Health inputs and cumulative health deficits among the older Chinese

Using a health economics framework, we examined how both individual level investments at different life stages and current community-level environmental factors affect individual health stock and flows at old ages. We used a nationwide dataset from the 2002 and 2005 waves of the Chinese Longitudinal Healthy Longevity Survey, which included more than 15,000 adults aged 65 and older from 22 provinces in mainland China. We measured health stock with a cumulative health deficit index, a measure developed in geriatrics and gerontology that reflects deficits, illnesses, and functional impairment in numerous domains of health. The cumulative health deficit index has not been used in health economics before, but is a significant contribution because it captures the health stock concept very well and overcomes the problems of inconsistency resulting from the use of different measures of health stock in research. Our results show that several proxy measures for individual health investments in both childhood (nutritional status and parental survival status) and adulthood (family financial condition and access to healthcare) yielded positive returns to health stock measured by the cumulative health deficit index. Investments in social connections and healthy behaviors (religious involvement, alcohol use, and exercise) also produced positive returns in health stock. Current community-level factors such as air quality and labor force participation rate were significantly associated with levels of health deficits in old age as well. Yet, most of these individual investment and community environment variables did not significantly affect short-term health flows (improvement or deterioration in health status over three years). Our findings have important implications for developing preventive health programs in the context of population aging by focusing on policy-relevant predictors and a comprehensive indicator of health status in later life.     

健康中国建设进程指数的建立与应用研究

目的：本研究旨在建立健康中国建设进程指数（Healthy China Process Index,HCPI）,为推进健康中国战略各项目标任务有效落实提供参考和依据。方法：采取文献研究、德尔菲法建立健康中国建设进程指数,通过广泛的数据收集,开展了国家层面健康中国建设进程指数测算及分析。结果：HCPI指标体系包含健康水平、健康生活、健康服务与保障、健康环境、健康产业5个维度13个指标,采取多层均权法赋权,以定基极差法进行标准化,应用几何平均法核算指数。结论：自2015年以来健康中国建设进程正在稳步推进,当前阶段应将普及健康生活、完善健康服务和保障作为推进健康中国战略的重点任务,对健康环境建设应予以持续关注。     

Employing Community Voices: Informing Practice and Programming through Camden Healthy Start Focus Groups

Objectives Women living in communities with low-socioeconomic status, substandard healthcare, and ongoing exposure to social disparities encounter barriers to healthcare, often making it difficult to access health services. Barriers may stem from provider interactions with clients, conditions of the healthcare facility, or even language barriers. This prompts a call for providers to be keenly aware of the obstacles women encounter when attempting to access services. Methods In an effort to facilitate better access to services, Camden Healthy Start conducted six focus groups. Thirty-nine women between the ages of 22–56 participated. A total of 39 questions were posed to participants about health behavior, health services, pregnancy, reproductive health, and barriers to accessing services. Each 2 h session was audio recorded, translated and transcribed. Following the format of the Women’s Health: Attitudes and Practices in North Carolina Focus Group Research, responses were analyzed and themes emerged. Results This article discusses characteristics of healthcare services and cultural insensitivity that impact women’s access and act as barriers to care. The results signal the need for Healthy Start to apply a more relational engagement when providing services. Consideration for Practice Relational engagement includes getting to know the client as a person first, respecting their rights to autonomy in the decision making process, and demonstrating an understanding of the client’s culture and inclusion of their voices in the conversation.     

Childhood nutritional deprivation and cognitive impairment among older Chinese people

Late-life cognitive impairment may have its origins in childhood. Here, we examine the associations between markers of childhood nutritional deprivation and cognitive impairment in older adults. We made use of the 2002 and 2005 waves of the Chinese Longitudinal Healthy Longevity Survey to examine these associations for persons aged 65–105 (N = 15,444). Anthropometric measures (arm length, knee height) and self-reported hunger were used to measure early-life nutritional deficiencies. Cognitive impairment was measured using the Chinese version of the Mini Mental State Examination. Results from multivariate logistic regression models show that both anthropometric measures and self-report markers of early-life nutritional status were significantly associated with the odds of cognitive impairment at baseline for both men and women after controlling for age and ethnicity. Adjustments for childhood and adulthood socioeconomic status, adulthood health, and lifestyle habits had little effect on these associations except for the effect of hunger among men. Results from multinomial logistic regression models show that during the three-year follow-up period, arm length was significantly associated with the onset of cognitive impairment after controlling for various confounders in men, but not in women. Our findings suggest that early-life nutritional deprivation may contribute to cognitive impairment among older Chinese adults.     

