Strongyloidiasis: an issue in Aboriginal communities

Strongyloidiasis, a disease caused by the parasitic gut nematode (roundworm), Strongyloides stercoralis, has the highest prevalence in the world in rural and remote Aboriginal communities of northern Australia. With prevalences greater than 25%, these communities have rates of strongyloidiasis higher those in the worst affected developing countries where surveys have been recently conducted. Available data indisputably support that strongyloidiasis is more prevalent in rural and remote Aboriginal communities than in the mainstream Australian community. However control of strongyloidiasis has not been given a high priority by government health departments, with the result that Aboriginal people in remote and rural communities in Northern Australia are still suffering from a preventable and treatable disease. This article suggests that the only way to address the strongyloidiasis problem in Indigenous communities is to have strongyloidiasis recognised and addressed at the national level. One component of this must be making health departments responsible for establishing appropriate systems of effective treatment for and monitoring of patients with strongyloidiasis.     

Engaging communities in health intervention research/practice

Asking communities to participate in heath intervention is an increasingly popular strategy in public health and health promotion. The Community Health Educator Model, developed through a series of Participatory Action Research (PAR) projects in cancer screening in the UK during the 1990s, is a participatory health intervention model that emphasises community engagement. Although the model has been adopted by many health districts in the UK, little is known about the effectiveness of its appropriation; crucially, how researchers/practitioners engage with communities has seldom been reported. This paper presents the author's reflection on her experience in developing a set of community organising tools to respond to the diversity found in communities in practice. It suggests that engagement can be enhanced if the contingent and constructed nature of the concepts of ‘ethnicity’ and ‘community’ in the real world can be better understood. Researchers and practitioners need to cultivate a tolerance to difference and ambiguity so as to negotiate the ever-shifting boundary of engagement.     

Narratives of social support and health in Aboriginal communities

OBJECTIVE: Societies that foster high-quality social relationships and social support seemingly produce healthier populations. Existing research identifies social support as a significant dimension and determinant of Canadian Aboriginal health, yet patterns of morbidity and mortality overwhelmingly reflect social causes (e.g., violence, suicide), thereby suggesting that social support may not be widely accessible within this population. This paper seeks to understand how broader societal factors (e.g., colonialism) work to influence access to social support in the everyday social environments of Aboriginal communities. METHOD: Narrative analysis of interviews with 26 Aboriginal Community Health Representatives (CHRs) from across Canada. RESULTS: Sources of social support are institutional (e.g., those employed to provide support) and intimate (e.g., family). In terms of access to social support, CHRs' stories reflected a narrative detailing the post-colonial context. Key elements of this narrative include the child-parent relationship, group-belonging, trust, socio-economic dependence, and the changing nature of help. Findings suggest that features of the broader societal context (e.g., poverty) have manifested as local social conditions (e.g., providing help has come to be seen as a possible source of income), thereby reducing access to social support. Access to this resource is also affected as institutional and intimate supports tend to overlap in Aboriginal communities, many of which are small in terms of size and population. CONCLUSION: Research and policy options must recognize the post-colonial influences that affect the everyday realities of Aboriginal communities and study the complex interactions between these influences, and how health determinants--like social support--play out in local places as a result of this legacy.     

Physical activity and public health: training courses for researchers and practitioners

The authors explore development of courses in continuing education intended to provide additional research and practice capacity for addressing the growing burden of chronic disease and disability from physical inactivity. Two annual training courses on physical activity and public health are described. The courses are developed with funding from the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition and Physical Activity. The University of South Carolina, School of Public Health, Prevention Research Center has been an active collaborator and was responsible for developing and implementing the courses. An eight-day "Course on Research Directions and Strategies," is offered to postdoctoral researchers, and practitioners may take a six-day "Practitioners' Course on Community Interventions." Both courses are designed to increase the number of professionals qualified to implement physical activity community interventions and conduct physical activity and public health research.     

