erhältlichen regelmässig erhobenen Daten über Gesundheit von Kindern wird vorgestellt, die-vorausgesetzt sie ist für alle europäischen Länder vorhanden die Grundlage für eine brauchbare und vergleichbare Datenbank für Gesundheitsdaten von Kindern in Europa bilden wird. Vorgeschlagen wird eine europäische Studiengruppe zur Koordination von Indikatoren über Gesundheit von Kindern und weitere Forschungsprojekte über Morbidität und Lebensqualität werden empfohlen.

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Résumé Les indicateurs permettant de juger l'état de santé d'une population d'enfants sont examinés de manière critique et les possibilités de collecter des données de morbidité et de qualité de vie sont discutées. Une courte liste de données actuellement collectées de routine est présentée qui, si elle devenait disponible dans tous les pays européens, formerait le socle d'une base de données européenne, utilisable et comparable, concernant la santé des enfants. La création d'un groupe de consensus européen sur les indicateurs de santé chez l'enfant est proposée, et de nouvelles recherches sur la mesure de la morbidité et de la qualité de vie sont recommandées.

     

Community health status indicators: adding a geospatial component

An Internet mapping application is being introduced in conjunction with the release of the second version of the Community Health Status Indicators (CHSI) Report. The CHSI Geographic Information Systems (GIS) Analyst is an easy-to-use Web-based mapping application that provides new opportunities for the visualization, exploration, and understanding of the indicators. Indicators can be mapped and compared visually to other areas, including peer counties and neighboring counties. The Web site is accessible from a link on the CHSI Report Web site or directly from an Internet Web browser. In this paper, we discuss the conceptualization and implementation of this public health mapping application.     

我国妇幼健康状况分析框架的构建

该文系统地回顾了健康的内涵及其影响因素理论,以国际妇女卫生指标框架与综合健康医学模式为基础,结合我国妇幼群体的特征,提出了我国妇幼健康状况分析框架。该框架分为妇幼健康状况和妇幼健康影响因素两个层面,其中妇幼健康状况包括完好状态/生长发育、患病、功能、预期寿命和死亡4个要素,妇幼健康影响因素涉及环境、生活方式与行为、医疗卫生服务和生物遗传4个方面。     

Public participation in regional health policy: a theoretical framework

How best to involve the public in local health policy development and decision-making is an ongoing challenge for health systems. In the current literature on this topic, there is discussion of the lack of rigorous evaluations upon which to draw generalizable conclusions about what public participation methods work best and for what kinds of outcomes. We believe that for evaluation research on public participation to build generalizable claims, some consistency in theoretical framework is needed. A major objective of the research reported on here was to develop such a theoretical framework for understanding public participation in the context of regionalized health governance. The overall research design followed the grounded theory tradition, and included five case studies of public participation initiatives in an urban regional health authority in Canada, as well as a postal survey of community organizations. This particular article describes the theoretical framework developed, with an emphasis on explaining the following major components of the framework: public participation initiatives as a process; policy making processes with a health region; social context as symbolic and political institutions; policy communities; and health of the population as the ultimate outcome of public participation. We believe that this framework is a good beginning to making more explicit the factors that may be considered when evaluating both the processes and outcomes of public participation in health policy development.     

Year 2000 health status indicators: a profile of California.

OBJECTIVES: To examine the health status of Californians using a set of 18 health status indicators (HSIs) corresponding to goals set forth in Healthy People 2000 and to develop a health status profile for use in research and surveillance, policy development program planning, and program evaluation. METHODS: Federal, state, and county data were used to evaluate California''s performance on 18 indicators of health status related to mortality, disease incidence, and health risks. RESULTS: By 1994, California had achieved Year 2000 objectives associated with seven HSIs and significant declines in mortality associated with two other HSIs. Nationally, California was ranked among the states with the lowest rates for infant mortality, lung cancer, female breast cancer, and syphilis but among states with the highest rates for homicide, AIDS, measles, tuberculosis, late prenatal care, childhood poverty, and poor air quality. CONCLUSIONS: California''s experience may provide a useful model for other state and local health agencies monitoring the health status of populations using HSIs associated with Year 2000 objectives.     

Advancing health disparities research within the health care system: a conceptual framework

We provide a framework for health services-related researchers, practitioners, and policy makers to guide future health disparities research in areas ranging from detecting differences in health and health care to understanding the determinants that underlie disparities to ultimately designing interventions that reduce and eliminate these disparities. To do this, we identified potential selection biases and definitions of vulnerable groups when detecting disparities. The key factors to understanding disparities were multilevel determinants of health disparities, including individual beliefs and preferences, effective patient-provider communication; and the organizational culture of the health care system. We encourage interventions that yield generalizable data on their effectiveness and that promote further engagement of communities, providers, and policymakers to ultimately enhance the application and the impact of health disparities research.     

Clinical prevention and population health: curriculum framework for health professions

The Clinical Prevention and Population Health Curriculum Framework is the initial product of the Healthy People Curriculum Task Force convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers. The Task Force includes representatives of allopathic and osteopathic medicine, nursing and nurse practitioners, dentistry, pharmacy, and physician assistants. The Task Force aims to accomplish the Healthy People 2010 goal of increasing the prevention content of clinical health professional education. The Curriculum Framework provides a structure for organizing curriculum, monitoring curriculum, and communicating within and among professions. The Framework contains four components: evidence base for practice, clinical preventive services-health promotion, health systems and health policy, and community aspects of practice. The full Framework includes 19 domains. The title "Clinical Prevention and Population Health" has been carefully chosen to include both individual- and population-oriented prevention efforts. It is recommended that all participating clinical health professions use this title when referring to this area of curriculum. The Task Force recommends that each profession systematically determine whether appropriate items in the Curriculum Framework are included in its standardized examinations for licensure and certification and for program accreditation.     