Lay evaluation of services for childhood asthma

Users' views on health services are increasingly valued, but insufficient attention has been given to evaluations of childhood services. Asthma, the most common chronic childhood disease, is an significant condition around which to explore views of childhood services, especially since most care is provided in the community rather than in hospital. The aim of the present study was to investigate the views of children, young people and their parents on primary care services for childhood asthma, to explain how they should be characterised as evaluators of health services, and to identify the dimensions of care which they see as important. The authors conducted semi-structured interviews with 20 families recruited from responders to a respiratory symptoms questionnaire and from two general practices. Data were analysed using the constant comparative method. Children and young people identified outcomes of care, quality of care, communication and the professional-patient relationship, and organisation and access to healthcare as the key dimensions of their experiences of health services. They were active and critical, judging the performance and delivery of health services against standards which drew on lay knowledge and experience. Parents also emphasised outcomes, quality, organisation and access to healthcare as important, and drew attention to the complex and challenging nature of the professional-parent relationship. Parents had several roles, seeing themselves as carers and advocates as well as users of health services. They also drew on lay standards to evaluate care. Children and young people are willing and able to give active and critical views on health services. Parents' views should also be sought in their own right.     

Healthcare and the long haul: Long distance truck drivers--a medically underserved population

BACKGROUND: Long distance trucking is associated with significant health risks. However, to our knowledge no published data exist regarding healthcare service access by the estimated two million long-haul truckers in the United States. METHODS: A cross-sectional study was designed to assess access to healthcare among these workers. Five hundred-twenty-one anonymous self-administered surveys were completed at 16 truck stops in 14 states from July through August 2002. RESULTS: Forty-seven percent of those surveyed lack a regular healthcare provider, 20% frequent emergency rooms and urgent care centers, 32% were unable to receive needed healthcare within the last year, and 56% had difficulty utilizing healthcare services at home. Individuals lacking health insurance (31%) experienced more difficulty with healthcare access than the insured within the last year, were more often without a regular provider (P = 0.002 and P < 0.001), and utilized urgent care centers and emergency rooms more often than the insured (25 vs. 17%). CONCLUSIONS: Long distance truck drivers are at risk for poor health outcomes and experience significant difficulty accessing healthcare services. Further studies concerning how to best provide healthcare to this vulnerable, underserved population are needed.     

理性评估中国医改三年成效

新一轮医改三年来进展顺利,在促进基本公共卫生服务逐步均等化、加快推进基本医疗保障制度建设、初步建立国家基本药物制度、健全基层医疗卫生服务体系、推进公立医院改革试点等方面取得明显成效,基层基本医疗卫生制度模式初现雏形。理性评价医改三年的成效,客观分析其中存在的问题,直接影响到进一步推进和完善医改。本文根据评估标准,对三年医改成效、进展和制度建设进行评估,并就下一步医改面临的挑战提出政策建议。     

Demographic and health factors associated with mammography utilization

PURPOSE: The purpose of this study was to determine the frequency of mammography utilization among women in 2002 and to compare it with Healthy People 2010 targets. Relationships between demographic and health factors and utilization were explored. METHODS: This study used data from 93,657 women completing the 2002 Behavioral Risk Factor Surveillance Survey, a population-based telephone survey measuring behavioral risk factors. Relationships between demographic and health factors and mammography utilization were explored by bivariate and logistic regression analyses. RESULTS: Seventy-six percent of women reported having had a mammogram within the past 2 years. Utilization was significantly associated with age; ethnicity; race; education; income; employment; perceived health; health insurance coverage; access to physicians; and receipt of basic, preventive health care services. When controlling for other factors, women who had a personal doctor, had health insurance, had higher incomes, and were older had the greatest odds of having received a mammogram within the past 2 years. CONCLUSIONS: This assessment indicates that, overall, the Healthy People 2010 mammography utilization target is being met. However, though utilization is improving for some at-risk groups, women without health insurance; women without a personal doctor; and women not receiving basic, preventive care fall short of the Healthy People 2010 target.     

“健康中国”建设监测评估框架和指标体系研究

以“健康中国”建设的目的与基本特征为基础,充分借鉴国外内相关领域战略规划监测评估经验,初步建立了“健康中国”监测评估逻辑模型。在此基础上,以《“健康中国2030”规划纲要》为统领,遴选形成了包含健康水平、健康生活、健康服务、健康保障、健康环境、健康产业6个维度170个具体指标的“健康中国”建设监测评估指标体系。通过开展2018年度“健康中国”建设进展监测评估工作,以期全面客观反映当前“健康中国”建设成效和问题,为推动“健康中国”建设提供科学依据和决策参考。     

Age and sex differences in the association between access to medical care and health outcomes among older Chinese

Background

Whether the association between access to medical care and health outcomes differs by age and gender among older adults in China is unclear. We aimed to investigate the associations between self-reported inadequate access to care and multiple health outcomes among older men and women in mainland China.

