A study to determine how needs assessment is being used to improve health

Objective: To determine how needs assessment is being used in Health Authorities and General Practice.Design: A postal survey of a one in two sample of Scottish GPs, semistructured interviews with selected health authority executives and a random sample of GPs.Subjects: Nine hundred and sixty-five GPs (54% of those sent the postal questionnaire), 47 randomly selected GP practices and 36 selected health authority (called health boards in Scotland) executives.Results: In health authorities, a view of commissioning/planning emerged with three components: (1) planning (including needs assessment); (2) leadership; and (3) strong relationships with stakeholders. Health authority executives believed that GP involvement is one of several vital components but doubted the commitment of all but a few GPs to the planning process. GPs welcomed enhanced influence but feared increases in workload and admitted to a lack of training in the skills required for needs assessment. Health authority executives aspired to place needs assessment at the centre of planning but admitted that, at present, cost and volume issues predominate. Most GPs were not involved in needs assessment and argued that it is not part of a GPs core activity. National needs assessment documents were well received by health authorities but made little or no impact on GPs.Conclusions: Needs assessment will have little involvement from primary care until there are changes in the attitudes and skills of the majority of GPs. Fundamental changes are required in health authority priorities and practice if their rhetoric about needs assessment is to be turned into reality. The role of needs assessment could be enhanced but this will only happen if it can be shown to lead to improved health outcomes while addressing the financial pressures that currently dominate the agenda.     

西藏三地区卫生管理培训需求调查分析

目的：了解西藏三地区卫生机构的管理人员未来1—3年内卫生管理的培训需求,为西藏自治区卫生行政部门和医疗卫生机构制定适合西藏地区特点的培训体系提供参考依据。方法：采用现场问卷调查和小组访谈等多种方法收集信息。结果：明确了培训对象,以及其对培训目标、内容与方法、师资、教材、考核评价和培训组织等方面的要求。结论：西藏三地区卫生机构亟待加强科学的卫生管理方面的培训。     

Deterioration,drift, distraction,and denial: How the politics of austerity challenges the resilience of prison health governance and delivery in England

Extant scholarship has demonstrated that macroeconomic austerity disproportionately harms marginalised end-users. Its impact on the governance and delivery of health provisions on such individuals, however, has received less attention. Drawing on interviews with 27 policy elites involved with England’s prison health policy, interviewees perceive that austerity policies have shaped and constrained the prison health system through the politics of deterioration, drift, distraction, and denial. The deterioration of the prison workforce size has been linked to diminished prisoner access to healthcare, attendant with an increased number of riots, assaults, acts of self-harm, and suicides. Concurrently, the microeconomic structure of organised crime is filling the void in prison governance, thus conducing to heightened abuse of psychoactive substances, as well as a surge in associated medical emergencies and violence. Successful prosecution of prior sexual offences, continued incarceration of those imprisoned for indeterminate sentences, and harsh sentencing practices have created policy drift, unremitting overcrowding, and reinforced excessive dependency on prison healthcare resources. The rapid turnover of justice ministers and intensified push for prison privatisation have enabled widespread distraction. Moreover, despite well-documented crises besetting English prisons, politicians seemingly remain in a state of denial. Preventive imprisonment, recurrent spending, and enhanced financial and political accountability measures are necessary to mitigate the effects of austerity and germane policies fomenting inimical impacts on England’s prison health system.     

Together we can make a difference: the case for transnational action for improved health in prisons

In spite of international differences in the treatment of incarcerated persons, as a group, they are vulnerable to poor health status and lack of access to quality health care. The health care of prisoners is affected by knowledge and commitment to ideas of human rights and social justice, as well as economic conditions. Prisoners are at increased risk of both acute and chronic diseases, and may constitute a threat to the health of other prisoners, their attendants or outside communities upon release. Mental illness and related problems of substance abuse are prevalent in prison populations, with many US prisons serving as modern asylums. Public health workers and organizations can stimulate and implement action to improve health in prisons. The World Federation of Public Health Associations can play a leadership role in co-ordinating and facilitating collaborative international action and research to enhance the health of prisoners and their communities worldwide.     