Economic inequality and population health: looking beyond aggregate indicators

This paper studies the sensitivity of various health indicators to income inequality as measured by regional Gini coefficients, using individual microdata from Finland over the period 1993–2005. There is no overall association between income and health at the regional level. We discovered that, among men, there are no significant associations between income inequality and several measures of health status. Among women or among both sexes combined, there are some indications of associations in the predicted direction between income inequality and physical health, disability retirement, sick leave, and consumption of medicines, but none are robust to different model specifications. Only among the population aged less than 30 there is some indication that mental health is associated with inequality. Our findings confirm that income inequality in small populations (not large enough to measure the overall class pyramid of the society) is often immaterial for health outcomes.     

Community health status indicators project: the development of a national approach to community health

The Community Health Status Indicators Project (CHSI) 2008 provides 16-page reports for the 3141 counties in the United States, each of which includes more than 300 county-specific data items related to chronic and infectious diseases, birth characteristics or outcomes, causes of death, environmental health, availability of health services, behavioral risk factors, health-related quality of life, vulnerable populations, summary measures of health, and health disparities. The CHSI, originally initiated in 2000, provides county-level health profiles for all U.S. counties so that programs addressing community health can readily access community health indicators. Each county report also permits comparisons of a county's health status with similar "peer counties," with all counties, and with national Healthy People 2010 objectives. Under the leadership of a public-private partnership, the CHSI Steering Committee updated each county report and added new information and features to create CHSI 2008. This new CHSI version includes data for 1994 through 2006 from multiple surveillance systems. New features include an enhanced Web site, an Internet mapping application, and a downloadable database of the indicators for all counties.     

Smokers and drinkers in a health maintenance organization population: Lifestyles and health status

This study examines, among a large health maintenance organization population, the prevalence of two high-risk lifestyle practices (smoking and problem drinking), their interrelationships, and their relationships with other lifestyle practices, sociodemographic characteristics, and health status measures. Results, based on a random sample of 1,133 adults, showed that smoking and problem drinking are strongly correlated. Individuals with no drinking problems had an age-, sex-, and education-adjusted smoking prevalence of approximately 20%, while problem drinkers smoked at about twice that rate. In addition, reporting one type of problem drinking behavior (binge, chronic, or drinking and driving) at least doubled, and in one instance increased by sixfold, the likelihood of reporting another type of problem drinking behavior. Smokers and problem drinkers were more likely to be younger than age 65, to be irregular seat belt users (smokers and binge drinkers only), and not to belong to voluntary organizations. Results of the analysis suggest that detection, prevention, and treatment of drug use, in general, might prove more beneficial than only focusing on smoking and problem drinking. In addition, because binge drinking and drinking and driving were so widespread among younger age groups, it might prove more beneficial to consider preventive strategies that change the sale and distribution of alcohol and make the environment safer in which to drink, such as providing transportation to get drinkers back home.     

Age-related differences in cognition: Lifestyle, health status, coping and sociodemographic factors

This study examines to what extent memory capacity is Influencedby lifestyle, health or sociodemographic factors. The data werederived from the Maastricht Aging Study (MAAS), a large studycarried out in The Netherlands. For the current study 1,673people aged 24–88 years completed a postal survey on ‘Health,Cognition, and Psychosocial factors’. The dependent variablewas ‘memory capacity’ as measured by the Metamemoryin Adulthood (MIA) questionnaire. The study shows that age,gender and coping abilities play an important role in influencingthe variation in memory capacity. The lifestyle factors of smokingand mental activity also had a significant effect on memorycapacity in certain age-specific subgroups. These results suggeststhat future research should focus on these variables as determinantsof cognitive ageing.     

Comparing indicators of health or nutritional status

The performance of an indicator of health or nutritional status depends on its sensitivity and specificity properties over a range of cut-offs. Frequently, it is of interest to compare indicators to pick the best for a given purpose, such as screening for disease or monitoring to detect changes in prevalence of inadequate nutriture. Relative operating characteristic (ROC) analysis provides an objective method for making this comparison, but the application of this methodology as described for epidemiologists in this Journal is now outdated for most indicators. Recent developments are noted and an alternative analysis for use with continuous Gaussian data is presented here. The estimators and statistical test procedures proposed here are compared with the previously described methods, by means of a computer simulation study. The new procedures are found to be superior for continuous Gaussian data, and have the practical advantage that they do not require use of a specialized computer program. The implications of these results for comparing indicators to be used to monitor population prevalences are discussed.     

Readying health services for climate change: a policy framework for regional development

Climate change presents the biggest threat to human health in the 21st century. However, many public health leaders feel ill equipped to face the challenges of climate change and have been unable to make climate change a priority in service development. I explore how to achieve a regionally responsive whole-of-systems approach to climate change in the key operational areas of a health service: service governance and culture, service delivery, workforce development, asset management, and financing. The relative neglect of implementation science means that policymakers need to be proactive about sourcing and developing models and processes to make health services ready for climate change. Health research funding agencies should urgently prioritize applied, regionally responsive health services research for a future of climate change.