Creating a state minority health policy report card

A state minority health policy report card may provide an important tool for evaluating and promoting state policies to reduce health disparities. This study develops criteria that can form the basis of such a state report card and assesses the performance of all fifty states on these measures. The results indicate wide variation among states, with geographic region being a significant predictor of performance on all four measures. Future research should be conducted on other predictors of state variation in minority health policy and connections between state policy and health outcomes for minorities.     

Health regions and geographic scales

The present article aims to discuss how the so-called health regions have been organized in Brazil since the respective governing ruling was issued (NOAS - SUS 01/2001). In order to clarify this new context, the author emphasises such concepts as region and geographic scale. The regional division under this ruling is based on the regional planning concept underlying the country's territorial policies since the founding of the Brazilian Institute of Geography and Statistics (IBGE). However, the apportionment in health regions has been both a requirement for improving the Unified National Health System (SUS) and a qualitative change in the national health policy. It is necessary to move forward by relating the regional division to the issue of scale. What is at stake is whether the regionalization of health in Brazil represents an improvement in the mediations between the various scales in the SUS.     

Effect of school policy on tobacco use by school personnel in Bihar, India

This study examined the relationship between school tobacco policies and tobacco use prevalence among school personnel. Two subsets of schools were identified in Bihar, India: Federal Schools (with a tobacco policy), and State schools (without a tobacco policy). Stratified probability samples of 50 schools each were selected. The survey was conducted through an anonymous, self-administered questionnaire. School personnel from State Schools (non-policy schools) reported significantly higher daily cigarette smoking and daily current smokeless tobacco use compared to personnel in Federal schools (policy schools). Teachers in State schools did not teach about health consequences of tobacco, and they had not received training for such teaching. Extent of teaching about health consequences of tobacco varied across topics for teachers in Federal schools. They received negligible training, but more than 35% reported access to teaching materials. More than one-half the personnel from Federal schools knew about their school's policy prohibiting tobacco use among students and school personnel, and about policy enforcement. Personnel in State schools did not know about tobacco control policy in their schools. All school personnel in both types of schools were near unanimous in supporting policy prohibiting tobacco use in schools. The study demonstrated an association between enacting a school policy regarding tobacco use and school personnel's use of tobacco, curricular teaching, and practical training of students. Findings suggest that more extensive introduction of comprehensive school policies may help reduce tobacco use among school personnel.     

Place, positionality, and priorities: Experts’ views on women's health at the Mexico–US border

Improving health care in the Mexican–US transborder region presents challenges not only of harmonization of systems but differences in values and expectations for policies. We explore the contrasting and overlapping views of health experts in both countries regarding the ways in which geographic location, scale, and professional roles shape their notions of the region, priorities for women's health, and interpretations of the socio-cultural concept of gender in relation to health. The study is based on interviews with legislators, health administrators, health advocates, and researchers on each side of the border. We suggest ways in which more nuanced perspectives might be brought to bear in the policy discourses on the region.     

Avian and pandemic human influenza policy in South-East Asia: the interface between economic and public health imperatives

The aim of this study was to analyse the contemporary policies regarding avian and human pandemic influenza control in three South-East Asia countries: Thailand, Indonesia and Vietnam. An analysis of poultry vaccination policy was used to explore the broader policy of influenza A H5N1 control in the region. The policy of antiviral stockpiling with oseltamivir, a scarce regional resource, was used to explore human pandemic influenza preparedness policy. Several policy analysis theories were applied to analyse the debate on the use of vaccination for poultry and stockpiling of antiviral drugs in each country case study. We conducted a comparative analysis across emergent themes. The study found that whilst Indonesia and Vietnam introduced poultry vaccination programmes, Thailand rejected this policy approach. By contrast, all three countries adopted similar strategic policies for antiviral stockpiling in preparation. In relation to highly pathogenic avian influenza, economic imperatives are of critical importance. Whilst Thailand's poultry industry is large and principally an export economy, Vietnam's and Indonesia's are for domestic consumption. The introduction of a poultry vaccination policy in Thailand would have threatened its potential to trade and had a major impact on its economy. Powerful domestic stakeholders in Vietnam and Indonesia, by contrast, were concerned less about international trade and more about maintaining a healthy domestic poultry population. Evidence on vaccination was drawn upon differently depending upon strategic economic positioning either to support or oppose the policy. With influenza A H5N1 endemic in some countries of the region, these policy differences raise questions around regional coherence of policies and the pursuit of an agreed overarching goal, be that eradication or mitigation. Moreover, whilst economic imperatives have been critically important in guiding policy formulation in the agriculture sector, questions arise regarding whether agriculture sectoral policy is coherent with public health sectoral policy across the region.     