The impact of health needs assessment and prioritisation on District Health Board planning in New Zealand

Objectives District Health Boards (DHBs) in New Zealand are mandated to assess and prioritise the health needs of their resident populations. This paper evaluates the impact of those health needs assessments (HNAs) and prioritisation practices on health service planning and purchasing in the first 3 years of the DHBs (2001–2003). Methods DHB HNAs, 5‐yearly strategic plans, and annual plans were evaluated using document analysis to determine the impact of needs assessments on prioritisation and planning by boards. Key informant interviews with DHB senior managers were used to identify differences between boards. Results HNAs had relatively little influence on the direction of planning and purchasing. HNAs conducted in DHBs that focussed on planning at the service level and in relation to population subgroups using a ‘mixed‐scanning’ approach and ‘service planning groups’ had a greater impact on planning and purchasing than more comprehensive approaches. DHBs found prioritisation difficult due to the level of control exercised by central government over their actions. Conclusions HNAs in New Zealand need to be less ambitious, more focussed and more closely institutionally linked to prioritisation, service planning and purchasing processes if they are to have an impact on the allocation of resources. Copyright © 2009 John Wiley & Sons, Ltd.     

A new approach to prison public health? Challenging and advancing the agenda for prison health

This paper explores recent developments in prison public health, recommending that future prison health policies and practices become more ‘upstream’ in their outlook and approach. It is argued that this will require much firmer acknowledgement of the significance of broad, systemic and structural determinants of prisoner health, particularly if the World Health organization's vision for a ‘healthy prison’ is to be realized. Epidemiological evidence plainly shows that prisoners have experienced—and continue to experience—worse health than the general population, despite the fact that prison settings across the European Union have been targeted for health promotion by the World Health Organization since 1994. In 2005, WHO launched a new 10-year prison public health plan, which it envisages will begin to address key prison health determinants. In the UK, New Labour has identified prison health as a key public health objective within Choosing Health, although health interventions within prisons continue to be predominantly geared towards efficient and effective primary and secondary healthcare, and much less towards public health goals. This paper strives to open up the debate on prison public health, advocating a progressive and more sustainable approach to developing and commissioning health services for prisoners.     

A rapid needs assessment of the provision of Health Technology Assessment in the south-west peninsula

BACKGROUND: Key to delivering UK policies on clinical governance, evidence-based practice and value for money is Health Technology Assessment (HTA). Despite the provision of HTAs through the National Institute for Health and Clinical Excellence (NICE), local health organizations still undertake HTA and make decisions based on them. In some regions, capacity is provided by centralized arrangements, but in others provision is ad hoc. This rapid needs assessment evaluates the provision of HTA in the south-west peninsula, and its scope, content and quality. METHODS: We used semi-structured interviews and documentary analysis to assess the need for HTA. RESULTS: HTAs are most commonly used by drug and therapeutics committees and joint formulary committees. The scope of technologies assessed was predominantly drugs. The quality of literature review in HTAs was variable and virtually none considered value for money. Informants felt there was insufficient provision of local HTAs. Local focus and clinical engagement were seen as key to the implementation of appraisal decisions, but this was threatened by weak links with commissioning and processes to prioritize decisions across primary care trusts. CONCLUSIONS: The quality of some HTAs poses a risk to clinical and corporate governance.     

Health challenges of mothers with special needs children in Pakistan and the importance of integrating health social workers

ABSTRACT

There is concern that mothers of special needs children in developing countries like Pakistan are neglected populations facing hidden health challenges. The aim of this study was to investigate the kinds of health challenges mothers experience and to highlight the role of health social workers in supporting the needs of mothers. Twenty-one mothers were sampled across three cities and findings were analyzed through a thematic content analysis approach. Findings revealed that mothers faced significant and salient challenges under eight sub-categories of mental health and six sub-categories of physical health. We recommend that health social workers collaborate with healthcare practitioners to improve health services for mothers and also coordinate with other social workers, community members, and policymakers for improving both social and structural support for special needs families.     