Methods

Based on four latest waves available so far from a national longitudinal study in mainland China in 2005–2014, we used multilevel random-effect logistic models to estimate the contemporaneous relationships between inadequate access to care and disabilities in instrumental activities of daily living (IADL) and cognitive impairment in men and women at ages 65–74, 75–84, 85–94, and 95+, separately. We also used multilevel hazard models to investigate the relationships between reported access to care and mortality in 2005–2014. Nested models were used to adjust for survey design, sociodemographic background, enrollment in health insurance, and health behaviors.

Results

Approximately 6.5% of older adults in China reported inadequate access to care in the period of 2005–2014; and the percentages increased with age and were higher among women at older ages (≥75?years). Overall, older adults with self-reported inadequate access to care had greater odds of IADL and ADL disabilities and cognitive impairment than those with adequate access to healthcare. The elevated odds ratios (ORs) in men were higher in middle-old (75–84) and old-old (85–94) age groups compared to other age groups; whereas the elevated ORs in women were higher in young-old (65–74) and middle-old (75–84) age groups. The relationship between access to care and the health outcomes was generally weakest at the oldest-old ages (95+). Inadequate access to care was also linked with higher mortality risk, primarily in adults aged 75–84, and it was somewhat more pronounced in women than in men.

Conclusions

Increased odds of physical disability and cognitive impairment and increased risk of mortality are linked with inadequate access to care. The associations were generally stronger in women than in men and varied across age groups. The findings of the present study have important implications for further improving access to health care and improving health outcomes of older adults in China.

     

Determinants of Therapy Access for US School-Aged Children with Developmental Disabilities

Developmental disabilities (DDs) affect the health of many children nationwide. Access to therapy services (e.g., speech and language therapy, occupational therapy) for children with DDs can help to optimize their health across the lifespan. Policy initiatives such as state Medicaid Home and Community Based Services (HCBS) waivers intended to improve therapy access for school-aged children with DDs may benefit from increased knowledge of therapy access state variation and determinants. This study aimed to (1) determine whether significant state variation in therapy access exists and (2) examine associations of child, parent or family, neighborhood, healthcare, and state determinants with therapy access among US school-aged children with DDs. This was a secondary analysis of individual level data from the 2016 and 2017 National Survey of Children’s Health and state level data from the 2016 American Community Survey, 2016 Health Resources and Services Administration, 2015-16 Office of Special Education Programs, and 2016 Centers for Medicare and Medicaid Services. The dependent variable was if the child was currently accessing therapy services to meet his/her developmental needs. Independent variables examined included characteristics of the child (e.g., age), parent or family (e.g., income), neighborhood (e.g., neighborhood amenities), healthcare (e.g., medical home), and state factors (e.g., number of state HCBS waivers targeting children with DDs). We fit weighted multilevel regression models to examine therapy access variation and determinants across states. The sample included 9,984 US children ages 6-17 years with ADHD, learning disability, developmental delay, speech and language disorder, ASD, blindness, deafness, intellectual disability, epilepsy, cerebral palsy, Tourette syndrome, and/or down syndrome. The sample represented 19% of the US child population ages 6-17 years. Overall, 34.6% of school-aged children with DDs were accessing therapy services. Statistically significant variation in therapy access for children with DDs was found across states (σ2 = .11, SE = .04, Range: Iowa = 21.7%, D.C. = 51.1%). Older child age and private insurance were each associated with significantly lower adjusted odds of therapy access. Functional limitations, individualized education program, frustration accessing services, and care coordination need were each associated with significantly higher adjusted odds of therapy access. Bivariate analysis results showed lower number of medically underserved areas, higher percent of children with IDEA Part B services, and higher number of HCBS waivers per state were each associated with higher odds of therapy access; however, these associations did not remain statistically significant in multivariable analysis results. Multivariable analysis results for children with DDs in waiver states demonstrated higher estimated annual costs per child to be associated with lower adjusted odds of therapy access (aOR = 0.85; 95% CI: 0.81-0.90). Sensitivity analysis results also showed that among children with DDs and functional limitations, ≥2 state HCBS waivers were associated with increased adjusted odds of therapy access. Therapy access for school-aged children with DDs varies widely across states, reflecting geographic disparities in care. Results further highlight pronounced disparities in therapy access by age, insurance, and service needs among school-aged children with DDs. To advance equitable access to therapy services for school-aged children with DDs, targeted policy and practice initiatives remain needed. Agency for Healthcare Research and Quality.     

