University of Washington School of Public Health Extended Degree Program News and People

Infographic: How Community Health Workers Save Lives in the Developing World

2011-03-21T15:57:00.000-07:00

"Imagine if pregnant women and their kids in developing countries could be given simple, lifesaving health care, even when miles away from a hospital or doctor. Community health workers—trained practitioners who provide health care for pregnant women, assist in childbirth, and treat newborns—provide just that service. Without community health workers, pregnant women and newborn babies in the developing world are at risk for disease. More than 350,000 women die in childbirth and pregnancy each year, and almost 3.6 million babies die before they are a month old. Even small complications can be deadly for people living so far away from hospitals. Community health workers are saving lives by using a very basic—but very important—set of solutions and techniques."

Link to graphic:
http://www.good.is/post/infographic-how-community-health-workers-save-lives-in-the-developing-world/

Who is healthier? Please take the GBD 2010 Health Measurement Survey!

2010-08-10T11:02:00.000-07:00

Imagine two people. One is completely blind. The other suffers from constant and intense back pain.

Who is healthier overall?

A landmark global health survey being launched today will explore the impact of different diseases and injuries. A person’s health state may limit how well parts of the body or mind work. Some people are not able to do everything that others can, with some people more severely limited than others. This survey intends to measure peoples’ priorities and values around these various states of health.
We are writing to ask you and your organization to participate in this online survey, which can be found at this link: http://gbdsurvey.org

The survey is part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, in collaboration with four other leading institutions: Harvard University, Johns Hopkins University, the University of Queensland, and the World Health Organization.

Our goal is to collect responses from at least 50,000 people worldwide. Please consider sharing this email and encouraging participation within your organization. In addition, we would ask you to consider forwarding information about this survey to colleagues and contacts outside your organization who might be interested in participating.

The survey takes about 15 minutes to complete. Participation is completely voluntary and anonymous. In the near future, we hope to translate the survey into additional languages.

By participating in the survey, you will contribute to the scientific understanding of global health problems and ultimately enable policymakers and health care leaders to make better decisions based on a stronger evidence base. Summary survey results will be posted online at www.healthmetricsandevaluation.org upon completion of the study in spring 2011.

For more information, please contact us at: info@globalburden.org

Thank you very much for taking part in this important public health assessment.

Follow the GBD project on Twitter: http://twitter.com/globalburden
Become a GBD fan on Facebook and follow the survey’s progress: http://www.facebook.com/gbdsurvey

Buying Health Care, the Individual Mandate, and the Constitution

2010-06-28T08:47:00.000-07:00

Posted by NEJM • June 23rd, 2010

Sara Rosenbaum, J.D., and Jonathan Gruber, Ph.D.

"In Rashomon, a classic film that explores the concept of truth, director Akira Kurosawa presents a story about a single incident retold by four narrators, leaving the audience to figure out what is real. Litigation has a Rashomon-like quality to it: two sides meet in a courtroom and each presents its case, arguing not only that abstract legal principles favor its cause, but equally important, that its version of the event that gave rise to the dispute should be the filter through which the court decides the matter.

Three separate cases raising constitutional challenges to the Affordable Care Act (ACA) are now under way and together they present issues of great legal complexity. Yet although difficult legal questions must be resolved, a pivotal issue is whose version of events will serve as the judicial analytic filter. For reasons related to the very basis of Congress’s constitutional power to enact health care reform, the fight is over whether the individual mandate to purchase health insurance (or pay a tax) is about regulating individuals’ economic conduct or regulating their noneconomic status. Depending on which characterization of the facts prevails, the individual mandate either falls within or lies outside Congress’s power to act"

For the full article:
http://healthcarereform.nejm.org/?p=3582&query=home

Food Safety and Global Health: An International Law Perspective

2010-05-25T15:52:00.000-07:00

(home page for Global Health Governance: http://www.ghgj.org/ )

Stefania Negri

“Following the recurrence of serious events of food contamination across the globe, food safety has become a matter of ever increasing international concern and the World Health Organization has defined foodborne diseases as a global public health challenge. Protecting global health from foodborne hazards is a compelling duty and a primary interest of both States and non-State actors; it calls for enhanced proactive cooperation between national and international institutions. Unfortunately, the present state of international law on food safety regulation and governance is still unsatisfactory and reforms are desirable in many respects.

This paper suggests that improvements and progresses could be achieved in three major areas of intervention:

a. the human rights framework, where the profile of the emerged right to safe food should be raised by way of express recognition in international human rights law, backed up by authoritative interpretation by the UN Committee on Economic, Social and Cultural Rights and strengthening of accountability and remedial measures;

b. the regulatory framework, where trade and health issues related to food safety should be addressed in a way that contributes to easing tensions between trading parties while prioritizing consumer protection over freedom of trade;

c. the sanitary framework, where international preparedness and response to public health hazards posed by foodborne diseases should benefit, where appropriate, from the extended application of the International Health Regulations and the possible devise of enforcement measures aimed at ensuring international health security….”

Read the entire article at: http://www.ghgj.org/Negri_food%20safety%20and%20global%20health.pdf

Scaling Up in International Health: What are the Key Issues?

2010-05-18T17:25:00.000-07:00

Lindsay J Mangham and Kara Hanson

“The term ‘scaling up’ is now widely used in the international health literature, though it lacks an agreed definition. The authors review what is meant by scaling up in the context of changes in international health and development over the last decade. They argue that the notion of scaling up is primarily used to describe the ambition or process of expanding the coverage of health interventions, though the term has also referred to increasing the financial, human and capital resources required to expand coverage.

The authors also discuss four pertinent issues in scaling up the coverage of health interventions: the costs of scaling up coverage; constraints to scaling up; equity and quality concerns; and key service delivery issues when scaling up. They then review recent progress in scaling up the coverage of health interventions. This includes a considerable increase in the volume of aid, accompanied by numerous new health initiatives and financing mechanisms. Finally, the authors reflect on the importance of obtaining a better understanding of how to deliver priority health interventions at scale, the current emphasis on health system strengthening and the challenges of sustaining scaling up in the prevailing global economic environment.”
The abstract:
http://heapol.oxfordjournals.org/cgi/content/abstract/25/2/85

Three accompanying commentaries:

Lucy Gilson and Helen Schneider
Commentary: Managing scaling up: What are the key issues?
http://heapol.oxfordjournals.org/cgi/content/full/25/2/97

Susan M Cleary
Commentary: Trade-offs in scaling up HIV treatment in South Africa
http://heapol.oxfordjournals.org/cgi/content/full/25/2/99

Viroj Tangcharoensathien and Walaiporn Patcharanarumol
Commentary: Global health initiatives: Opportunities or challenges?
http://heapol.oxfordjournals.org/cgi/content/full/25/2/101

The Impact of Income Inequalities on Sustainable Development in London

2010-05-14T11:42:00.000-07:00

“If the UK enjoyed levels of equality closer to countries like Sweden or Japan, the evidence indicates that obesity in London would decline by 50 per cent, mental illness would be reduced to less than one-third of its present levels, and the teenage birth rate would be cut by almost three quarters. It shows that although the biggest improvements would be seen in the poorest boroughs, life in the richest ones would also get better.

The impact of income inequalities on sustainable development in London is a powerful and compelling new report written by Richard Wilkinson and Kate Pickett, published by the London Sustainable Development Commission.”

Access the report at: http://www.equalitytrust.org.uk/docs/londonequality.pdf

The Biology of Disadvantage: Socioeconomic Status and Health

2010-05-14T10:52:00.000-07:00

“This volume is the product of the JohnD. andCatherine T.MacArthurNetwork on Socioeconomic Status (SES) and Health. For the last 12 years the network has provided a structure through which scientists from a wide range of disciplines jointly addressed the question: How does SES get under the skin to affect health? In 1999, early in our life as a network, we organized a conference held at the National Institutes of Health on SES and health in industrialized nations. The conference presentations were published as a special volume of the Annals of the New York Academy of Sciences. Since that time, network members have worked together to provide answers to the central questions about the relationship of SES and health. In the process, numerous articles and books reflecting our work have been published.
The current volume builds on these findings and stands as a bookend to the former Annals volume, presenting what we have learned in our decade of work since the 1999 conference, and our thoughts on the current state of knowledge about the pathways by which SES affects health.”

1. Adler, N.E., M. Marmot, B.S. McEwen & J. Stewart. 1999. Socioeconomic Status and Health in Industrial Nations: Social, Psychological, and Biological Pathways. Ann. N. Y. Acad. Sci. 896.

2. MacArthur Research Network on SES and Health. http://www.macses.ucsf.edu/publications/pubchron.php

Full-length articles in the volumen can be accessed at:
http://www3.interscience.wiley.com/journal/123291860/issue

Deadly Delivery: The Maternal Health Care Crisis in the U.S.

2010-05-11T14:20:00.000-07:00

“More than two women die every day in the USA from complications of pregnancy and childbirth. Approximately half of these deaths could be prevented if maternal health care were available, accessible and of good quality for all women in the USA. A recent report by Amnesty International USA analyzes the barriers to health care that result in the USA’s troubling maternal mortality and morbidity statistics. Among other issues, the report examines discrimination; financial, bureaucratic and language barriers to accessing care; information about maternal care options; participation in care decisions; staffing and quality questions; and accountability and oversight.”

A summary of the report is available at: http://www.amnestyusa.org/dignity/pdf/DeadlyDeliverySummary.pdf
The full report is can be accessed at: http://www.amnestyusa.org/dignity/pdf/DeadlyDelivery.pdf

Harnessing the Potential of the Mobile Phone for Health and Agriculture in Uganda (TEDxSeattle - Fiona Lee & David Edelstein)

2010-05-10T16:59:00.000-07:00

Ontario Women’s Health Equity Report: Access to Health Care Services

2010-05-07T12:28:00.000-07:00

“Access to health care services continues to be an important issue for Ontarians in general and for women in particular. Lack of access to services can result in costly and potentially avoidable complications, increased disease and disability, and reduced quality of life. The access to health services chapter reports on access to primary care, specialist care, home care and care for chronic conditions. Information on how barriers to care vary for at-risk population subgroups can help decision makers identify targets for intervention to foster timely access to effective services.”
The chapter’s key findings and recommendation can be read at: http://www.powerstudy.ca/webfm_send/121
To learn more about the Project for an Ontario Women’s Health Evidence-Based Report (POWER study), go to: http://www.powerstudy.ca/

Still on Health Care Reform, see below a call for conference abstracts on Health Care Reform and Health Equity.

2010-05-07T12:27:00.000-07:00

CALL FOR ABSTRACTS
Submission of abstracts is invited for the 2010 Academy for Health Equity Conference, "Achieving Health Equity in the Era of Healthcare Reform," to be held on August 18-20, 2010 at the Marriott Denver South at Park Meadows, Littleton, CO. All abstracts are due by Monday, May 31, 2010 at 11:59 p.m. Eastern time. Authors are encouraged to submit abstracts on topics related to the conference theme, as well as current and emerging issues related to health disparities and health equity. More information about the abstract submission process can be found at:
https://cmt.research.microsoft.com/AHEC2010/Default.aspx.

Health Care Reform and Primary Care: The Growing Importance of the Community Health Center

2010-05-07T11:46:00.000-07:00

Eli Y. Adashi, M.D., H. Jack Geiger, M.D., and Michael D. Fine, M.D.

During the debate over U.S. health care reform, relatively little attention was paid to the long-established network of community health centers (CHCs) in the United States. And yet this unique national asset constitutes a critical element of any reform intent on expanding access to health care through a primary care portal. With an eye toward meeting the primary care needs of an estimated 32 million newly insured Americans, the recently passed Patient Protection and Affordable Care Act underwrites the CHCs and enables them to serve nearly 20 million new patients while adding an estimated 15,000 providers to their staffs by 2015. The “new” CHCs have arrived.
Read the full article at: http://content.nejm.org/cgi/reprint/NEJMp1003729.pdf?ssource=hcrc

CDC: Tobacco Control States Highlights 2010

2010-04-26T13:06:00.000-07:00

From the CDC:

"Tobacco use is the single most preventable cause of death in the United States. Each year in the United States, cigarette smoking and exposure to secondhand smoke causes 443,000—or 1 in 5 deaths. Economic losses are also staggering. Smoking-caused diseases result in $96 billion in health care costs annually.
Some states have significantly improved the health of their citizens by reducing smoking rates, thereby decreasing smoking-related diseases, deaths, and health care costs. Even in economically challenging times, states can make a significant difference in public health by employing high-impact, cost-effective tobacco control and prevention strategies to—

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn people about the dangers of tobacco

Enforce bans on tobacco advertising, promotion, and sponsorship

Raise state cigarette taxes on tobacco

Tobacco Control State Highlights 2010 guides states in developing and implementing high-impact strategies and assessing their performance. This report also provides state-specific data intended to—

Highlight how some states are making great strides in reducing smoking rates using evidence-based strategies while also showing that more work needs to be done in other states

Enable readers to see how their own states perform

Help policymakers with decision making"

See more at:
http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2010/index.htm

Improving Access to Language Services in Health Care: A Look at National and State Efforts (Policy Brief)

2010-04-19T11:52:00.000-07:00

(April 9, 2009 by Melanie Au, Erin Fries Taylor, Marsha Gold)

Interest in providing access to language services in health care has increased in the past several years. This is particularly evident in recent state legislation that emphasizes health plan responsibility in promoting language services. This brief assesses emerging national efforts and profiles work in three leading states—California, Minnesota, and New York—to highlight challenges, successes, and implications for future policy and activities related to language services. The experiences of these states impart lessons to others looking to provide language services and ultimately improve health care for patients with limited English proficiency.