Australian federal,state and territory policy on the health and wellbeing of young people: A scoping review

BackgroundThe health and wellbeing of young people are critical for the future of society but the extent to which they are addressed by overarching Australian Federal, State and Territory health policy is difficult to determine. Analysing high-level youth health policy will help establish how Australian governments are articulating and prioritising issues and may guide local and international health agendas.MethodsThis scoping review aimed to determine the extent, range and nature of Australian high-level government policy focused on the general health and wellbeing of the general population of young people. Policies published by Australian Federal, State, or Territory government departments between 2008 and 2019 were thematically analysed employing Braun and Clark's six-step recursive framework.FindingsTwelve policy documents met inclusion criteria. Three meta-themes emerged, comprising policy development, youth health challenges, and policy goals. Policy goals fell into three ubiquitous and overarching categories focused on supporting public health, promoting equity, and improving the health system for young people.ConclusionsA number of youth-specific health policies have been developed by Australian governments in recent years. Whilst goals and strategies are clearly articulated, more can be done to ensure a youth voice in policy development. The policy goals of supporting public health, promoting equity and improving the health system deserve consideration from other countries developing youth health policies.     

The role of states in mental health policy in Brazil

This article examines the role of States in mental health policy in Brazil from 1990 to 2009. The methods included the use of an electronic questionnaire on State coordination of mental health in 24 Brazilian States, document review, and analysis based on official data. The results showed that the States use various strategies and tools to conduct mental health policy, especially in monitoring and services delivery. However, the study showed that States have not developed systematic approaches to planning, coordination with other levels of government, or coordination of care. Funding poses a major challenge for management of mental health at the State level. The study suggests that overcoming the challenges in mental health policy depends on the relationship between the Federal government, States, and Municipalities in drafting policies to address each region's specific needs, the promotion of participatory planning, and investment in the sector.     

Modifying national malaria treatment policies in Peru

Between 1998 and 2001, the Peruvian Ministry of Health made sweeping changes in its malaria treatment policies in response to a resurgence of disease and the spread and intensification of antimalarial drug resistance. On the Pacific Coast, the first-line treatment for uncomplicated Plasmodium falciparum malaria was changed to combination therapy with sulfadoxine-pyrimethamine plus artesunate; in the Amazon region, mefloquine-artesunate combination therapy was introduced. With these changes in treatment policy, Peru became the first country in the Americas to use combination therapy with an artemisinin drug as its first-line treatment for falciparum malaria and the first country in the world to use two different drug combination therapy regimens based on an artemisinin drug in different regions of the country. This paper describes the process involved in assessing the geographic distribution and intensity of antimalarial drug resistance throughout the country and the use of that information to guide decisions related to national malaria treatment policy.     

State health expenditure accounts: building blocks for state health spending analysis

The dynamics of financing health care among various levels of government and the private sector are rapidly changing; structural relationships among health care providers are also being altered. These changes are placing increased importance on State-level expenditure estimates that will be instrumental in measuring the differential impact of Federal policies and State-specific initiatives on individual States. This article presents personal health care expenditures (PHCE) for 1980-93. Statistics show wide variation in level and rate of growth of regional spending per person. These statistics also quantify differences in both the percent of health care costs in each State borne by Medicare and Medicaid and in the proportion of each State's economy devoted to the provision of health care.     