荆州市104家企业健康管理需求调查

目的了解荆州市企业对健康管理的需求,并探讨企业健康管理服务的策略和途径。方法采用自行设计问卷随机对荆州市104家企业的中高层管理人员进行健康管理需求调查,发放问卷312份,收回273份,有效回收率为87．4％。计数资料用百分比、累计百分比表示。结果荆州市企业的主要健康问题中各类慢性病占28．4％、不健康行为占40．1％、职业病占22．8％、环境污染占8．7％,企业所需求的健康管理服务项目集中表现为健康专题讲座占37．2％、健康咨询占53．8％、解读体检报告占43．2％、营养指导占10．5％、绿色就医占14．7％等。结论不同类型的企业都表现出了对健康管理的重视,针对企业目前的主要健康问题和健康需求,建立了适合本地区企业健康管理服务模式,为企业员工提供了针对性的健康指导、健康干预措施,将有较好的前景。     

Health departments' implementation of public health's core functions: an assessment of health impacts

OBJECTIVES: The purpose of this article was to investigate the relationship between state health agencies' adherence to the recommendations of the United State's Institute of Medicine's (IOM) report, The Future of Public Health, and changes in their populations' health. STUDY DESIGN: Data were abstracted from agencies' plans, budgets, annual reports, etc. spanning a 5-year period. A comprehensive change in population health measure over the same period was drawn from the UnitedHealth Group's annual survey. METHODS: Configurations, based on public health core functions, were established using linear regression and qualitative comparative analysis. The dependent variable was a holistic measure of change in a state population's health status. RESULTS: State agencies that most completely adopted a public health model emphasizing assessment, assurance and policy development also experienced significant improvements in their population health measures. CONCLUSIONS: State agencies that more completely adopted the IOM's public health core functions had a concomitant improvement in their populations' health statuses. Further research to explore if there is a causal link between adoption of the core functions and positive health impacts is warranted.     

Health needs of prisoners in England and Wales: the implications for prison healthcare of gender, age and ethnicity

This paper aims to provide evidence of the healthcare needs of prisoners in relation to gender, age and ethnicity, drawing from a larger systematic overview of the policy and research literature concerning primary care nursing in prisons in England and Wales. The literature overview shaped the initial stages of a research project funded by the Department of Health to examine the views and perspectives of prisoners and nurses working in prisons, and to identify good primary care nursing in the prison environment. At total of 17 databases were searched using search terms related to primary healthcare in prisons (health, nurs*, primary care, healthcare, family medicine, prison*, offender*, inmate*) with terms truncated where possible in the different databases. Following this, a sifting phase was employed using inclusion/exclusion criteria to narrow and focus the literature perceived as relevant to the research questions. All papers were critically appraised for quality using standardised tools. Findings from the literature overview show that prisoners are more likely to have suffered some form of social exclusion compared to the rest of society, and there are significantly greater degrees of mental health problems, substance abuse and worse physical health in prisoners than in the general population. Women, young offenders, older prisoners and those from minority ethnic groups have distinct health needs compared to the prison population taken as a whole, with implications for the delivery of prison healthcare, and how these needs are met effectively and appropriately.     