"More than 23 million Americans have limited English proficiency (LEP), which complicates their ability to obtain quality health care (Youdelman 2008; Flores et al. 2008). Language barriers in the health care setting can lead to problems such as delay or denial of services, issues with medication management, and underutilization of preventive services (Green et al. 2005; Jacobs et al. 2004; Gandhi et al. 2000). Difficulty in communication also may limit clinicians’ ability to understand patient symptoms and effectively provide treatment (Karliner et al. 2004).

Moreover, existing research suggests the quality of communication between patients and providers is strongly associated with providers’ ability to deliver better and safer care for LEP patients (Ponce et al. 2006). Language services, such as translation and interpretation, can facilitate this communication and thus improve health care quality, the patient experience, adherence to recommended care, and ultimately health outcomes (Flores 2005; Jacobs et al. 2006; Karliner et al. 2007)."

Read the rest here: http://www.ahrq.gov/populations/languageservicesbr.pdf

Resource: Culture Clues™ UW Med Center for Patient and Family Education Services

2010-04-14T13:59:00.000-07:00

Culture Clues™ are tip sheets for clinicians, designed to increase awareness about concepts and preferences of patients from the diverse cultures served by University of Washington Medical Center.
http://depts.washington.edu/pfes/CultureClues.htm

Resource: Ethnomed

2010-04-14T13:38:00.000-07:00

"EthnoMed contains information about cultural beliefs, medical issues and related topics pertinent to the health care of immigrants to Seattle or the US, many of whom are refugees fleeing war-torn parts of the world."

http://ethnomed.org/

Job Insecurity and Health: A Study of 16 European Countries

2010-03-19T11:53:00.000-07:00

Krisztina D. László, Hynek Pikhart, Mária S. Kopp, Martin Bobak, Andrzej Pajak, Sofia Malyutina, Gyöngyvér Salavecz and Michael Marmot

Abstract
Although the number of insecure jobs has increased considerably over the recent decades, relatively little is known about the health consequences of job insecurity, their international pattern, and factors that may modify them. In this paper, we investigated the association between job insecurity and self-rated health, and whether the relationship differs by country or individual-level characteristics. Cross-sectional data from 3 population-based studies on job insecurity, self-rated health, demographic, socioeconomic, work-related and behavioral factors and lifetime chronic diseases in 23,245 working subjects aged 45–70 years from 16 European countries were analyzed using logistic regression and meta-analysis. In fully adjusted models, job insecurity was significantly associated with an increased risk of poor health in the Czech Republic, Denmark, Germany, Greece, Hungary, Israel, the Netherlands, Poland and Russia, with odds ratios ranging between 1.3 and 2.0. Similar, but not significant, associations were observed in Austria, France, Italy, Spain and Switzerland. We found no effect of job insecurity in Belgium and Sweden. In the pooled data, the odds ratio of poor health by job insecurity was 1.39. The association between job insecurity and health did not differ significantly by age, sex, education, and marital status. Persons with insecure jobs were at an increased risk of poor health in most of the countries included in the analysis. Given these results and trends towards increasing frequency of insecure jobs, attention needs to be paid to the public health consequences of job insecurity.

The entire article can be purchased at: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBF-4Y40THB-3&_user=10&_coverDate=01%2F08%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=07eec1d4e80488296825b9467c07b7e4

TEDx Seattle

2010-03-16T13:30:00.000-07:00

Convening Community Through Social Technologies:
Stories from Puget Sound to Cape Town

April 16, 2010
8 a.m. to 5 p.m. (Agenda to be determined)
Pacific Science Center

This regional TEDx event will bring together great minds in creativity, scholarship, and entrepreneurship to discuss the possibilities and prospects of social development enhanced through information technologies. Inspiring projects and innovative leaders from Seattle to Cape Town will be showcased in this day-long conference.

TEDx Seattle is organized by the Master of Communication in Digital Media program at the University of Washington

http://tedxseattle.com/

Black:White Disparities in the United States and Chicago: A 15-Year Progress Analysis

2010-03-04T16:41:00.000-08:00

Jennifer M. Orsi, MPH, Helen Margellos-Anast, MPH, and Steven Whitman, PhD

Abstract

Objectives: In an effort to examine national and Chicago, Illinois, progress in meeting the Healthy People 2010 goal of eliminating health disparities, we examined whether disparities between non-Hispanic Black and non-Hispanic White persons widened, narrowed, or stayed the same between 1990 and 2005.

Methods: We examined 15 health status indicators. We determined whether a disparity widened, narrowed, or remained unchanged between 1990 and 2005 by examining the percentage difference in rates between non-Hispanic Black and non-Hispanic White populations at both time points and at each location. We calculated P values to determine whether changes in percentage difference over time were statistically significant.

Results: Disparities between non-Hispanic Black and non-Hispanic White populations widened for 6 of 15 health status indicators examined for the United States (5 significantly), whereas in Chicago the majority of disparities widened (11 of 15, 5 significantly).

Conclusions: Overall, progress toward meeting the Healthy People 2010 goal of eliminating health disparities in the United States and in Chicago remains bleak. With more than 15 years of time and effort spent at the national and local level to reduce disparities, the impact remains negligible. (Am J Public Health. Published online ahead of print December 17, 2009: e1–e8. doi:10.2105/AJPH.2009.165407)

Read the entire article at: http://www.suhichicago.org/files/publications/AJPH.2009.165407v1.pdf

Articles on Racism and Birth Outcomes Disparities

2010-03-04T16:33:00.000-08:00

Dominguez, TP, Strong, EM, Gillman, MW, Krieger, N, Rich-Edwards, JW (2009). Differences in the self-reported racism experiences of US-born and foreign-born Black pregnant women. Social Science & Medicine, 69, 258-265.
Abstract: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBF-4W40WRJ-1&_user=582538&_coverDate=07%2F31%2F2009&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1233835187&_rerunOrigin=scholar.google&_acct=C000029718&_version=1&_urlVersion=0&_userid=582538&md5=497c9664de234caecd8da67ff74604cb

Dominguez, TP (2008). Race, racism, and racial disparities in adverse birth outcomes [Special issue: Societal Factors in Pregnancy: Why Worry?]. Clinical Obstetrics and Gynecology, 51, 360-370.
Abstract: http://journals.lww.com/clinicalobgyn/Abstract/2008/06000/Race,_Racism,_and_Racial_Disparities_in_Adverse.19.aspx

Dominguez, TP, Dunkel Schetter, C, Glynn, L, Sandman, C, & Hobel, C (2008). Racial differences in birth outcomes: The role of general, pregnancy, and racism stress. Health Psychology, 27, 194-203.
Abstract: http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=2008-03424-008&CFID=6656129&CFTOKEN=73853457

Global Health Justice

2010-02-22T11:23:00.000-08:00

Jennifer Prah Ruger, Yale University

PUBLIC HEALTH ETHICS VOLUME 2 • NUMBER 3 • 2009 • 261–275

“What are the respective roles and responsibilities of global, national, and local communities as well as individuals themselves to address health deprivations and avert health threats? This article offers the beginnings of a theory of global health justice, arguing for universal ethical norms (general duty) with shared global and domestic responsibility (specific duties) for health. It offers a global minimalist view I call ‘provincial globalism’ as a mean between nationalism and cosmopolitanism, in which a provincial consensus must accompany a global consensus on health morality. This minimalist account asserts global and national duties to promote human flourishing and, more specifically, individuals’ central health capabilities. In this view, justice requires prioritizing responsibilities through shared health governance to reduce shortfall inequalities in central health capabilities - a general duty to reduce premature mortality and escapable morbidity. It examines the difficulties presented by the philosophical principles of connectedness, causality, remediation, partiality, and capacity in the allocation of responsibility for global health. It offers a theory of responsibility allocation based on a functional, health agency centered and homeostatic balanced understanding of the analytical components required to solve global health problems and parcels out roles and responsibilities at the global, national, local, and individual levels accordingly. Allocations of responsibility rest on the effectiveness and special obligations of different actors, respecting self-determination by groups and individuals and seeking voluntary commitments. This view understands that the remedy for global health problems must be sustainable to take nations and the global health community to a new global health equilibrium that remedies current problems and prepares for new health threats to come.”

Available online at: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1502810

Also in the same Volume are:
Special symposium on Justice and the Social Determinants of Health

Website: http://bit.ly/5momXc

James Wilson
Justice and the Social Determinants of Health: An Overview

Jonathan Wolff
Disadvantage, Risk and the Social Determinants of Health

Sridhar Venkatapuram
A Bird's Eye View. Two Topics at the Intersection of Social Determinants of Health and Social Justice Philosophy

Daniel M. Hausman
Benevolence, Justice, Well-Being and the Health Gradient

Gopal Sreenivasan
Ethics and Epidemiology: Residual Health Inequalities

Norah Mulvaney-Day and Catherine A. Womack
Obesity, Identity and Community: Leveraging Social Networks for Behavior Change in Public Health

Jennifer Prah Ruger
Global Health Justice

Christopher Lowry and Udo Schüklenk
Two Models in Global Health Ethics

Stephen Holland
Public Health Paternalism—A Response to Nys

Thomas Nys
Public Health Paternalism: Continuing the Dialogue

PAHO/WHO Online Course on Social Determinants of Health

2010-02-22T11:14:00.000-08:00

The course consists of an online tutorial with four learning units that make connections between health, and equity, social justice and human rights. The purpose of the Introductory Module is to raise awareness of and provide insight into the Social Determinants of Health (SDH) in order to reduce health inequities, encourage changes in the political agenda and contribute to a better administration of social justice and enforcement of human rights. The module is mainly targeted at WHO/PAHO staff members as well as Health Ministries’ officials in all countries who are engaged in designing action programs, policies and plans for SDH, but is free to access and fully available to the public.

For information go to: http://www.who.int/social_determinants/tools/en/

URL for online course: http://dds-dispositivoglobal.ops.org.ar/curso/

*Available in English and Spanish. A Portuguese version also will be available online soon.

Racism and Immigrant Health

2010-02-16T10:54:00.000-08:00

This policy brief presents evidence of the major health and health access inequities that exist for racialized people in Canada and elsewhere, and, for racism as a determinant of health. The brief also offers policy and research actions needed to address racism and reduce health inequities.
To read the complete brief, go to: http://canada.metropolis.net/pdfs/racism_policy_brief_e.pdf
Metropolis site: http://canada.metropolis.net/

Equality and Health

2010-02-16T10:50:00.000-08:00

The website http://www.equalitytrust.org.uk/ has compiled evidence on the effects of inequality in various domains of health. The website also provides remedies for greater equality, and links to educational resources.

Chimamanda Adichie: The danger of a single story

2010-01-28T12:05:00.000-08:00

http://www.ted.com/talks/chimamanda_adichie_the_danger_of_a_single_story.html

Public Availability of the Health Disparities Calculator

2010-01-07T11:19:00.000-08:00

“The Health Disparities Calculator (HD*Calc) is a statistical software designed to generate multiple summary measures to evaluate and monitor health disparities (HD). HD*Calc was created as an extension of SEER*Stat that allows the user to import SEER Data or other population based health data such as National Health Interview Survey, California Health Interview Survey, Tobacco Use Supplement to the Current Population Survey, and National Health and Nutrition Examination Survey.
Several of the measures included in HD*Calc are not commonly used to evaluate cancer-related health disparities. An important function of HD*Calc is to facilitate use of a range of HD measures so that researchers can explore their utility in different situations.”
More info on the HD*Calc is available here: http://seer.cancer.gov/hdcalc/

Tackling the Wider Social Determinants of Health: Evidence from Systematic Reviews

2010-01-07T11:14:00.000-08:00

Bambra, C.,1 Gibson, M.,2 Sowden, A.,3 Wright K.,3 Whitehead, M.,4 Petticrew, M.5
1 Department of Geography, Durham University
2 MRC Social and Public Health Sciences Unit, Glasgow
3 Centre for Reviews and Dissemination, University of York
4 Division of Public Health, University of Liverpool
5 Public and Environment Health Research Unit, London School of Hygiene and Tropical Medicine

Abstract

Background: There is increasing pressure to tackle the wider social determinants of health, through the implementation of appropriate interventions. However, turning these demands for better evidence about interventions around the social determinants of health into action requires identifying what we already know and highlighting areas for further development.