Changes in the health burden of a national sample of children with asthma

This paper focused on the extent to which factors that are modifiable by health policies or provider recommendations influenced the level and changes in the burden of childhood asthma. Demographic factors, access to health care services, and asthma control activities were posited to potentially influence the level and changes in health burden of children with asthma. The Medical Expenditure Panel Survey data from 1996–1999 on 3–11 year old U.S. children with asthma (N = 784) were used. The findings of multilevel models of perceived burden indicated unfavorable trajectories among those families who had public health insurance. Asthma control activities were associated with favorable trajectories of both perceived and objectively measured burden. These findings emphasized the significance of asthma control and access to high quality and stable health care services as health policy targets.     

学校卫生的根本任务是实现学生健康全面覆盖

儿童青少年处在旺盛的生长发育阶段,具有学校集体生活的聚集性,社会文化对不健康的行为与生活方式影响巨大,健康状况呈现出新的特征.青少年死亡率下降幅度低于5岁以下儿童,近视和肥胖等常见病高发并呈低龄化,体能下滑趋势没有得到根本遏制,心理健康状况不容乐观.学校卫生是我国公共卫生的重要组成部分,目标是维护和促进儿童青少年健康.新时代学校卫生工作要呼应“健康中国”行动,落实政府责任与担当,实现学生健康全面覆盖.当前,健康中国战略实施为学生健康全面覆盖提供了政策保障,近视防控工作的有力推进为学生健康全面覆盖提供了先行示范.     

Access and effectiveness in psychological therapies: self-help as a routine health technology

The ability of psychological treatment services to deliver effective and accessible mental healthcare, as demanded by the National Service Framework for mental health, is compromised by the traditional configuration of psychological therapy services, powerful gatekeeping by these services and the difficulties which exist in engaging primary care in mental healthcare. Although a number of service models have been suggested, most address access from the perspective of secondary care service providers. In particular, self-help, a powerful ideology and a clinically effective health technology, is given insufficient prominence in psychological therapy services. Self-help is often only considered for mild problems or as an adjunct to therapy, and it is assumed that mental health professionals with traditional therapeutic skills are needed to support self-help. Following a review of access and self-help in psychological therapies, the present authors propose criteria against which services could be designed in order to fully utilise self-help as a powerful health technology in psychological therapies. Accompanying these criteria is a research framework drawn from recent work on access and illness self-management that can be used to evaluate the performance of services attempting to improve access to psychological therapies.     

Environmental barriers to health care among persons with disabilities--Los Angeles County, California, 2002-2003

In 2002, an estimated 51.2 million persons in the United States (approximately 18.1% of the population) had a disability. Recent data suggest that substantial disparities in health behaviors and overall health status exist between persons with and without disabilities. Nonetheless, when they have access to adequate health care, persons with disabilities can lead healthy lives. The World Health Organization's International Classification of Functioning, Disability, and Health stresses the importance of environment (e.g., physical environment, attitudes of others, or policies) as either a barrier or facilitator in the daily activities of persons with disabilities. In addition, increasing access to health and wellness treatment programs for persons with disabilities and reducing the proportion of persons with disabilities who report environmental barriers to participation in daily activities are goals of Healthy People 2010 (objectives 6-10 and 6-12). However, few population-based studies have explored how environment affects the lives of those with disabilities. To determine the prevalence of disability among persons in Los Angeles County, California, and assess the effects of environmental barriers on these persons, residents were surveyed during 2002-2003. The results of that survey suggested that persons with physical or sensory disabilities experienced several environmental barriers and that the prevalence of barriers varied by demographic characteristics, household income, and severity of disability. To improve quality of life among persons with disabilities, public and private health agencies should implement measures to remove environmental barriers to health care and other services.     