北京市5所打工子弟学校学生健康需求评估分析

目的了解打工子弟学校学生在健康方面的需求及其健康相关问题,为今后在打工子弟学校开展健康服务提供依据。方法选取北京市5所打工子弟学校,在三～六年级学生中,每个年级随机抽取1～2个班的学生,共计558名进行定量调查。结果北京市目前多数学校卫生政策没有完全覆盖到打工子弟学校,学校需要政府的政策支持;打工子弟学校学生伤害发生率为23.22%,龋齿患病率为44.09%,视力不良率为29.75%,尝试吸烟率为13.00%,健康状况、健康信念、健康生活方式、健康技能及健康知识等综合健康素养评价指标、学校卫生指标均低于公立学校学生。结论打工子弟学校健康需求主要为:物质环境改善,对学生、教师开展健康教育工作和政府政策支持。为提高学生健康水平,应该在打工子弟学校中开展健康促进工作。     

The state of the public health system in England

A public health system has been described as 'a complex network of individuals and organizations that have the potential to play critical roles in creating the conditions for health' (Institute of Medicine). The idea of such a system is not new and draws heavily on the work of the World Health Organization. This paper assesses the state of the public health system in England as it has evolved since the mid-1970s, based on a scoping study commissioned by the National Institute for Health Research (NIHR) Service Delivery and Organization to inform its public health research programme. It identifies the principal components of the ideal public health system, and explores the challenges facing those seeking to devise a more coherent and effective system. The paper concludes that despite public health being high on the policy and political agendas, the prominence given to it has yet to be matched by success across the system as a whole. There is also a need to address what is perceived to be policy incoherence, and an absence of joined-up thinking. Tackling problems such as the obesogenic environment demands a whole-systems approach that cuts across government, as well as requiring action by industry, communities, families and society as a whole.     

A critical examination of the health promoting prison two decades on

Two decades since the WHO Regional Office for Europe outlined and published a report on health promotion in prison, which stimulated further debate on the concept of the ‘health promoting prison’, this paper discusses the extent to which the concept has translated into practice and the extent to which success has been achieved. This paper primarily focuses on why there has been a gap between the strategic philosophy of health promotion in prison and practical implementation, suggesting that factors such as ‘lifestyle drift’ and public and political opinion have played a part. A further argument is made in relation to the overall commitment of European countries and more broadly WHO in their support of settings-based health promotion in this context. It is proposed that there has been a weakening of commitment over time with a worrying ‘negative trajectory’ of support for health promoting prisons. The paper argues that despite these challenges, the opportunities and potential to address the needs of those who are often most vulnerable and excluded is colossal and acting to tackle this should be a greater priority.     

Health impact assessment: a tool for healthy public policy

Healthy Public Policy is one of the key health promotion actions. Advancement of Healthy Public Policy requires that the health consequences of policy should be correctly foreseen and that the policy process should be influenced so that those health consequences are considered. Health Impact Assessment is an approach that could assist in meeting both requirements. Policies often produce health impacts by multiple indirect routes, which makes prediction difficult. Prediction in Health Impact Assessment may be based on epidemiological models or on sociological disciplines. Health Impact Assessment must be based on an understanding of, and aim to add value to, the policy-making process. It must therefore conform to policy-making timetables, present information in a form that is policy relevant and fit the administrative structures of policy makers. Health Impact Assessment may be used to inform health advocacy but is distinct from it. There is a danger that Health Impact Assessment could be misunderstood as health imperialism.     

浅谈突发公共卫生事件应对中健康促进工作的策略

突发公共卫生事件,是指一些突然发生的,可能或者已经造成社会重大传染病疫情、不明原因的群体性疾病或者造成大量人群食物中毒或者其他严重影响公众健康的紧急事件。在我国2003年颁布的《突发公共卫生事件紧急条例》中对其特征进行了定义:一是具有突发性;二是在公共卫生领域发生;三是严重危害公众健康。在面对突发公共卫生事件发生后,应该及时对事件进行分析、处置,开展广泛深入的健康教育和健康促进工作,可促进公众正确应对灾害,提高自我的防护意识和能力,可以对事件造成的损失进行补救,减少对社会、经济、政治和人民群众生命财产的损害,有利于维护公众健康和社会秩序。对于突发公共卫生事件,除了在发生之后及时应对以外,在平时要开展健康促进工作,对突发公共卫生事件进行预防,并且在其不可避免的发生时,将其危害降到最低。该文对突发公共卫生事件应对中健康促进工作进行探讨。