Methods: Systematic review methodology was used to identify systematic reviews (from 2000-
2007, developed countries only) that described the health effects of any intervention based on the wider social determinants of health: water and sanitation, agriculture and food, access to health and social care services, unemployment and welfare, work conditions, housing and living environment, education, and transport.

Results: Thirty systematic reviews were identified. Generally, the effects of interventions on health inequalities were unclear. However, there is suggestive systematic review evidence that certain categories of intervention may impact positively on inequalities or on the health of specific disadvantaged groups, in particular interventions in the fields of housing and the work environment.

Conclusion: Intervention studies which address inequalities in health are a priority area for future public health research.

Full article can be accessed here: http://jech.bmj.com/content/early/2009/08/19/jech.2008.082743.full.pdf

Thank You for Your Service

2009-12-30T11:35:00.000-08:00

Thank You for Your Service
Caring for Our Troops

The Experiences of a Health Care Provider
From Santa Cruz to Alaska
By Diana Hull, ExDP alumnus

Working as a civilian Physician Assistant contractor for the Department of Defense is something I never really imagined myself doing. But when the opportunity came along, in need of a job and curious about the assignment, I applied. After many weeks of waiting for credentialing and security checks, my application is approved. As a primary care provider, my assignment is to work at Fort Lewis, in Washington state for 14 weeks during the summer of 2009. From there, I will go to Fort Wainwright, Alaska, for 6 weeks, to provide post-deployment assessments for soldiers returning from Iraq to the United States. I am to be away from my tranquil coast-side Santa Cruz home for nearly five months.

I arrive at Fort Lewis to begin work at Madigan Medical Center. With a patient population of nearly 33,00 people it is one of the largest military health centers in the U.S. Before I start seeing patients I must complete another round of credentialing, security checks and orientation; including a seemingly endless barrage of training in subjects like biological warfare, personnel recovery, security, human trafficking and suicide-risk awareness.

As I enter and orient myself to the military world, I realize that I am experiencing a unique culture. The enlisted are multi-racial and international Americans. I meet with American soldiers from all over the world– places like Tonga, Senegal and Puerto Rico¬– as well as from every state in America, particularly the south. Most are young and uneducated, many are coming from shattered lives and looking for security. Others have long proud family histories of military service and some are politically motivated. Regardless of where they come from or the reason they have joined, they share a commonality, their humanity.

I begin to learn the social structure and observe the system operatives. My tactical strategy is to learn the rules of engagement and grasp, as quickly as possible, the institutional knowledge I will need to function effectively as a health care provider in this new environment. I must also learn a new language– the language of acronyms: “get a PHA for the SRP at DCS in the BCTC, soldier, what is your MOS?...91whisky." Respect, mission and service to country are the operating values. The words, “Thank-you for your service”, are spoken like the mantra, “Namaste” in yoga class.

The world around me is a curious blend of military and civilian. Active duty military mix in a parallel working environment with non-military professionals. We don’t see many soldiers in Santa Cruz but they make up a large part of the population in the Pacific North West. The active duty enlisted are easy to recognize as they dress in combat fatigues at all times. This uniform remains a constant reminder that we are at war.

After 3 weeks of orientation, I am ready to work. I am confident in my medical skills. With two decades of experience, I can easily adapt to disparate working environments. However, productivity goals are expected and necessary to increase capacity. I must learn how the military health care system operates and learn to use an electronic medical record. Both pose daunting tasks. To achieve a 20 minute appointment goal I must divide my patient time skillfully: 7 minutes for a history, 3 minutes to perform an exam, 1 minutes to make my assessment, 4 minutes for health education and a treatment plan and 5 minutes to chart my notes in the electronic medical record. In a perfect world, that might work, but there are so many variables. And staying on time is important.

The military medical system provides socialized medicine to nearly 10 million Americans. Military enlistees, retirees and their families receive health care coverage paid for by the US tax payer. The Department of Defense has established TRICARE as the regionally managed organization that oversees health care delivery, access and payment for the Army, Navy and Air Force world wide. Though ability to pay does not hinder care, members still face the challenge of access to care that plagues the fee-for-service civilian health system. For the Military Health System (MHS), the limiting factor to access is not the numbers of uninsured; it is the lack of providers to meet the demand.

Primary care providers offer preventive medicine, take care of acute conditions and manage chronic disease while operating as the gatekeepers to specialists. However, the wait for an appointment with an assigned provider can take months. Studies have shown that the quality of care in the MHS parallels the quality of care in civilian systems. Yet in the MHS care is frequently disrupted when providers leave on missions, are deployed, retired or quit. Thus, patients find themselves frustrated by a lack of continuity and this fragmentation promotes the perception that quality care is lacking. The challenge that confronts the MHS is that there are not enough health care providers to meet demand. This results from a rapid turn over rate and frequent deployment cycles of military medical providers. Gaps in coverage are difficult to fill and result in delays to access that cause frustration for both the patients and the providers within the MHS.

The military’s response to this problem has included hiring civilian medical contractors to temporarily fill the gaps during deployment cycles. Civilian health care contractors augment military medical staff to provide primary care services in military clinics and perform pre and post-deployment health assessments for troops coming and going from Iraq and Afghanistan. Active duty soldiers receive extra medical resources at the troop medical clinics and at daily sick-call services. But full health care coverage and additional resources do not provide an adequate safety net for those with the greatest needs.

For the enlisted soldiers and their families, these needs are great. The uncertainty and stress of a soldier’s deployment is mirrored by partners and children. While the divorce rate among the enlisted is not well tracked and remains controversial, the pressure on families is apparent. I treated many young wives suffering depression associated with separation anxiety. Wives who could not bear the separation, take their children and return to families of origin during the 12-15 months their husbands are deployed. Others suffer alone. Over-utilization of the health care system often results from the insecurity and anxiety that drives young women to repeatedly seek unnecessary medical help. As in any civilian population, heavy users of the medical system often have a psychological or emotional need that can not be adequately addressed in a medical visit. For military families, the tremendous physical, mental and emotional stress from combat, long separations and readjustment to family life poses a challenge for the enlisted, their families and the entire military health care system.

As pressure builds seemingly random acts of violence erupt. A murder/suicide occurred on base at the PX at Fort Lewis this summer when a man shot his wife in the cafeteria, then turned the gun on himself. Violent acts such as these, likely result from a complexity of unrelated pressures. The stress of war and multiple deployments are certainly contributors, but as the military reaches and scrapes to build it’s volunteer army, the backgrounds of the enlisted may require a different quality of scrutinization. People enter the Military with a history. Violence and abuse along with psychological instability are endemic in American culture. But the Military is the only industry that distributes weapons and trains people to kill. As suicide and homicide rates escalate, all contributing factors must be scrutinized, including evaluating the system itself.

The army is attempting to better understand and to intervene to meet the needs of its soldier population. The DoD Center for Deployment Health Research-Post Deployment and Occupational Health Epidemiology conducts health studies to understand the behavioral needs of deployed soldiers. Risk behaviors, injury reduction, and exposure risks are assessed and behavioral interventions which include Post-deployment assessments, are being implemented. A DoD task force, which includes civilians, has recently been established in an attempt to study the problem of troop suicide and will report findings in the summer of 2010.

“Everyone Cares, Never Accept Defeat... Army Suicide Prevention”. Risk awareness billboards are posted prominently on base to encourage soldiers to seek help should they need it. All military personnel are required to complete suicide prevention training. Yet, the system is not fail-safe. In part, this is because the MHS is stretched beyond capacity as it strives to meet the demand for care. However, there are safety-net services for soldiers. Family support services help families struggling with deployment issues. Foster families are available for single soldiers. Education to decrease stigma and improve identification of post traumatic stress disorder (PTSD) is reinforced among the soldiers, officers, families and health care providers.

Yet, even with support, challenges exist in getting help when and where it is needed. The effects of recurring PTSD are likely to be minimized by the soldier and overlooked by providers. For soldiers, symptoms of depression and anxiety can look like weakness. Soldiers are being prepared to fight a war and they do not want to be perceived as weak. As a result, symptoms of depression, anxiety and PTSD often remain hidden and untreated, until they become unbearable and can result in violence.

The army core values instruct soldiers to put the welfare of the nation, the army and subordinates before their own. Selfless-service, loyalty and duty are a part of these core values. With soldiers doing 3-4 deployments symptoms of depression, anxiety and PTSD frequently co-exist and can amplify, while remaining undetected. This problem is likely to grow as thousands of troops move from Iraq into Afghanistan.

It is mid-August and I have arrived in Fairbanks, ahead of the soldiers. The small frontier town is quiet, for the time being. A battalion of 4,700 soldiers are to return from 12 months of deployment in Iraq– infantry-men, airborne, fire command, mortar gunners, officers, medics, cooks, engineers, mechanics and Generals¬–will fly in by plane loads over a 6 week period. Upon landing, the first adjustment this Battalion confronts is a 100 degree climate change as the temperature plummets from 130 degrees in Iraq to 30 degrees in Fairbanks. To breathe fresh air again and to see green trees after facing suffocating sand storms, unbearable heat and noxious fumes from the burning trash pits, is a relief. The arriving soldiers welcome the two days of leave they are granted before they must, yet again, don their combat fatigues, leave their families and join their company to complete a mandatory post-deployment health assessment.

As a health care provider, I am a part of a medical team that includes eight midlevel health care providers and one doctor along with several social workers and behavioral health specialists. The soldiers are processed as they return by companies from Iraq. This team can screen nearly 400 soldiers daily. The health care providers review an electronic health questionnaire each soldier fills out via PDA while still in Iraq, a take a focused medical history and assess behavior health risk. The questionnaires collect data that will be used for research and give soldiers an opportunity to report and record injuries and trauma sustained while on duty. Exposures to toxic substances, symptoms of traumatic brain injury, post traumatic stress disorder and behavioral health risks for alcohol abuse and mood-disorders are assessed via this primary screening. Providers use the electronic medical record to make referrals to medical and mental health specialists and to access medical records that were recorded during previous deployments worldwide. Following the medical assessment, the Behavior Health Specialists play an important role in providing a secondary mental health screening. They also offer the Providers a referral source for immediate mental health support, if indicated.

All providers on the team are alert for the unstable soldier who is at risk for causing harm to himself or to others. Yet, tragedies will happen, as our team encountered when a soldier from the Battalion died by his own hand within two days of returning from Iraq. He had not yet completed his post-deployment assessment and it will never be known if screening might have identified him as a risk and prevented his death.

An enhanced post-deployment health assessment program was established nearly four years ago as an outcome of military deployment studies demonstrating that deployment related health problems for soldiers evolve over time. The physical and mental stress soldiers endure may not be apparent during the immediate post-deployment period but will often emerge three to six months later.

A young soldier met his 7 month old child for the first time 3 days ago. He states that his wife, also military, is angry at him- angry that he was not permitted to be present for the birth. He is sad, and worries about their marriage. They have registered for a marriage retreat offered through the military chaplain services.

Bringing soldiers in for assessment offers continuity by reuniting soldiers with their company and providing an opportunity for support. During the post-deployment assessment, soldiers meet individually with health care providers who are trained to ask questions that focus on behavioral needs. Providers establish empathy with soldiers and encourage them to express concerns so that those who need help can be identified.

Army statistics demonstrate a steady increase in the number of suicides of enlisted white males under the age of 25. These numbers have increased over the past six years with a sharp upward spike that began in 2006, and continues to rise. While there is no simple solution to this problem, the answer, at least in part, may lie in the realm of the obvious. Many of the soldiers I interviewed struggled with overwhelming feelings of isolation, depression and boredom during their deployment; yet most claimed that these symptoms lifted once they reunited with family and friends. All humans seek love, and meaningful connections with others is essential to well-being.