Public health responses for skin cancer prevention: the policy framing of Sun Safety in Australia, Canada and England

This paper employs the policy analytic approaches of framing and narrative to examine national differences in public health policies using a case study of Sun Safety programs in Australia, Canada and England. The study shows how a single public health issue identified at the global scale (rising skin cancer rates) is framed differently based upon specific social, cultural and political situations. The result is a different story, or narrative, embedded in each national policy. This study provides an example of how health policy is defined, constrained and limited through the process of problem identification and policy resolution. The paper concludes that framing and narrative analysis are powerful tools for understanding the place-specific implementation of public health policies and initiatives.     

社会办医政策环境的调查分析

本文通过对东、中、西部地区172家社会办医疗机构进行问卷调查,分析其对社会办医相关政策的看法。调查发现,被调查机构最关切医保政策障碍,占总数的26.5%。不同地区、级别、经营性质社会办医疗机构对当前规划设置、医保准入、学科建设等方面政策需求不同。东部地区机构希望对规划有所突破,中部地区希望改变人才政策,而西部地区则认为受到土地政策限制。三级医院更关注科研项目和土地政策,二级医院则更关注准入政策。有44.8%的被调查机构认为监管政策比公立医院严格,而营利和非营利性机构对监管严格程度的感受没有差别。结合调查结果,本文提出了针对不同类型机构诉求细化政策、促进投入和购买服务等政策的落实以及加强非营利性机构监管等政策建议。     

A conceptual model to be used for community-based drinking-water improvements

A conceptual model that can be applied to improve community-based drinking-water in crisis-type situations has been developed from the original general science and technology/development bridging concept and from a case study in Northwest Bangladesh. The main feature of this model is the strengthened role of communities in identifying and implementing appropriate drinking-water improvements with facilitation by multi-disciplinary collaborative regional agency networks. These combined representative community/regional agency networks make decisions and take actions that involve environmental and health data, related capacity factors, and appropriateness of drinking-water improvements. They also progressively link regional decisions and actions together, expanding them nationally and preferably within a sustainable national policy-umbrella. This use of the model reflects stronger community control and input with more appropriate solutions to such drinking-water crisis situations and minimization of risk from potentially-inappropriate 'externally-imposed' processes. The application here is not intended as a generic or complete poverty-alleviation strategy by itself but as a crisis-solving intervention, complementary to existing and developing sustainable national policies and to introduce how key principles and concepts can relate in the wider context. In terms of the Bangladesh arsenic crisis, this translates into community/regional networks in geographic regions making assessments on the appropriateness of their drinking-water configuration. Preferred improvement options are decided and acted upon in a technological framework. Options include: pond-sand filters, rainwater harvesting, dugwell, deep-protected tubewell, and shallow tubewell with treatment devices. Bedding in the regional drinking-water improvement configuration protocols then occurs. This involves establishing ongoing representative monitoring and screening, clear delineation of arsenic-contaminated wells with inter-regional linking, and national expansion within national drinking-water policy frameworks.     

The dynamics of the health labour market

One of the most important components of health care systems is human resources for health (HRH)--the people that deliver the services. One key challenge facing policy makers is to ensure that health care systems have sufficient HRH capacity to deliver services that improve or maintain population health. In a predominantly public system, this involves policy makers assessing the health care needs of the population, deriving the HRH requirements to meet those needs, and putting policies in place that move the current HRH employment level, skill mix, geographic distribution and productivity towards the desired level. This last step relies on understanding the labour market dynamics of the health care sector, specifically the determinants of labour demand and labour supply. We argue that traditional HRH policy in developing countries has focussed on determining the HRH requirements to address population needs and has largely ignored the labour market dynamics aspect. This is one of the reasons that HRH policies often do not achieve their objectives. We argue for the need to incorporate more explicitly the behaviour of those who supply labour--doctors, nurses and other providers--those who demand labour, and how these actors respond to incentives when formulating health workforce policy.     