对我国城市健康养老评价指标体系的分析与思考

[目的]通过对《全球老年友好城市建设指南》(简称《指南》)和《“健康中国2030”规划纲要》(简称《纲要》)中的指标体系以及国内与城市健康养老评价指标体系相关的文献及资料进行分析、归纳和总结,为构建一套既符合国际标准又适应中国国情的城市健康养老评价指标体系提供借鉴。[方法]采用“老年友好城市、健康城市、康养城市、长寿之乡、指标”等作为关键词,基于中国知网、万方数据库,以及政府官网和国家卫生健康委员会网站等,搜索国内与城市健康养老评价指标相关的文献和资料。[结果]《指南》和《纲要》中的指标均涉及健康生活、健康服务和健康环境3个方面;同时,二者也存在一定的差异:《指南》侧重于从微观角度评价老年人群的住、行、环境、社会参与、尊重和包容、就业、信息交流和健康服务等8个方面;《纲要》则侧重于从宏观角度评价全体人群的健康水平、健康生活、健康服务与保障、健康环境和健康产业等5个方面。同时,通过对纳入的21篇文献的分析可知,我国有关老年友好城市评价指标体系构建的研究相对较少,尚未在全国范围内建立起一套系统完整的指标体系;现有的健康城市、康养城市和长寿之乡指标体系均基于我国国情构建,可以借鉴其中城市健康和养老方面的相关指标。[结论]未来在构建城市健康养老评价指标体系时,应以《指南》和《纲要》为指导,并结合我国既有的相关指标体系,该指标体系应该是科学全面的、既与国际接轨又符合中国国情需要的城市健康养老评价指标体系。     

Healthcare-seeking patterns among immigrants in Portugal

Equity of access to health services is a major concern as it is an important precondition for positive health outcomes. However, inequities in use of health services among immigrant populations persist. Despite the increasing research in the field, patterns of healthcare seeking among immigrant populations and its associated factors are not fully understood. This study aimed to investigate healthcare-seeking patterns among immigrants in Portugal and identify factors associated with utilisation of health services. A cross-sectional study was conducted between October 2008 and May 2009 with a sample of 1,375 immigrants residing in the Lisbon region. Data were collected through a structured questionnaire applied by trained interviewers. Two stepwise logistic regressions were conducted to identify which factors were associated with utilisation of the National Health Service (NHS) and with healthcare seeking for the first time in Portugal at the Primary Health Care service, estimated by calculating odds ratios and 95% confidence intervals. Among participants, around 77% reported having used the NHS; 50% sought health-care for the first time at the Primary Health Care service and 33% at the emergency room. Lower odds of having used the NHS were associated with being male, Brazilian or eastern European compared with being African, and undocumented. Lower odds of having sought health-care for the first time at the Primary Health Care service were associated with being male and undocumented. These results suggest that further efforts are needed to tackle inequalities in access to care and promote the utilisation of health services, particularly among the more vulnerable immigrant groups. Increasing appropriate utilisation of health services, including the primary and preventive care services, may lead to better health outcomes. Immigrants' involvement and participation should be incorporated into the development of health strategies to improve access and utilisation of healthcare services.     

Statewide prevalences of concern about enough food, 1996-1999

OBJECTIVE: Food insecurity is defined as not having access at all times to enough food for an active and healthy life-style. A Healthy People 2010 objective is to increase food security and reduce the risk of hunger for all households. The objective of this study was to characterize the prevalence of concern about enough food and its association with other sociodemographic and health characteristics at the state level. METHODS: Adult respondents participating in the Behavioral Risk Factor Surveillance System survey provided information on concern about enough food from nine states from 1996 through 1999. RESULTS: Overall, the prevalence of concern about enough food ranged from 3.1% to 11.8% for individual states. Across states, low household income was the strongest predictor of concern about enough food. The odds of being concerned about enough food were generally higher among respondents who were female, younger, and without health care coverage. The odds were generally lower among those reporting excellent or very good general health and among non-Hispanic whites. CONCLUSION: Food security scales could be used at the state level to track progress for the Healthy People 2010 objective of reducing food insecurity and hunger across American households.     

Planning for the North Carolina healthy homes initiative

Substandard housing conditions have been linked to widespread childhood environmental health ailments, including two of the leading causes of childhood morbidity: lead poisoning and asthma. In 2009, the United States Surgeon General called for action around healthy homes. Improving home health environments can alleviate the cycle of childhood morbidity and mortality. The North Carolina (NC) Department of Environment and Natural Resources Children's Environmental Health Branch is working to build capacity at the State level to expand the childhood lead poisoning prevention program to respond to additional in-home environmental health issues. To achieve this objective, North Carolina must consider recommendations for assessment, management, and evaluation. This paper will situate healthy homes on the national public health agenda; discuss ways that healthy homes programs address children's environmental health disparities; introduce the NC Healthy Homes Initiative; explore current healthy housing efforts in North Carolina through an examination of the Guilford County Healthy Homes Initiative; and provide recommendations for the NC Healthy Homes Initiative to address children's environmental health disparities.