Upon completion of my assignments in Washington and Alaska, I return to the gentle tranquility of Santa Cruz, California. As I re-enter the provincial familiarity of my home environment I realize that, in the broad spectrum of the thousands of people I have met over the past five months, it is the unique characteristics and diverse qualities of individuals that builds the capacity of the United States military. My biggest learning during the summer of 2009 was to understand that the US military is far greater than the politics that encompass it, and as diverse as America Herself. In witnessing such diversity in a uniformed society, I gained a deeper respect for the complexities and contradictions inherent in military ethos. A struggle can exist between competing forces such as the harsh requirements of military endeavors with the sentient nature and human needs of individuals. But the remedy resides in greater understanding; for it is through compassion and acts of humanity that we will find ways to secure the well being of our soldiers and encourage peace in our society.

How can Gender Equity be addressed through Health Systems?

2009-12-18T12:05:00.000-08:00

Sarah Payne, School for Policy Studies, University of Bristol, United Kingdom

“Gender differences in health and in how well health systems and health care services meet the needs of women and men are well known: in Europe, there are variations in terms of life expectancy, the risk of mortality and morbidity, health behaviors and in the use of health care services. There is also increasing research evidence demonstrating the importance of a number of different social determinants of health, and these interact with gender inequalities in ways that can magnify the impact on health.
Additionally, there has also been an increasing recognition that health policy may exacerbate gender inequalities when it fails to address the needs of either men or women, and that health systems must address gender equity. This forms part of good stewardship, as well as meeting the needs of the populations served. Gender equity objectives have also been identified in position statements from WHO, the United Nations and the European Union (EU). For the purposes of this policy brief, the ‘policy problem’ is the way in which health systems might address gender equity in order to reduce the health gap between men and women and to improve efficiency. This document identifies some of the main approaches used to address gender equity in health systems, elaborating on three examples in order to suggest how these methods might be developed in the context of health policies across Europe.”
Read the full policy brief at: http://www.euro.who.int/document/E92846.pdf

Access: How do Good Health Technologies get to Poor People in Poor Countries?

2009-12-18T11:45:00.000-08:00

(image source and book site: http://www.accessbook.org/index.htm)

Laura J. Frost & Michael R. Reich, Harvard Center for Population and Development Studies

“Many people in developing countries lack access to health technologies, even basic ones. Why do these problems in access persist? What can be done to improve access to good health technologies, especially for poor people in poor countries? This book answers those questions by developing a comprehensive analytical framework for access and examining six case studies. Access to health technologies in poor countries is shaped by social, economic, political, and cultural processes. To understand those processes, the authors develop an analytic framework based on four A’s: Architecture, Availability, Affordability, and Adoption. The book applies this approach to explain why some health technologies achieved more access than others. The technologies include praziquantel (for the treatment of schistosomiasis), hepatitis B vaccine, malaria rapid diagnostic tests, vaccine vial monitors for temperature exposure, the Norplant implant contraceptive, and female condoms. The book is based on research studies commissioned by the Bill & Melinda Gates Foundation.

The entire book is available at: http://www.accessbook.org/download/AccessBook.pdf

Poverty, Equity, Human Rights and Health

2009-12-18T11:39:00.000-08:00

(Sources: http://www.familymedicine.medschool.ucsf.edu/csdh/ and http://www.hsph.harvard.edu/pihhr/)

Paula Braveman, Department of Family and Community Medicine and Center on Social Disparities in Health, University of California San Francisco

Sofia Gruskin, International Health and Human Rights Program, Francois Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health

Abstract

Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions’ work. Equity and human rights perspectives can contribute concretely to health institutions’ efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways:
(1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions;
(2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health;
(3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor;
(4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and
(5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector.

Read the entire article at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2572503/pdf/12973647.pdf

Moving from Them to Us: Challenges in Reframing Violence among Youth

2009-12-16T11:06:00.000-08:00

(image source)

Lori Dorfman, DrPH, Berkeley Media Studies Group Public Health Institute
Lawrence Wallack, DrPH, College of Urban and Public Affairs, Portland State University

“One national effort aimed at addressing the root causes of violence in cities across America is Urban Networks to Increase Thriving Youth (UNITY). The UNITY national consortium, supported by CDC and led by Prevention Institute, the Harvard School of Public Health, and the UCLA School of Public Health Southern California Injury Prevention Research Center, consists of more than 200 members from city government, national and state organizations, and community-based organizations across the country. UNITY helps institute policies and new practices that 1) prevent violence up front, before it happens, 2) intervene in the thick of it for families and neighborhoods already at risk, and 3) address the aftermath of violence to repair the trauma and help young people reenter society safely, successfully, and sustainably.

On behalf of UNITY, Prevention Institute asked BMSG to collect, summarize, and synthesize the work that has been done to date on framing youth and violence. This paper describes framing and the challenges particular to the context of violence prevention, with the goal of moving youth violence from being understood primarily as a criminal justice issue dealt with after the fact to being seen as a preventable public health issue. The paper explores how youth and violence have been portrayed in the news (based on BMSG’s as well as others’ studies); how the issue of race complicates depictions of youth and violence; and how public attitudes about government can inhibit public support for violence prevention. Based on this review, we make recommendations to the UNITY National Consortium for reframing violence among youth.

The paper begins with an overview of framing generally, followed by a discussion of how framing applies to news in particular and how youth, race, and crime have been portrayed in news coverage. It is important to consider how race and government are framed in addition to how violence is framed because youth violence is conflated with race and because the solutions to violence are dependent on government participation. The paper then considers challenges for reframing violence among youth in the light of how race and government are framed. Based on this review, and drawing from our experience working on and studying violence prevention and other public health issues, we make recommendations for next steps to UNITY and its partners...”

The link to the paper is: http://www.bmsg.org/pdfs/BMSGReframingViolenceRev.pdf

Workplace Safety and Health: Enhancing OSHA's Records Audit Process could Improve the Accuracy of Worker Injury and Illness Data

2009-12-14T10:43:00.000-08:00

(image source)
“Under the Occupational Safety and Health Act of 1970, the Department of Labor's (DOL) Occupational Safety and Health Administration (OSHA) is responsible for protecting the safety and health of the nation's workers. The act requires DOL to collect and compile work-related injury and illness data. GAO was asked to determine (1) whether DOL verifies that employers are accurately recording workers' injuries and illnesses and, if so, the adequacy of these efforts, and (2) what factors may affect the accuracy of employers' injury and illness records. GAO analyzed OSHA's audits of employers' injury and illness records, interviewed inspectors who conducted the audits, surveyed occupational safety and health practitioners, and obtained the views of various stakeholders regarding factors that may affect the accuracy of the data.

DOL verifies some of the workplace injury and illness data it collects from employers through OSHA's audits of employers' records, but these efforts may not be adequate. OSHA overlooks information from workers about injuries and illnesses because it does not routinely interview them as part of its records audits. OSHA annually audits the records of a representative sample of about 250 of the approximately 130,000 worksites in the high hazard industries it surveys to verify the accuracy of the data on injuries and illnesses recorded by employers. However, OSHA does not always require inspectors to interview workers about injuries and illnesses--the only source of data not provided by employers--which could assist them in evaluating the accuracy of the records. In addition, some OSHA inspectors reported they rarely learn about injuries and illnesses from workers since the records audits are conducted about 2 years after incidents are recorded. Moreover, many workers are no longer employed at the worksite and therefore cannot be interviewed. OSHA also does not review the accuracy of injury and illness records for worksites in eight high hazard industries because it has not updated the industry codes used to identify these industries since 2002. OSHA officials told GAO they have not updated the industry codes because it would require a regulatory change that is not currently an agency priority. The Bureau of Labor Statistics (BLS) also collects data on work-related injuries and illnesses recorded by employers through its annual Survey of Occupational Injuries and Illnesses (SOII), but it does not verify the accuracy of the data. Although BLS is not required to verify the accuracy of the SOII data, it has recognized several limitations in the data, such as its limited scope, and has taken or is planning several actions to improve the quality and completeness of the SOII...”
Full report (including recommendations) available at: http://www.gao.gov/new.items/d1010.pdf

Epidemiological Approaches to Health Disparities

2009-12-14T10:27:00.000-08:00

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The November 2009 issue of Epidemiological Review focuses on epidemiological approaches to health disparities. See Table of Contents below.

Epidemiologic ReviewVolume 31, Number 1, 1 November 2009
Sherman A. James
Epidemiologic Research on Health Disparities: Some Thoughts on History and Current Developments

Epidemiologic Reviews Advance Access published on October 11, 2009Epidemiol Rev 2009 31: 1-6; doi:10.1093/epirev/mxp010

Gina S. Lovasi, Malo A. Hutson, Monica Guerra, and Kathryn M. Neckerman
Built Environments and Obesity in Disadvantaged Populations
Epidemiologic Reviews Advance Access published on July 9, 2009
Epidemiol Rev 2009 31: 7-20; doi:10.1093/epirev/mxp005

Laura C. Senese, Nisha D. Almeida, Anne Kittler Fath, Brendan T. Smith, and Eric B. Loucks
Associations Between Childhood Socioeconomic Position and Adulthood Obesity
Epidemiologic Reviews Advance Access published on July 31, 2009
Epidemiol Rev 2009 31: 21-51; doi:10.1093/epirev/mxp006

Fiona McKenzie and Mona Jeffreys
Do Lifestyle or Social Factors Explain Ethnic/Racial Inequalities in Breast Cancer Survival?Epidemiologic Reviews Advance Access published on August 12, 2009
Epidemiol Rev 2009 31: 52-66; doi:10.1093/epirev/mxp007

Marie Lynn Miranda, Pamela Maxson, and Sharon Edwards
Environmental Contributions to Disparities in Pregnancy Outcomes
Epidemiologic Reviews Advance Access published on October 21, 2009
Epidemiol Rev 2009 31: 67-83; doi:10.1093/epirev/mxp011

Michael R. Kramer and Carol R. Hogue
What Causes Racial Disparities in Very Preterm Birth? A Biosocial Perspective
Epidemiologic Reviews Advance Access published on May 28, 2009
Epidemiol Rev 2009 31: 84-98; doi:10.1093/ajerev/mxp003

William A. Vega, Michael A. Rodriguez, and Elisabeth Gruskin
Health Disparities in the Latino Population
Epidemiologic Reviews Advance Access published on August 27, 2009
Epidemiol Rev 2009 31: 99-112; doi:10.1093/epirev/mxp008

Marjorie K. Mau, Ka'imi Sinclair, Erin P. Saito, Kau'i N. Baumhofer, and Joseph Keawe'aimoku Kaholokula
Cardiometabolic Health Disparities in Native Hawaiians and Other Pacific Islanders
Epidemiologic Reviews Advance Access published on June 16, 2009
Epidemiol Rev 2009 31: 113-129; doi:10.1093/ajerev/mxp004

Gilbert C. Gee, Annie Ro, Salma Shariff-Marco, and David Chae
Racial Discrimination and Health Among Asian Americans: Evidence, Assessment, and Directions for Future Research
Epidemiologic Reviews Advance Access published on October 4, 2009
Epidemiol Rev 2009 31: 130-151; doi:10.1093/epirev/mxp009

Jason Beckfield and Nancy Krieger
Epi + demos + cracy: Linking Political Systems and Priorities to the Magnitude of Health Inequities—Evidence, Gaps, and a Research Agenda
Epidemiologic Reviews Advance Access published on May 27, 2009
Epidemiol Rev 2009 31: 152-177; doi:10.1093/epirev/mxp002

Michael R. Kramer and Carol R. Hogue
Is Segregation Bad for Your Health?
Epidemiologic Reviews Advance Access published on May 23, 2009
Epidemiol Rev 2009 31: 178-194; doi:10.1093/epirev/mxp001

Healthy People 2020: The Road Ahead

2009-12-07T15:56:00.000-08:00

“Every 10 years, the U.S. Department of Health and Human Services (HHS) leverages scientific insights and lessons learned from the past decade, along with new knowledge of current data, trends, and innovations. Healthy People 2020 will reflect assessments of major risks to health and wellness, changing public health priorities, and emerging issues related to our nation's health preparedness and prevention.”
More information about Healthy People 2020 is available at the link below:http://www.healthypeople.gov/hp2020/

USDA’s Report on Household Food Security in the U.S. in 2008

2009-12-07T15:09:00.000-08:00

(from USDA.gov)

“Eighty-five percent of American households were food secure throughout the entire year in 2008, meaning that they had access at all times to enough food for an active, healthy life for all household members. The remaining households (14.6 percent) were food insecure at least some time during the year, including 5.7 percent with very low food security—meaning that the food intake of one or more household members was reduced and their eating patterns were disrupted at times during the year because the household lacked money and other resources for food. Prevalence rates of food insecurity and very low food security were up from 11.1 percent and 4.1 percent, respectively, in 2007, and were the highest recorded since 1995, when the first national food security survey was conducted. The typical food-secure household spent 31 percent more on food than the typical food-insecure household of the same size and household composition. Fifty-five percent of all food-insecure househ! olds participated in one or more of the three largest Federal food and nutrition assistance programs during the month prior to the 2008 survey.”