Regional influence on early consumption of foods other than breast milk in infants less than 6 months of age in Brazilian State capitals and the Federal District

The aim was to assess regional influences on food consumption in infants less than six months of age. A cross-sectional study was conducted in a sample of 18,929 infants participating in the Second Survey on Breastfeeding Prevalence in Brazilian State Capitals and the Federal District in 2008. Consumption rates for tea, fruit juices, formula milk, and porridge were calculated for the State capitals from the five geographic regions of the country. Food consumption was estimated by logit analyses and Poisson models. Differences in food consumption profile were observed between the different regions: tea was more common in State capitals in the South (RP = 2.37), while non-maternal milk (RP = 1.50 and 1.47) and juices (RP = 1.57 and 1.55) were more frequent in the Northeast and Southeast, respectively. Porridge was more common in the Northeast (RP = 3.0). Brazil's geographic regions thus display different infant feeding patterns. Public policy should take cultural diversity into account when planning strategies to improve infant nutrition and health.     

Mental health reform in the Russian Federation: an integrated approach to achieve social inclusion and recovery

OBJECTIVE: To facilitate mental health reform in one Russian oblast (region) using systematic approaches to policy design and implementation. METHODS: The authors undertook a three-year action-research programme across three pilot sites, comprising a multifaceted set of interventions combining situation appraisal to inform planning, sustained policy dialogue at federal and regional levels to catalyse change, introduction of multidisciplinary and intersectoral-working at all levels, skills-based training for professionals, and support for nongovernmental organizations (NGOs) to develop new care models. FINDINGS: Training programmes developed in this process have been adopted into routine curricula with measurable changes in staff skills. Approaches to care improved through multidisciplinary and multisectoral service delivery, with an increase in NGO activities, user involvement in care planning and delivery in all pilot sites. Hospital admissions at start and end of the study fell in two pilot sites, while the rate of readmissions in all three pilot sites by 2006 was below that for the region as a whole. Lessons learned have informed the development of regional and federal mental health policies. CONCLUSION: A multifaceted and comprehensive programme can be effective in overcoming organizational barriers to the introduction of evidence-based multisectoral interventions in one Russian region. This can help facilitate significant and sustainable changes in policy and reduce institutionalization.     

Towards a common public health strategy for the region of South Eastern Europe

Aim

A seminar organised in the framework of the Public Health Collaboration in South Eastern Europe programme (PH-SEE), Belgrade, Serbia and Montenegro, 23–28 August 2004, aimed to answer the question: Is there a real need for a regional public health policy framework in South Eastern Europe (SEE)? The answer is probably yes because the specific situation in the SEE region has to be taken into account for the development of relevant and realistic public health goals.

Methods

To evaluate the current situation in the SEE region, Strengths, Weaknesses, Opportunities and Threats (SWOT) methodology was applied. A set of key messages and recommendations have been formulated. Based on the priorities identified and agreed upon, PH-SEE experts formulated five goals.

Results

The result of very intensive work was a framework for a regional SEE public health strategy being drafted during the seminar. An initial 5-year term was established beginning in 2005. This framework represents only a first step towards an officially agreed upon regional strategy framework.

Conclusions

The purpose of that exercise was to demonstrate the benefits of regional collaboration by using the technical competence and experience of public health professionals in the region. Moreover, the harmonisation with European Union (EU) public health standards and policies must be considered in health policy development in the region.     

