Implementing state tobacco treatment services: lessons from the Massachusetts experience

This case study was conducted between 2000 and 2003 to examine the implementation of community based tobacco treatment programs funded by the Massachusetts Department of Public Health Tobacco Control Program (MTCP). Four dimensions of implementation, drawn from several models of program evaluation are explored: (a) quantity of services, (b) quality of services, (c) implementation/use of systems, and (d) sustainability. The quantity of services delivered was high, reflecting MTCP's focus on increasing availability of services, particularly in underserved populations. The quality of physician-delivered tobacco intervention did not meet national benchmarks for delivery of all 5As (Ask, Advise, Assess, Assist, Arrange follow-up) and only about half of organizations reported routine systems for auditing tobacco use documentation. Implementation of systems to identify tobacco users and deliver tobacco treatment varied widely by community health settings, with low rates of tobacco use documentation found. Finally, in an era of greater competition for scarce prevention dollars, sustainability of services over time must be planned for from the outset, as indicated by the success of programs that sustained services by proactively and creatively incorporating tobacco treatment into their organizations. This case study can inform states' policies in their design of tobacco treatment services in community health settings.     

Beauty and smoking: the utilization of public health programs in the prevention of tobacco use disorders

Research in tobacco prevention is increasingly showing that anti-smoking campaigns aimed at youth work. However, not all interventions are effective, and some have had unintended harmful effects, even to the point of increasing tobacco use by youth. In this commentary, we discuss potentials risks associated with interventions poorly supported by the evidence, using the example of tobacco prevention campaigns that focus on the effects of smoking on beauty. We conclude with two points: 1) the importance of using strategies based on evidence, and 2) the importance of rigorous evaluation of innovative strategies.     

The Massachusetts approach: a new way to restructure state health insurance markets and public programs

In April 2006, Massachusetts enacted legislation to reorganize both its health insurance markets and a large portion of its health care subsidy system. In this paper we consider how the Massachusetts approach differs from most previous state health reform efforts, while also noting its antecedents. We examine the policy implications of the legislation's key elements and discuss how other states might consider altering the scope and specifics of those components. We conclude that both parts of the Massachusetts reform strategy merit consideration by other states and together hold promise for expanding coverage, particularly by addressing the problem of coverage discontinuity.     

Preparation of public health services for carrying out programs of health delivery to the Kazakhstan population

XXVII Congress of CPSU and Programme of CPSU set a goal of overall dispensarization of population to be carried out up to 1995. With the object of formulating the main directions in the activity of health institutions of Kazakhstan while preparing for the transition towards overall dispensarization, the results of an experiment conducted in a town and in one of the rural regions of the Republic were used; the experiment was conducted without increasing the actual number of medical personnel. Highlighted was the organization of labour of medical staff, the level of knowledge and attitude to work. For this purpose questionnaires were sent to 131 physicians and 220 paramedical personnel which made it possible to identify tasks in view of the overall dispensarization and attitude to it among physicians, paramedical personnel and the population. The level of morbidity of urban and rural population was given before introduction of overall dispensarization and after its implementation. The positive health effect of overall dispensarization was established in relation to the population of the mentioned regions. The norms of requirements in ambulatory-outpatient and inpatient care under conditions of overall dispensarization were recommended for the workers of machine-building industry.     

The economics of public health: financing drug abuse treatment services

Drug abuse treatment financing exhibits a heterogeneous set of sources from federal, state, and local governments, as well as private sources from insurance, patient out-of-pocket, and charity. A public health model of drug abuse treatment is presented for a market that can be characterized by excess demand in many communities and an implied policy of rationing. According to best estimates, as many as 6.7 million individuals may need treatment, but only an estimated 1.5 million individuals actually participated in treatment episodes. Since, as demonstrated empirically, drug abuse treatment has a robust and positive social net benefit to society, it is perplexing that treatment financing stops with a rationing outcome that inhibits social welfare. The justification for public financing is centered on the external costs of drug addiction, but subsidization is grounded in the reality that a large number of addicted individuals do not have sufficient resources to pay for treatment out-of-pocket, nor do they have private insurance coverage. Social welfare losses are generated by financial arrangements that are inconsistent with rational budgeting theory and as such would lead to non-optimal organization and management of the drug abuse treatment system.     

Using geographic information systems to match local health needs with public health services and programs

Local health departments (LHDs) play an important role in ensuring essential public health services. Geographic information system (GIS) technology offers a promising means for LHDs to identify geographic gaps between areas of need and the reach of public health services. We examined how large LHDs could better inform planning and investments by using GIS-based methodologies to align community needs and health outcomes with public health programs. We present a framework to drive LHDs in identifying and addressing gaps or mismatches in services or health outcomes.     

Difficulties involved in taking health services to the people: the example of a public health care center in a Caracas barrio

This paper discusses the difficulties faced by a typical Ministry of Health and Social Welfare maternal and infant health care services center. These service modules are usually located in the lower income barrios of Venezuela's urban centers. Recent experiences as seen by supervisors of the regional and district offices of the Ministry and the center's staff were evaluated following in-depth interviews, direct observation and scanning of clinical records over a three month period. The study concludes that the major problem areas influence the Ministry's primary goal of extending coverage to a greater proportion of the needy population and maintain the quality of the services: inadequate administrative structure leading to logistics difficulties; and the clinic location and the characteristics of the barrio itself and of the client population.     

准确把握新时代我国公共卫生体系建设的概念及内涵

党的二十大报告强调人才是第一资源,并对全面推进健康中国建设、健全公共卫生体系提出了明确要求。“健康中国”战略提出实现“以健康为中心”,加强疾病预防和健康促进,使医疗和预防有效融合。群医学是运用、融合当代医学及相关学科的知识、技术、艺术和学术,作为公共卫生的医学基础,实现人群整体与长远健康效益最大化的一门医学学科。群医学人才队伍建设符合人才强国战略,群医学实践与健康中国建设趋向一致。本文分析探讨了群医学人才队伍建设的必要性与现实性,并通过总结和借鉴国外群医学人才培养的相关经验与实践,提出了我国群医学人才队伍建设的思考。     

Total quality management in the delivery of public health services: a focus on North Carolina WIC programs.

Principles of quality improvement have been successfully implemented in the for-profit sector of the United States economy. The purpose of this study is to test the use of quality improvement strategies including development of leadership skills, a focus on internal quality, ongoing training and staff development, and efficient use of resources in the delivery of services in the public sector. The emphasis of this study is strategies for improving the delivery of nutrition education and supplemental foods to high-risk women, infants, and children through a federally funded program called WIC.     

Mental health services in Ethiopia: emerging public health issue

Objectives

Examine the mental health issues in Ethiopia in relation to services offered in this direction.

Study Design

Retrospective.

Methods

Results of the 2005 Ethiopian Demographic and Health Survey and other secondary data sources were explore dimensions of to understand the mental health issues.

Results

The average prevalence of mental disorders in Ethiopia was 18 % for adults and 15% for children. People are now more than ever aware of the importance of mental health. Families now do not need much agitation to seek medical help for their mentally ill members. Unfortunately, the mental health services are available only in Addis Ababa the capital city of Ethiopia. By consequence, a large number of the adolescent is homeless, and lives on the street. Low status of women in Ethiopia underpins and often directly undermines utilization of reproductive health services. Even though, the policy makers or research managers are giving more importance to the reproductive health issues. But, mental health services are emerging issues which determines the development goals of the country.

Conclusion

A critical requirement for the mental health promotion is to have information, increase mental health services, trained skilled workers, education and self-confidence to access available services. The key policy rapid actions needed.