Access the full report at the link below: http://www.ers.usda.gov/Publications/ERR83/ERR83.pdf

OPEN COURSE: Winter 2010 - HSERV 561: Health Promotion Planning and Evaluation with Clarence Spigner

2009-11-25T15:40:00.000-08:00

Course Description:
Green & Krueter’s PRECEDE/PROCEED [Predisposing, Reinforcing, and Enabling Constructs in Educational (and Environmental) Diagnosis and Evaluation and Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development, respectively] model for health program planning and evaluation is employed as a conceptual framework in this three credit two-quarter course. The model incorporates phases 1 through 8 of Green & Krueter’s planning and evaluation procedures. Students employ the model in order to demonstrate theoretical and practical knowledge of how planning informs evaluation.

Continues through Spring 2010. Can be taken either as total distance or as partial distance (On site days for February 4th, 2010, and April 8th, 2010)

For more course information, instructor bio, and how to register:

http://depts.washington.edu/hsedp/courses/96

OPEN COURSE: WINTER 2010 - Global Health 545: Child Health in Developing Countries with Donna Denno

2009-11-25T15:34:00.001-08:00

Course Description:
This course provides an overview of the health problems of children in developing countries. The course will provide an understanding of the causes and effects of the most prominent child health problems. We will examine trends and progress in global child health and explore potential explanations for these trends—both positive and negative. We will learn about programmatic interventions, both prevention and treatment, currently being utilized to respond to global child health problems as well as some interventions being developed for future implementation. We will also examine health intervention delivery models, introduce methodology for measuring impact of programmatic interventions, and learn about some of the major groups involved in child health globally.

For more course info and how to register: http://depts.washington.edu/hsedp/courses/274

OPEN COURSE: HSERV 571 - Cultural Competency for Public Health Practice with Sharyne Thornton

2009-11-25T15:31:00.000-08:00

Course Description:
Application of cultural competency to clinical practice, health care management, and health services research when working with culturally diverse populations. Methodological orientation is qualitative, historical, and ethnographic. Lecture, narratives, discussions, guest presentations, film, video. Interdisciplinary perspective appropriate for graduate students in public health, health administration, nursing, social work, and anthropology.
Requires one day on site: Thursday February 4th, 2010

For more info about the course, instructor, and how to register:
http://depts.washington.edu/hsedp/courses/98

OPEN COURSE: WINTER 2010 - EPI 521 Epidemiology of Maternal and Child Health Problems with Marcia Williams

2009-11-25T15:20:00.000-08:00

Course Description:
The course focuses on three distinct periods of growth and development: prenatal, perinatal/neonatal, and childhood. Beyond a basic introduction to epidemiological issues associated with maternal and child health (MCH), two current themes of discussion and debate will be incorporated throughout the course. These are (1) the role of socio-economic factors in
determining the pregnancy and childhood outcomes of at-risk populations, and (2) understanding the relationship between racial/ethnic identity and disparities in maternal and child health.

Total distance course.

For more info: http://depts.washington.edu/hsedp/courses/170

Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement

2009-09-30T13:56:00.000-07:00

“Ensuring the delivery of high-quality, patient-centered care requires understanding the needs of the populations served. The nation’s health care data infrastructure does not provide the necessary level of detail to understand which groups are experiencing health care disparities or would benefit from targeted quality improvement efforts. Categories for collection and methods of aggregation for reporting race, ethnicity, and language data vary. Challenges to improving data quality include non-standardized categories, a lack of understanding of why data are collected, health information technology (HIT) limitations, and a lack of sufficiently descriptive response categories, among others. Throughout the course of this report, the subcommittee addresses these challenges as it recommends a standardized approach to eliciting race, ethnicity, and language data and defines a standard set of categories for these data.”
Read the report brief at: http://www.iom.edu/Object.File/Master/72/817/Race%20Ethnicity%20report%20brief%20FINAL%20for%20web.pdf
The full report can be accessed at: http://www.nap.edu/catalog.php?record_id=12696

Analysis of Social Determinants of Health and Health Inequities: A Multi-Country Event on Approaches and Policy

2009-09-30T13:47:00.000-07:00

Kosice, Slovakia 12-17 October 2009
Routine monitoring of health inequities and the social determinants of health are critical to improving population health and in reducing avoidable difference in health opportunities and risks. However, this area remains generally limited or marginal within health intelligence functions and mainstream policy practice.
The WHO Regional Office for Europe through its Office for Investment for Health and Development (WHO Venice Office) is organizing a multi-country event, in collaboration with the Faculty of Medicine of P.J. Safarik University and the Kosice Institute for Society and Health (KISH), focusing on applied research and policy analysis on social determinants of health and health inequities.
Aims
1. Provide a forum for policy-makers, planners and analysts specifically from countries of central and Eastern Europe (CCEE) the Baltic states and Balkans republics, to debate, test and apply know-how, tools and practical techniques to monitor and analyze social inequities in health. 2. Strengthen and guide existing capacity and intelligence in using evidence and analytical tools to advance national and sub-national strategies and targets to reduce social inequities in health.
Thematic areas include
Contemporary issues in the research and analysis of Social Determinants of Health and Health Inequities (SDHI) Explanatory frameworks for social inequities in health Health equity surveillance - data availability and equity stratifiers in routine statistics and reporting Approaches and methods in analysis of social determinants of health and health inequities. Ethnicity in research and policy Translation of research findings into policy and programs. Equity focused policy analyses and option generation Economic analyses and incentives for addressing social determinants of health. Public awareness of Social Inequities
Event website: http://www.lf.upjs.sk/omek/ http://www.euro.who.int/socialdeterminants/news/20090714_1

Health Reform Briefing: “Health Equity: A Moral and Economic Imperative!”

2009-09-28T11:19:00.000-07:00

On September 17, 2009, The Joint Center for Political and Economic Studies Health Policy Institute partnered with Drexel University School of Public Health’s Center for Health Equality and Health Management Associates to analyze major health reform legislation by assessing the implications for racial and ethnic minorities.
The Joint Center is also working with Johns Hopkins University Bloomberg School of Public Health’s Center for Health Disparities Solutions to weigh the economic benefits of addressing health disparities against the cost of programs to reduce them.
Participants Included:
The Honorable Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services
Ralph B. Everett, Esq., President and CEO, Joint Center for Political and Economic Studies
Brian D. Smedley, Ph.D., Vice President and Director, Health Policy Institute, Joint Center for Political and Economic Studies
Dennis P. Andrulis, Ph.D., MPH, Director, Center for Health Equality and Associate Dean of Research, Drexel University
Darrell Gaskins, Ph.D., Associate Professor of Health Economics, African American Studies Department,University of Maryland, College Park
Thomas A. LaVeist, Ph.D., Director of the Johns Hopkins University Bloomberg School of Public Health’s Center for Health Disparities Solutions
View the event webcast at following the link below:
http://www.jointcenter.org/hpi/events/health-reform-briefing-%E2%80%9Chealth-equity-moral-and-economic-imperative%E2%80%9D

Income, Poverty, and Health Insurance Coverage in the United States: 2008

2009-09-28T11:11:00.000-07:00

“This report presents data on income, poverty, and health insurance coverage in the United States based on information collected in the 2009 and earlier Annual Social and Economic Supplements (ASEC) to the Current Population Survey (CPS) conducted by the U.S. Census Bureau.
Data presented in this report indicate the following:
• Real median household income fell between 2007 and 2008, and the decline was widespread. Median income fell for family and nonfamily households, native- and foreign-born households, households in 3 of the 4 regions, and households of each race category and those of Hispanic origin.1 These declines in income coincide with the recession that started in December 2007.2
• The poverty rate increased between 2007 and 2008.
• The percentage of uninsured in 2008 was not statistically different from 2007, while the number of uninsured increased between 2007 and 2008.
These results, though widespread, were not uniform across groups. For example, between 2007 and 2008, real median income was statistically unchanged for households maintained by a person 65 years old and over but declined for households maintained by people of all other age group categories. Additionally, the poverty rate increased for children under 18 and for people 18 to 64 but remained statistically unchanged for people 65 and over; and the percentage of uninsured for non-Hispanic Whites, Asians, and Hispanics increased, while the percentage of uninsured for Blacks was not statistically diff erent.3
These results are discussed in more detail in the three main sections of this report—income, poverty, and health insurance coverage. Each section presents estimates by characteristics such as race, Hispanic origin, also derive economic well-being from noncash benefits, such as food stamps and housing subsidies, and they have reductions in disposable income due to taxes and increases in disposable income due to refundable tax credits. The official poverty thresholds were developed more than 40 years ago and have been criticized for not taking into account rising standards of living, expenses such as child care that are necessary to hold a job, variations in medical costs across population groups, and geographic differences in the cost of living.”
The full report can be accessed at:
http://www.census.gov/prod/2009pubs/p60-236.pdf
For additional information on the source of the data and accuracy of the estimates in the report, visit: http://www.census.gov/hhes/www/p60_236sa.pdf

Education Matters for Health

2009-09-28T11:04:00.000-07:00

“Education can influence health in many ways. An issue brief, prepared by the Robert Wood Johnson Foundation Commission to Build a Healthier America, examines three major interrelated pathways through which educational attainment is linked with health—health knowledge and behaviors; employment and income; and social and psychological factors, including sense of control, social standing and social support. In addition, this brief explores how educational attainment affects health across generations, examining the links between parents’ education—and the social and economic advantages it represents—and their children’s health and social advantages, including opportunities for educational attainment.”
Access the brief by following the link below:
http://www.rwjf.org/files/research/commission2009eduhealth.pdf

Understanding Health Inequalities

2009-09-28T10:59:00.000-07:00

(image source)
Understanding Health Inequalities
Graham H (ed).
2nd ed. Open University Press, 2009.

http://www.mcgraw-hill.co.uk/html/0335234593.html

“Understanding Health Inequalities second edition provides an accessible and engaging exploration of why the opportunity to live a long and healthy life remains profoundly unequal.

Hilary Graham and her contributors outline the enduring link between people’s socioeconomic circumstances and their health and tackle questions at the forefront of research and policy on health inequalities. These include:
* How health is influenced by circumstances across people's lives and by the areas in which they live
* How health is simultaneously shaped by inequalities of gender, ethnicity and socioeconomic position
* How policies can impact on health inequalities

All the chapters have been specially written for the new edition by internationally-recognized researchers in social and health inequalities. The book provides an authoritative guide to these fields as well as presenting new research.”

Book blurb:

"Thoroughly updated and revised, this new edition of Understanding Health Inequalities, edited by Hilary Graham, remains a welcome and timely contribution. Replete with thoughtful essays on health inequities analyzed in relation to societal structure, social position and geography ... the volume provides important insights into how class, racial/ethnic, gender, and spatial health inequities are produced - and how they can be rectified. The world economic crisis launched by the implosion of unregulated financial markets in the fall of 2008 only serves to underscore the volume's central conclusion: that government regulation and intervention, premised on a commitment to equity, is essential for tackling health inequalities. Health professionals, students, and any and all working for healthy and sustainable ways of living will benefit from this collection." Nancy Krieger, Harvard School of Public Health, USA

Contributors
Karl Atkin, Mel Bartley, G. David Batty, David Blane, Bo Burstrom, Danny Dorling, Anne Ellaway, Hilary Graham, Barbara Hanratty, Kate Hunt, Saffron Karlsen, Catherine Law, Sally Macintyre, James Nazroo, Naomi Rudoe, Bethan Thomas, Rachel Thomson, Margaret Whitehead

Towards the Elimination of Cancer Disparities

2009-09-10T16:09:00.000-07:00

Medical and Health Perspectives
Koh, Howard K. (Ed.)
2009, XII, 384 p. 28 illus., Hardcover
ISBN: 978-0-387-89442-3
Online version available

http://www.springer.com/biomed/cancer/book/978-0-387-89442-3


“The societal burden of cancer is one of the major public health challenges of our time, yet that burden is not equally shared by all. Troubling disparities have been documented not only by racial/ethnic group but also by social class, insurance status, geography, and a host of other factors. Furthermore, such disparities represent the end result of a constellation of forces stemming from both within the health care system and outside of it. Many currently existing cancer disparities are preventable.

To date, few publications capture the breadth and depth of the dimensions of cancer disparities from both the clinical and public health perspective. This volume broadens concepts of disparities beyond traditional race/ethnicity discussions to explore a more systematic analysis of how, where, and why disparities occur across the cancer continuum. We will also analyze the issue of social disparities with respect to certain major cancers, with emphasis on the particular role of socioeconomic position.