Environmental public health research: engaging communities

Environmental public health research is a multi-disciplinary and multi-institutional field of endeavor that is changing. New and innovative approaches are vital to researchers and communities. Partnerships and collaborations also are part of the equation. Thus, engaging communities is a necessary component for successful environmental public health research. The federal government has a fiduciary and a moral responsibility to provide ethical research in communities with the same integrity as required for individuals. There is an inherent distrust by many communities, especially minority communities, in light of past public health research failures. Communities targeted by public health researchers may be aware of the need to improve the community's environmental health and quality of life but are unsure of the methods and benefits. This in turn requires competent and attentive collaborations between the community and the researcher(s). Communities are indeed more astute to their physical surroundings, but may still not understand the nature and intent of the research process. Therefore, the collaboration and partnership should start as early in the design, planning, and execution of the project as possible. Future challenges in genetic screening and research will only increase the need for communities to be engaged in public health research.     

Housing and health in Indigenous communities: key issues for housing and health improvement in remote Aboriginal and Torres Strait Islander communities

Indigenous people living in remote communities face some particular difficulties with regard to housing and its impact on their health. This paper reviews the contemporary international understanding of the relationship between housing and health, the history of settlement and housing conditions in remote Aboriginal and Torres Strait Islander communities, and some of the recent initiatives to improve housing in these communities.     

反思我国公共卫生体系与再造建议

该文系统地描述了我国在应对严重急性呼吸道综合症 -SARS过程中所暴露出来的卫生体系中的问题 ,SARS对我国经济产生的影响 ,应对SARS的启示以及重建我国公共卫生体系的建议     

Engaging women's interest in colorectal cancer screening: a public health strategy

Screening rates for colorectal cancer are unacceptably low. New guidelines, public education campaigns, and expanded coverage of screening costs by healthcare insurance are expected to increase screening rates, but interventions targeting women may accelerate this change. Most American women already participate in regular cancer screening, in the form of Papanicolaou (Pap) tests and mammography, so they may be receptive to tailored messages about the need to add regular colorectal cancer screening to their preventive health regimen. In addition, their role in promoting the health of family members may position women to influence screening behavior in family and friends. Women may be particularly valuable change agents in populations where screening rates are traditionally low, such as medically underserved populations, the elderly or low socioeconomic status groups with competing health priorities, and populations with cultural values or practices inconsistent with the adoption of a new screening behavior. To serve as agents of change in their family and social networks, women must understand that colorectal cancer is not solely a man's disease and that the benefits of colorectal screening are similar to those of Pap testing and mammography. Colorectal cancer screening should also be promoted within a framework of a lifelong strategy for health maintenance for both men and women. The message to women should emphasize the value of colorectal cancer screening rather than the disagreement among experts over preferred screening strategies and should emphasize the value of shared decision making between the patient and her healthcare provider.     

European training in public health: A practical experience

Development of public health in Europe requires the human resourcesnecessary for planning and managing programmes with a European,intersectoral and multidisciplinary approach, based on the ‘healthfor all’ strategy. In this paper the European TrainingConsortium in Public Health (ETC-PH) presents the experienceof 4 years of developing educational activities and materialwith these approaches. Participants from different countriesand 5 institutions concerned with training in public healthhave been involved. Evaluation is positive both for studentsand teachers and an ETC network and project register have beencreated as a way for communication to continue and for the consortiumto offer ongoing support to all participants.     

Self-rated health status in an urban indigenous primary care setting: implications for clinicians and public health policy

Background: Self‐rated health status provides insights into the health beliefs of a population. This will be important for framing public health messages in the context of the need to ‘close the gap’ for Australian Indigenous people. Our primary objectives were to describe the self‐rated health status of Indigenous people attending the Inala Indigenous Health service, identify associations with positive and negative self‐rated health status and identify targets for public health awareness raising activity. Methods: Using a convenience sample, we approached all Indigenous patients attending the Inala Indigenous Health Service for an Indigenous adult health check between June 2007 and July 2008. From Indigenous adult health check data we analysed self‐rated health status and chronic disease risk factors. Results: Out of a possible 509, 413 patients were recruited (response rate 81%). The number of participants who rated their health as fair or poor was 47%. The association of greatest magnitude and statistical significance with Indigenous patients’ self rated health status (negative versus positive) was waist circumference followed by smoking, depression and age. Chronic disease risk factors not associated with self‐rated health status included systolic blood pressure, harmful alcohol use, marijuana use, presence of diabetes and lack of exercise. Conclusions: High rates of negative self‐rated health status were found. Public health awareness‐raising for Indigenous audiences should consider targeting chronic disease risk factors such as systolic blood pressure, harmful alcohol use, marijuana use, presence of diabetes and lack of exercise.