Planning for health sector reform in post-conflict situations: Kosovo 1999-2000

The restoration and development of health care systems in post-conflict situations and complex emergencies are attracting attention. Kosovo is unique in being a post-conflict situation, in a former socialist country, with an unclear political future, under temporary UN administration. The World Health Organization (WHO) led a process of developing a health policy framework for the emergency period that included elements of health sector reform, a somewhat controversial initiative. Reform elements of the policy were consistent with normative health policies in much of eastern and central Europe. There was tension between the need to have a policy in place rapidly and the desire to be participatory. Policy to deal with emergency situations that is not available at the time required is of limited value. Although there was some tension between relief and development agendas, the policy process did direct significant resources and effort in directions that contributed to longer-term reform and development. A policy framework does not ensure compliance with policy unless issues of authority, mandate, and leadership are clear. A rapidly developed health policy framework at the onset of an emergency is desirable. Policy developers should be experienced, seen as being neutral and be relatively independent of any specific donor or interest group. WHO is well situated to play this role if it meets certain conditions.     

Inequality trends in the demographic and geographic distribution of health care professionals in China: Data from 2002 to 2016

China has long been negatively affected by a shortage and maldistribution of health workers. This study aimed to examine the national and regional trends in the demographic and geographic distribution inequality of health care professionals in China from 2002 to 2016. Based on data from the China Health and Family Planning Statistical and China Statistical Yearbooks, we calculated the Gini coefficient and the Theil T and Theil L indices based on the number of health care professionals per capita and per geographic area to measure the inequalities in their demographic and geographic distribution, respectively. The contributions by intra‐regional and inter‐regional differences on total inequality were explored within and among East, Central, and West China via Theil index decomposition. We found that the national demographic distribution of health care professionals maintained in an absolute equality level, and the inequality indices decreased gradually, whereas the corresponding geographic inequalities were severe and presented a worsening trend. Compared with nurses, physicians not only maintained higher densities but also maintained a more equal distribution. Intra‐regional disparities within the east, central, and western regions were the main cause for overall demographic inequality, whereas both intra‐regional and inter‐regional disparities significantly contributed to overall geographic inequality. To conclude, the distribution equality of health care professionals by population was satisfactory, whereas the corresponding distribution inequality by area was severe. Different types of distribution inequality of health care professionals existed regionally and nationally despite their increasing quantities and densities. Factors beyond population size should be considered when the government introduces health workforce allocation policies.     

基于资本形成账户的北京市医疗卫生功能疏解分析

目的:为北京市卫生部门及时掌握卫生资源配置动态,把握医疗功能疏解契机,合理调整资源配置提供政策建议。方法:本研究利用卫生财务年报个案库汇总的核算方法,通过对区域间各类政府办卫生机构固定资本形成总额的描述性分析,研究北京市医疗功能疏解动态。结果:2015年北京市优质医疗资源及卫生行政资源疏解效果较好,但公共卫生资源发展不均衡。结论建议:在进一步鼓励优质医疗资源有效疏解的同时根据市场需求做好前期区域规划,避免盲目建设;重视公共卫生服务能力的均衡发展以及卫生行政管理能力的协同发展,出台配套政策合理配置公共卫生与卫生行政资源,为医疗功能的全面疏解做好储备工作。     

Collective health and regional integration in Latin America: An opportunity for building a new international health agenda

ABSTRACT

From its origins, the Latin American Social Medicine and the Collective Health (LASM/CH) movements have focused on thinking about health from and for the region. After the implementation of neoliberal policies, social improvements and the geopolitical strengthening of the region became the roots of new regional integration projects in South America. The objective of this article is twofold. First, we explore the legacy of long-standing efforts in the region that address the social and political dimensions of health, associated with the LASM/CH movements and their influence on the contemporary regional health agenda. Second, we analyze the UNASUR Health policy, its role in the construction of a regional health agenda, and the principles of South-South cooperation it supports. In order to accomplish this, a qualitative analysis was conducted, involving primary and secondary data. Through UNASUR, a new framework of regional health integration and regional health diplomacy emerged in South America and a ‘window of opportunity’ opened for the ideas of Social Medicine and Collective Health to occupy a dominant place on the regional health agenda. It is possible to observe a confluence between the principles and values of these movements and those of the main constituent bases of UNASUR Health.