This volume reflects the work of a number of experts in cancer disparities, led by members of the Executive Committee of the Program-in-Development for the Dana Farber / Harvard Cancer Center. In particular, this volume updates and expands an earlier 2005 monograph on the topic published in the journal Cancer Causes and Control (Nancy Krieger PhD, Editor).

Written for:

Those working in the cancer, from basic researchers to clinicians, and public health professionals as well as the educated general public.”

Structural Interventions for addressing Chronic Health Problems

2009-09-10T16:00:00.000-07:00

Mitchell H. Katz.
JAMA. 2009;302(6):683-685.

The chronic health problems of obesity, diabetes, heart disease, and cancer commonly affect adults living in developed countries and are both difficult to treat and costly, leading experts to stress the importance of prevention.1 Elimination of the 3 behavioral risk factors of sedentary lifestyle, poor diet, and smoking would decrease mortality by 35%.2

But how do we get individuals to exercise more, eat better, and stop smoking?

Health education has been effective in diminishing these risk factors, especially smoking, but education alone is unlikely to bring further progress. In fact, it would be difficult to find a sedentary obese smoker who did not know that he should exercise more, eat less, and stop smoking.

Intensive one-to-one and group behavioral interventions have been demonstrated to increase activity, reduce obesity, and promote smoking cessation, but effects have been modest and difficult to maintain. Moreover, translating these findings into practice has been hampered by insufficient funding and difficulty reaching those persons in greatest need.

Structural interventions offer a complementary approach to improving health by focusing on changing the physical, social, and economic environment. The interventions are structural in that, unlike individualized interventions, persons do not enroll or even know that they are participating.

Structural interventions are not a new idea. The increase in longevity that occurred in the early 20th century was largely due to physical improvements in the environment (e.g., sewage treatment) and at work sites (e.g., safer equipment). Other successful structural interventions include seat belts in cars, road safety standards, elimination of toxins such as lead in paint and gasoline, and water fluoridation. What is new, and potentially more challenging, is the use of structural interventions for chronic diseases.

Full article available at: JAMA. 2009; 302(6):683-685.

Low Life Expectancy in the United States: Is the Health Care System at Fault?

2009-09-10T15:43:00.000-07:00

Samuel H. Preston, Jessica Y. Ho.
NBER Working Paper No. 15213. Issued in August 2009.

Abstract

Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.

Excerpts

...The health care system could be performing exceptionally well in identifying and administering treatment for various diseases, but a country could still have poor measured health if personal health care practices were unusually deleterious. This is not a remote possibility in the United States, which had the highest level of cigarette consumption per capita in the developed world over a 50-year period ending in the mid-80's (Forey et al. 2002). Smoking in early life has left an imprint on mortality patterns that remains visible as cohorts age (Preston and Wang 2006; Haldorsen and Grimsrud 1999). One recent study estimated that, if deaths attributable to smoking were eliminated, the ranking of US men in life expectancy at age 50 among 20 OECD 2 countries would improve from 14th to 9th, while US women would move from 18th to 7th (Preston, Glei, and Wilmoth 2009). Recent trends in obesity are also more adverse in the United States than in other developed countries (OECD 2008 ; Cutler, Glaeser, and Shapiro 2003)...

The fact that Canada had for many years the second highest consumption of cigarettes per adult (Forey et al. 2002) makes it appear that geographic factors, perhaps related to conditions for growing or importing tobacco, had more to do with consumption patterns than did health systems. And public health authorities were not passive in the US. The US Surgeon General's (1964) report on the health hazards of cigarette smoking was the first major indictment of the habit by a government authority and it was quickly followed up with a massive anti-smoking media campaign (Cutler and Glaeser 2006). The US had the largest reduction in manufactured cigarettes consumed per adult of any country between 1970 and 2000 (Forey et al. 2002). Some of that decline was likely attributable to public health efforts (Cutler and Glaeser 2006)...

Summary

We have demonstrated that mortality reductions from prostate cancer and breast cancer have been exceptionally rapid in the United States relative to a set of peer countries. We have argued that these unusually rapid declines are attributable to wider screening and more aggressive treatment of these diseases in the US. It appears that the US medical care system has worked effectively to reduce mortality from these important causes of death.

This conclusion is consistent with other evidence that we have reviewed on the performance of the US health care system: screening for other cancers also appears unusually extensive; 5-year survival rates from all of the major cancers are very favorable; survival rates following heart attack and stroke are also favorable (although one-year survival rates following stroke are not above average); the proportion of people with elevated blood pressure or cholesterol levels who are receiving medication is well above European standards.

These performance indicators pertain primarily to what happens after a disease has developed. It is possible that the US health care system performs poorly in preventing disease in the first place. Unfortunately, there are no satisfactory international comparisons of disease incidence. Individuals report a higher prevalence of cancer and cardiovascular disease in the United States than in Europe, and biomarkers confirm the higher prevalence of many disease syndromes in the US compared to England and Wales. Higher disease prevalence is prima facie evidence of higher disease incidence, although it could also be produced by better identification (e.g., through screening programs) or better survival. The history of exceptionally heavy smoking in the US, and the more recent massive increase in obesity, suggest that a high disease incidence in the US could not be laid entirely at the feet of the health care system.

Evidence that the major diseases are effectively diagnosed and treated in the US does not mean that there may not be great inefficiencies in the US health care system. A list of prominent charges include fragmentation, duplication, inaccessibility of records, the practice of defensive medicine, misalignment of physician and patient incentives, limitations of access for a large fraction of the population, and excessively fast adoption of unproven technologies (Garber and Skinner, 2008; Cebul et al. 2008; Commonwealth Fund 2008). Some of these inefficiencies have been identified by comparing performance across regions of the United States. Of course, the fact that certain regions do poorly relative to others does not imply that the US does poorly relative to other countries. And many of the documented inefficiencies of the US health care system add to its costs rather than harm patients.

Just as we are not addressing issues of efficiency on the production side, we are not treating patient welfare as the main outcome. Practices that produce greater longevity do not necessarily enhance well-being. This potential disparity is central to the controversy involving PSA testing, which uncovers many cancers that would never kill patients but whose treatment often produces adverse side effects.

The question that we have posed is much simpler: does a poor performance by the US health care system account for the low international ranking of longevity in the US? Our answer is, "no".

Full paper can be purchased at the following link:
http://papers.nber.org/papers/w15213

Population and Health Policies

2009-09-09T11:24:00.000-07:00

T. Paul Schultz
Yale University
“…….The program evaluation literature for population and health policies is in flux, with many disciplines documenting biological and behavioral linkages from fetal development to late life mortality, chronic disease, and disability, though their implications for policy remain uncertain. Both macro and micro economics seek to understand and incorporate connections between economic development and the demographic transition.
The focus here is on research methods, findings, and questions that economists can clarify regarding the causal relationships between economic development, health outcomes, and reproductive behavior, which operate in many directions, posing problems for identifying causal pathways. The connection between conditions under which people live and their expected lifespan and health status refers to “health production functions”.
The relationships between an individual’s stock of health and productivity, well being, and duration of life encompasses the “returns to health human capital”. The control of reproduction improves directly the well being of women, and the economic opportunities of her offspring. The choice of population policies may be country specific and conditional on institutional setting, even though many advances in biomedical and public health knowledge, including modern methods of birth control, are now widely available.
Evaluation of a policy intervention in terms of cost-effectiveness is typically more than a question of technological efficiency, but also the motivation for adoption, and the behavioral responsiveness to the intervention of individuals, families, networks, and communities. Well-specified research strategies are required to address
(1) the economic production of health capacities from conception to old age,
(2) the wage returns to increasing health status attributable to policy interventions,
(3) the conditions affecting fertility, family time allocation, and human capital investments, and
(4) the consequences for women and their families of policies which change the timing as well as number of births………”
Read the full article at: http://www.econ.yale.edu/growth_pdf/cdp974.pdf

The Effect of Economic Recession on Population Health

2009-09-09T11:07:00.000-07:00

Economic recessions have paradoxical effects on the mortality trends of populations in rich countries. Contrary to what might have been expected, economic downturns during the 20th century were associated with declines in mortality rates. In terms of business cycles, mortality is procyclical, meaning it goes up with economic expansions and down with contractions, and not countercyclical (the opposite), as expected. So while most nations enjoyed sustained declines in mortality during the last century, the pace of the decline has been slower during economic booms and greater during so-called busts. The first rigorous studies demonstrating this trend have appeared only in the past 9 years, although the concept is not new. In contrast, for poor countries, shared economic growth appears to improve health by providing the means to meet essential needs such as food, clean water and shelter, as well access to basic health care services. But after a country reaches $5000 to $10 000 gross national product (GNP) per capita (or gross domestic product or gross national income per capita, all of which are similar for our purposes here), few health benefits arise from further economic growth.

The full article can be accessed at:
http://www.cmaj.ca/cgi/reprint/181/5/281

Also see media (European Time Magazine) report on the article at: http://www.time.com/time/health/article/0,8599,1919447,00.html

Mapping for Health Advocates

2009-09-09T10:54:00.000-07:00

“The Opportunity Agenda, with support from the Health Policy Institute at the Joint Center for Political and Economic Studies, commissioned a series of papers examining the effectiveness of web based mapping, and the role it can play in promoting health equity. Offering scholarly, practical, technical, and historical perspectives on the usefulness of mapping, health advocates can deepen their understanding of this powerful and persuasive tool.

In each report, case studies and best practices are presented. Looking across disciplines and at a wide range of social justice issues, advocates learn how maps can break down the complex data and research, developing visual aids that uncover the structural and social barriers that stand in the way of opportunity.

Since John Snow first published his map identifying the source of London's 1853 cholera epidemic, health advocates have been using maps to tell their story in a new and persuasive way. Advances with geographic information systems (GIS) have allowed developers to pull information from a large data set. This frees an unimaginable wealth of information right at their fingertips. Fuse this with the rise of engaging new and social media on the Internet, and the power to advocate effectively increases exponentially.

Interactive and GIS mapping holds many great benefits. At the core is room for organizations to work and collaborate together. Once the basic technical and data rich infrastructure has been set in place, the only thing left is the imagination.

Pulling from their own expertise, the authors in this volume present best practices and address the technical issues that need to be overcome in making these tools become even more widely used. Demand is a driving force in shaping how technology is used, and what tools will withstand the test of time. It is for this reason that we hope the reports found on this page will best familiarize you with this engaging technology, and provide you with the knowledge and desire that collectively can help us break down the barriers to health inequity in our country.”

The full report can be downloaded at:
http://opportunityagenda.org/mapping

Local Government Actions to prevent Childhood Obesity

2009-09-09T10:47:00.000-07:00

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“In the United States, 16.3 percent of children and adolescents between the ages of two and 19 are obese. The prevalence of obesity is so high that it may reduce the life expectancy of today’s generation of children and diminish the overall quality of their lives. While parents and other adult caregivers play a fundamental role in teaching children about healthy behaviors, those positive efforts can be undermined by local environments that are poorly suited to supporting healthy behaviors—and may even promote unhealthy behaviors. Local governments can play a crucial role in creating environments that make it easier for children to eat healthy diets and move more.

The Institute of Medicine’s Committee on Childhood Obesity Prevention Actions for Local Governments was convened to identify promising actions that local governments can take to curb obesity among children. The committee sought action steps that are within the jurisdiction of local governments; likely to directly affect children; based on the experience of local governments or sources that work with local governments; take place outside of the school day; and have the potential to promote healthy eating and adequate physical activity. The 2009 report Local Government Actions to Prevent Childhood Obesity presents the committee’s menu of recommended action steps for local government officials to consider in their efforts to prevent childhood obesity in their community.”

View full report brief at:
http://www.iom.edu/Object.File/Master/72/800/local%20govts%20obesity%20report%20brief%20FINAL%20for%20web.pdf

The Good Doctors: The Medical Committee for Human Rights and the Struggle for Social Justice in Health Care

2009-07-24T10:51:00.000-07:00

New York: Bloomsbury Press
This new book is by John Dittmer, one of the prize-winning historians of the civil rights movement.
From the back-cover descriptions:
"The good doctors of John Dittmer's history of the Medical Committee for Human rights labored at the crossroads of American medicine and American racism...the story of health workers confronting a system hard-wired to deliver second-class medicine to people of color... an important, dramatic, and timely contribution to our understanding of racism in medicine and health equity in America."
"The Good Doctors is a shocking reminder of how recently Jim Crow reigned over medical care in America....Dittmer tells the story of the courageous few in the medical profession who fought racial injustice and went on to many other battles...Freedom Summer, Selma, the antiwar movement, Alcatraz, Wounded Knee--they're all here...a turbulent and inspiring time that speaks forcefully to our own."
"The Good Doctors" is a triumph of passionate scholarship and balanced judgment."
A Doctor in Little Lhasa: One Year in Dharamsala with the Tibetans in Exile
By Timothy H. Holtz, M.D.
A young public health doctor's year-long experience in northern India providing community health care for a Tibetan community living in exile leads to life lessons in compassion, generosity, and the inseparable connection between health and human rights.
Following his formal medical training, where he encountered the health problems of refugees who had fled their countries human rights abuses, Holtz lives for a year in Dharamsala, the Peaceful Resting Place, home of the Dalai Lama in northern India. A Doctor in Little Lhasa recounts Holtz’s experiences working in the modest hospital that serves the Tibetan refugee and local populations. Working alongside other volunteer colleagues, Holtz’s journey leads to the joy and anxiety of delivering babies by candlelight, the sorrow of tending to dying children who have suffered terrible falls, and the challenges and rewards of delivering preventive health messages to newly arriving refugees from Tibet who have suffered innumerable human rights violations.
At one point, he must try to stop a dangerous outbreak of diphtheria from spreading, with no vaccines on hand. Sometimes he could only watch in frustration as patients died of diseases, such as drug-resistant tuberculosis, that could have been treated in an economically developed country. Holtz witnesses the depression, anxiety, and posttraumatic stress disorder borne of torture and mistreatment endured before fleeing Tibet. By documenting and publicizing the mental health needs of a group of Tibetan nuns who had been tortured in Tibet, he ensures that they will receive adequate care in the future. And he learns some sobering and important lessons as a physician, that addressing the underlying structural causes of suffering is necessary in the quest for social justice and the improvement of public health.
Since 1962, Dharamsala has been the official site of the Tibetan Government-in-Exile and home to the Dalai Lama. The Tibetan-run, donor-supported facility where Holtz worked has only the most basic equipment and resources, yet it serves a community in excess of 15,000 people. A Doctor in Little Lhasa also touches on the contemporary history of Tibet, as well as its people and culture. Tibetans have suffered persecution from the Chinese Government for more than 50 years, forcing thousands into exile across the Himalayan Mountains with little more than the clothes on their back.
“Required reading for students searching for a connection between medical training and social justice. Students and practitioners alike will find this book inspiring”. -- Paul Farmer, Presley Professor, Harvard Medical School
----------
A Doctor in Little Lhasa: One Year in Dharamsala with the Tibetans in Exile
Timothy H. Holtz, M.D.
Dog Ear Publishing
ISBN: 978-159858-883-5
232 pages, pictures
Available at: http://www.timothyholtzbooks.com/
Available at Ingram, Baker & Taylor, Amazon.com, and Barnes & Noble

The U.S. Government’s Global Health Policy Architecture: Structure, Programs and Funding

2009-07-24T10:48:00.000-07:00

This report provides the first comprehensive look at the U.S. government agencies and programs involved in the nation’s global health response, including their funding and their approaches. Federal funding for such initiatives reached $9.6 billion in fiscal year 2008, more than double the amount just four years earlier.
The report also provides overviews of the large-scale global health initiatives of the U.S. government, information on which countries receive support from the U.S., and a review of the key laws governing U.S. global health policy and relevant Congressional committees.

Executive summary: http://www.kff.org/globalhealth/upload/7881_ES.pdf
Full report: http://www.kff.org/globalhealth/upload/7881.pdf

Poverty-alleviation program participation and salivary cortisol in very low-income children

2009-07-24T10:41:00.000-07:00

Social Science & Medicine. 68(12):2180-2189. 2009.
Lia C.H. Fernald, Megan R. Gunnar.
Abstract

Correlational studies have shown associations between social class and salivary cortisol suggestive of a causal link between childhood poverty and activity of the stress-sensitive hypothalamic–pituitary–adrenocortical (HPA) system. Using a quasi-experimental design, we evaluated the associations between a family's participation in a large-scale, conditional cash
transfer program in Mexico (Oportunidades, formerly Progresa) during the child's early years of life and children's salivary cortisol (baseline and responsivity). We also examined whether maternal depressive symptoms moderated the effect of program participation. Low-income households (income <20th percentile nationally) from rural Mexico were enrolled in a large-scale poverty-alleviation program between 1998 and 1999. A comparison group of households from demographically similar communities was recruited in 2003. Following 3.5 years of participation in the Oportunidades program, three saliva samples were obtained from children aged 2–6 years from intervention and comparison households (n = 1197). Maternal depressive symptoms were obtained using the Center for Epidemiologic Studies-Depression Scale (CES-D). Results were that children who had been in the Oportunidades program had lower salivary cortisol levels when compared with those who had not participated in the program, while controlling for a wide range of individual-, household- and community-level variables. Reactivity patterns of salivary cortisol did not differ between intervention and comparison children. Maternal depression moderated the association between Oportunidades program participation and baseline salivary cortisol in children. Specifically, there was a large and significant Oportunidades program effect of lowering cortisol in children of mothers with high depressive symptoms but not in children of mothers with low depressive symptomatology. These findings provide the strongest evidence to date that the economic circumstances of a family can influence a child's developing stress system and provide a mechanism through which poverty early in life could alter life-course risk for physical and mental health disorders.

Click here for full article.

Epi + demos + cracy: Linking Political Systems and Priorities to the Magnitude of Health Inequities--Evidence, Gaps, and a Research Agenda

2009-07-14T08:00:00.000-07:00

By Jason Beckfield; Nancy Krieger
Epidemiologic Reviews 2009; doi: 10.1093/epirev/mxp002
A new focus within both social epidemiology and political sociology investigates how political systems and priorities shape health inequities. To advance—and better integrate—research on political determinants of health inequities, the authors conducted a systematic search of the ISI Web of Knowledge and PubMed databases and identified 45 studies, commencing in 1992, that explicitly and empirically tested, in relation to an a priori political hypothesis, for either
1) changes in the magnitude of health inequities or
2) significant cross-national differences in the magnitude of health inequities.

Overall, 84% of the studies focused on the global North, and all clustered around 4 political factors:

the transition to a capitalist economy;
neoliberal restructuring;
welfare states; and
political incorporation of subordinated racial/ethnic, indigenous, and gender groups.

The evidence suggested that the first 2 factors probably increase health inequities, the third is inconsistently related, and the fourth helps reduce them. In this review, the authors critically summarize these studies’ findings, consider methodological limitations, and propose a research agenda—with careful attention to spatiotemporal scale, level, time frame (e.g., life course, historical generation), choice of health outcomes, inclusion of polities, and specification of political mechanisms—to address the enormous gaps in knowledge that were identified.

democracy • epidemiology • health status • health status disparities • politics • public health • social class • socioeconomic factors

Free-access links to the online article:
Abstract:
http://epirev.oxfordjournals.org/cgi/content/abstract/mxp002?ijkey=xaXqimZNzdGpbSc&keytype=ref
Full Text:
http://epirev.oxfordjournals.org/cgi/content/full/mxp002?ijkey=xaXqimZNzdGpbSc&keytype=ref
PDF:
http://epirev.oxfordjournals.org/cgi/reprint/mxp002?ijkey=xaXqimZNzdGpbSc&keytype=ref

A Time of Opportunity: Local Solutions to Reduce Inequities in Health and Safety

2009-07-14T07:53:00.000-07:00

Prevention Institute prepared this report for the Institute of Medicine's Roundtable on Health Disparities to address solutions at the community, regional and state level to reduce inequities in health and safety. Recommendations in conjunction with successful examples of implementation are made in four key areas including community recommendations, health care recommendations, systems recommendations and overarching recommendations.
Access the report at: http://preventioninstitute.org/documents/IOM_TimeofOpportunity_052209_FINAL.pdf

WHO Assembly Resolution on: Reducing Health Inequities through Action on the Social Determinants of Health

2009-07-09T09:53:00.000-07:00

SIXTY-SECOND WORLD HEALTH ASSEMBLY - WHA62.14 - Agenda item 12.5

Available online as PDF file at:

http://apps.who.int/gb/ebwha/pdf_files/A62/A62_R14-en.pdf

"....Confirming the importance of addressing the wider determinants of health and considering the actions and recommendations set out in the series of international health promotion conferences, from the Ottawa Charter on Health Promotion to the Bangkok Charter for Health Promotion in a Globalized World, making the promotion of health central to the global development agenda as a core responsibility of all governments...."

CALLS UPON the international community, including United Nations agencies, intergovernmental bodies, civil society and the private sector:

(1) to take note of the final report of the Commission on Social Determinants of Health and its recommendations;

(2) to take action in collaboration with WHO's Member States and the WHO Secretariat on assessing the impacts of policies and programmes on health inequities and on addressing the social determinants of health;

(3) to work closely with WHO's Member States and the WHO Secretariat on measures to enhance health equity in all policies in order to improve health for the entire population and reduce inequities;

(4) to consider health equity in working towards achievement of the core global development goals and to develop indicators to monitor progress, and to consider strengthening international collaboration in addressing the social determinants of health and in reducing health inequities;

URGES Member States:

(1) to tackle the health inequities within and across countries through political commitment on the main principles of "closing the gap in a generation" as a national concern, as is appropriate, and to coordinate and manage intersectoral action for health in order to mainstream health equity in all policies, where appropriate, by using health and health equity impact assessment tools;

(2) to develop and implement goals and strategies to improve public health with a focus on health inequities;

(3) to take into account health equity in all national policies that address social determinants of health, and to consider developing and strengthening universal comprehensive social protection policies, including health promotion, disease prevention and health care, and promoting availability of and access to goods and services essential to health and well-being;

(4) to ensure dialogue and cooperation among relevant sectors with the aim of integrating a consideration of health into relevant public policies and enhancing intersectoral action;

(5) to increase awareness among public and private health providers on how to take account of social determinants when delivering care to their patients;

(6) to contribute to the improvement of the daily living conditions contributing to health and social well-being across the lifespan by involving all relevant partners, including civil society and the private sector;

(7) to contribute to the empowerment of individuals and groups, especially those who are marginalized, and take steps to improve the societal conditions that affect their health;

(8) to generate new, or make use of existing, methods and evidence, tailored to national contexts in order to address the social determinants and social gradients of health and health inequities;

(9) to develop, make use of, and if necessary, improve health information systems and research capacity in order to monitor and measure the health of national populations, with disaggregated data such as age, gender, ethnicity, race, caste, occupation, education, income and employment where national law and context permits so that health inequities can be detected and the impact of policies on health equity measured............."

Putting Women’s Health Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level

2009-07-08T09:53:00.000-07:00

Sizable Health Disparities Evident in Every State Between Women of Different Racial and Ethnic Groups

“A decade after U.S. Surgeon General David Satcher called for the elimination of racial disparities in health, women of color in every state continue to fare worse than white women on a variety of measures of health, health care access and other social determinants of health according to a new study by the Kaiser Family Foundation."

The report, "Putting Women's Health Care Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level," documents the persistence of disparities on 25 indicators between white women and women of color, including rates of diseases such as diabetes, heart disease, AIDS and cancer, as well as insurance coverage and health screenings. It also documents disparities in the factors that influence health and access to care, such as income and education. Women of color fared worse than white women on most measures and in some cases the disparities were stark.

National statistics mask substantial state-by-state variation in disparities. The report moves beyond national figures to quantify where disparities are greatest, providing new information to help determine how best to combat the problem. The analysis also provides new state-level data for women of many racial and ethnic populations that are often difficult to obtain.

"This report demonstrates that disparities in health are not one problem but many and vary from state to state -- and that a variety of strategies will be needed if we hope to turn things around," said Kaiser President and CEO Drew Altman.

American Indian and Alaska Native Women experience some of the Greatest Challenges

Among different racial and ethnic groups, American Indian and Alaska Native women had among the worst outcomes on many health indicators, often twice as high as white women. The percentage of American Indian and Alaska Native women in serious psychological distress was more than 1.5 times that of white women. They exhibited the highest rates of smoking and cardiovascular disease and had considerably higher rates of access problems, such as not having a recent checkup and not getting early prenatal care. One in three American Indian and Alaska Native women lived in poverty, and the median household income for such women was less than half that of white women.

At the same time, the report reveals tremendous variation among states within racial and ethnic groups. For example, among white women, the rate of diabetes was 7.5 times as high in West Virginia (6.0%) as in the District of Columbia (0.8%). Among women who are Asian American, Native Hawaiian and other Pacific Islander, 10% in Ohio had late or no prenatal care compared to 34% in Utah. Forty-three percent of Hispanic women in Oklahoma had not had a mammogram in the past two years, compared to 14.5% in Massachusetts.

"We conducted this study in an effort to shed light on the many challenges and the variety of experiences women of color face across the nation," said the Foundation's Cara James, the study's lead author. "We hope that states can use this information as guidance in developing effective solutions to eliminating disparities."

Disparities in States Vary, as do the Factors that shape them

Many forces contribute to the levels of disparities in the states. The report examined underlying factors such as poverty levels and high school graduation rates that are often beyond the control of state health officials. It also looked at some factors that officials do have a hand in shaping, such as the scope of states' Medicaid programs, which can influence how many people have health coverage in a state.

The report illustrates that there are substantial gaps across the board in some states, whereas in other states the differences among racial groups are narrower. For instance, Virginia, Maryland, Georgia and Hawaii all had relatively small disparities between women of color and white women on health outcomes, health care access and the social factors that influence health outcomes and access. In contrast, disparities were larger in Arkansas, Indiana, Louisiana, Mississippi, Montana and South Dakota.

In some states with relatively small disparities, such as Maine, white women and minority women were doing similarly well. In other states, such as Kentucky and West Virginia, they were doing similarly poorly.

The Foundation released the report at a briefing at the Foundation's Washington office. Concise state-specific fact sheets detailing the disparities data and access to interactive data tables are available at:

http://www.kff.org/womensdisparities

A companion video produced by the Foundation that puts a human face on the data through interviews with patients and providers at a clinic in Northern Virginia is available online at:
http://www.kff.org/minorityhealth/rehc061009vid.cfm

Full report:

Putting Women's Health Care Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level. Henry J. Kaiser Family Foundation and UCLA Center for Health Policy Research. June 2009.

http://www.kff.org/minorityhealth/7886.cfm

Seattle King County Public Health Reserve Corps

2009-07-07T13:31:00.000-07:00

King County Public Health Reserve Corps (PHRC) is recruiting now for all licensed medical and non-medical volunteers that are needed during major disasters and public health emergencies to limit injury, illness, suffering and death. When every minute counts, the PHRC will play a major role with:

* Setting up, working and running alternate care facilities, medical shelters or medication centers
* Dispensing medications
* Administering vaccinations
* Providing information and support to the community
* Conducting health screening

For more information about the Public Health Reserve Corps including how to apply visit www.kingcounty.gov/health/phrc or email phrc@kingcounty.gov .

Women’s Mental Health Publications

2009-07-01T09:07:00.000-07:00

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Action Steps for Improving Women's Mental Health: What It Means to You Action Steps for Improving Women's Mental Health

This report brought to your by the Office of Women’s Health brings together the most recent research, resources, products, and tools on mental health issues in women, and explores the role gender plays in diagnosing, treating, and coping with mental illness. It also points to resilience and social support systems as key factors in overcoming mental illness. The report outlines specific action steps for policy-makers, health care providers, researchers, and others to take in an effort to address the burden of mental illness on women's lives and increase their capacity for recovery.

Access the report here: http://download.ncadi.samhsa.gov/ken/pdf/OWH09-PROFESSIONAL/ActionSteps.pdf

See also, the corresponding consumer booklet that addresses the stigma associated with mental health, and provides information on the signs and symptoms of mental illness. The booklet also offers suggestions for support and solutions for preventing and coping with mental illness.
View the consumer booklet at:
http://download.ncadi.samhsa.gov/ken/pdf/OWH09-CONSUMER/womenmentalhealth.pdf

Unnatural Causes: Social Determinants of Health

2009-05-13T15:07:00.000-07:00

Nieman Reports, the quarterly magazine of Harvard's Nieman School of Journalism, contains a great article by journalist Madeline Drexler about the under-reported importance of the social determinants of health and production of the documentary series Unnatural Causes:

"Toppling the 'Big Three'-Medical Care, Behavior and Genes." http://www.nieman.harvard.edu/reportsitem.aspx?id=100959

There's also a sidebar called "Spreading the News": http://www.nieman.harvard.edu/reportsitem.aspx?id=100960

The Spring 2009 issue overall (21st Century Muckrakers: Investigating Medical and Health Issues) includes several great articles on health and medical reporting: http://www.nieman.harvard.edu/reports.aspx

Indigenous Children’s Health Report

2009-05-12T11:46:00.000-07:00

This report documents what we know about the health of Indigenous children (from birth to age twelve) and evaluates the quality of Indigenous child health data collection in Canada, Australia, New Zealand, and the United States.

Striking Indigenous/non-Indigenous health disparities were identified in all four countries, including:

• Infant Mortality Rates that are 1.7 to 4 times higher than those of non-Indigenous infants
• Higher rates of sudden infant death syndrome
• Higher rates of child injury, accidental death, and suicide
• Higher rates of ear infections
• A disproportionate burden of respiratory tract illness and mortality
• A disproportionate burden of dental caries
• Increased exposure to environmental contaminants, including tobacco smoke

Click here to see full report.

Why Your Zip Code may be more Important to Your Health than Your Genetic Code

2009-05-11T10:04:00.000-07:00

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James Marks, M.D., M.P.H
Robert Wood Johnson Foundation

How you see a problem drives how you create the solution.

We are not a healthy country. And while health reform focuses on coverage, cost, access and care, this is simply triage to a system that fails to ask the question "Why aren't we healthier in the first place?" Our health reform debate is focusing on where health ends (with medical care) and not on where our health begins (where we live, learn, work and play).

Last month, the Robert Wood Johnson Foundation Commission to Build a Healthier America released a report about all of those other things. This report comes out of a bi-partisan commission created to look at the factors that affect Americans' health in our homes, our work environments, and our communities. In wonky terms, we call these factors "social determinants of health." In plain English, the Commission's purpose was to look for ways beyond medical care that could improve our health.

What do we mean by "beyond medical care?" There is a ton of evidence that shows where and how people live, learn, work and play has a tremendous impact on our health. And while this link may seem intuitive to most, the extent of the relationship is not reflected in either the way we consider our own health or the way we go about creating solutions to make us a healthier nation as a whole.

Click here for the full article.

Click here for references for the article.

Click here for the full report.

World Bank admits most Health Aid Fails

2009-05-11T09:58:00.000-07:00

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Larry Elliot
The Guardian

The World Bank has made little progress in improving the health of poor people in spite of a $10bn (£6.75bn) increase in spending, its in-house monitoring body said last night.

Announcing a review of the Bank's health department from 1997 to 2008, the Independent Evaluation Group said that despite increasing spending from $6.7bn in 1997 to $16bn in 2006, progress had been poor.

The watchdog said the performance in Africa was "particularly weak", with only 27% of projects considered satisfactory.

It added that monitoring of health programs "remains weak" and "evaluation is almost non-existent". The lack of proper monitoring and evaluation had led to "irrelevant objectives, inappropriate project designs, unrealistic targets, and an inability to measure the effectiveness of interventions."

The IEG is a standalone unit that reports to the Bank's directors on "what works and what does not". The lead author of the report to the Bank's health, nutrition and population (HNP) department, Martha Ainsworth, said: "Overly complicated project designs and weak government capacity contributed to low outcomes."

Click here for the full article.

Click here for access to the World Bank report.

Human Rights Framework for Financing Health Care

2009-03-24T15:07:00.000-07:00

In response to President Obama’s eight principles for health care reform, the Human Right to Health Program, run by the National Economic and Social Rights Initiative (NESRI) and the National Health Law Program (NHeLP), has developed ten human rights principles for financing health care. These principles emerge from human rights standards recognized in the United States and around the world. They set down markers for health care reformers to help them meet human rights standards. Taken together the ten principles provide a framework for designing a sustainable, cost-effective system that treats health care as a public good and secures comprehensive care for all.

Click here for principles.

NESRI's site:
www.nesri.org

Health Care Reform Proposals: Californians Weigh In

2009-03-24T15:01:00.000-07:00

On August 11, 2007, some 3,500 Californians gathered in eight cities to take part in a daylong conversation on health care reform

The report from this daylong conversation is available at: http://www.californiaspeaks.org/_data/n_0002/resources/live/CAfinalreport.pdf

Below are some links to Independent Evaluations of the report.

Archon Fung, Taeku Lee."The difference deliberation makes: A report on the CaliforniaSpeaks statewide conversations on health care reform."
http://www.californiaspeaks.org/_data/n_0002/resources/live/Archon_Taeku%20Evaluation.pdf

For more information about CaliforniaSpeaks, including a webcast of the meeting and other independent evaluations of this deliberative process:

http://www.californiaspeaks.org

Mental Health and Inequality

2009-03-24T14:51:00.000-07:00

“Mental health is a fundamental element of the resilience, health assets, capabilities and positive adaptation that enable people both to cope with adversity and to reach their full potential and humanity. Mental health is also the key to understanding the impact of inequalities on health and other outcomes. It is abundantly clear that the chronic stress of struggling with material disadvantage is intensified to a very considerable degree by doing so in more unequal societies. An extensive body of research confirms the relationship between inequality and poorer outcomes, a relationship which is evident at every position on the social hierarchy and is not confined to developed nations. The emotional and cognitive effects of high levels of social status differentiation are profound and far reaching: greater inequality heightens status competition and status insecurity across all income groups and among both adults and children. It is the distribution of economic and social resources that explains health and other outcomes in the vast majority of studies. The importance of the social and psychological dimensions of material deprivation is gaining greater recognition in the international literature on poverty and informs current efforts to develop indicators that capture the missing dimensions of poverty.

A recently released WHO report explores the wealth of evidence that mental health influences a very wide range of outcomes for individuals and communities. These include healthier lifestyles; better physical health; improved recovery from illness; fewer limitations in daily living; higher educational attainment; greater productivity, employment and earnings; better relationships with adults and with children; more social cohesion and engagement and improved quality of life. These outcomes are not just or necessarily a consequence of the absence of mental illness, but are associated with the presence of positive mental health, sometimes referred to as ‘wellbeing’. Improving mental health is a worthwhile goal in itself: most people value a sense of emotional and social wellbeing; in addition, good mental health has many other far reaching benefits.”

Click here for the full article.

Socioeconomic Interventions and Studies on Social Determinants of Health

2009-03-24T14:19:00.000-07:00

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Costello, E. J. (2003). Relationships between Poverty and Psychopathology: A natural experiment. JAMA, 290, 2023-2029.

Bezruchka, S., Namekata, T., et al. (2008). Improving Economic Equality and Health: The Case of Postwar Japan. American Journal of Public Health, 98(4), 589-594.

Williams, D.R., Costa, M.V., Odunlami, A.O. Mohammed, S.A. (2008). Moving Upstream: How Interventions that Address the Social Determinants of Health can Improve Health and Reduce Disparities. Journal of Public Health Management and Practice, 14, Suppl: S8-S17.

Early Childhood Experiences and Health:
http://www.commissiononhealth.org/PDF/095bea47-ae8e-4744-b054-258c9309b3d4/Issue%20Brief%201%20Jun%2008%20-%20Early%20Childhood%20Experiences%20and%20Health.pdf

Community Interventions to Promote Healthy Social Environments: Early Childhood Development and Family Housing:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5101a1.htm

For studies that focus on HIV/AIDS, see the Nov 2007 Special Issue
of AIDS & Behavior that addresses housing/lack of housing, housing
interventions and HIV prevention and care:
http://www.springerlink.com/content/u14328031u83/?p=25342b32013c4f8bb51ac19cb34a135a&pi=14

Kehrer, B. H., Wolin, C. M. (1978). Impact of income maintenance on low birthweight: Evidence from the Gary Experiment. Journal of Human Resources,14(4), 432-461.
Pronyk, P. M., Hargreaves, J. R., Kim, J.C., et al. (2006). Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomized trial. Lancet, 368, 1973-1983.

Alesina, A., & Glaeser, E. L. (2004). Fighting poverty in the US and Europe: A world of difference. Toronto: Oxford University Press.

Bambra, C., Fox, D., & Scott-Samuel, A. (2005). Towards a politics of health. Health Promotion International, 20(2), 187-193.

Brady, D. (2003). The politics of poverty: Left political institutions, the welfare state, and poverty. Social Forces, 82, 557-588.

Navarro, V., & Shi, L. (2001). The political context of social inequalities and health. International Journal of Health Services, 31(1), 1-21.

Raphael, D., & Bryant, T. (2006). Maintaining population health in a period of welfare state decline: Political economy as the missing dimension in health promotion theory and practice. Promotion and Education, 13, 236-242.

Saint-Arnaud, S., & Bernard, P. (2003). Convergence or resilience? A hierarchical cluster analysis of the welfare regimes in advanced countries. Current Sociology, 51(5), 499-527.

Mohindra, K. S., Haddad, S. (2005). Women's interlaced freedoms: A framework linking microcredit participation and health, Journal of Human Development, 6(3), 353-374.

Mohindra, K.S., Haddad, S. & Narayana, D. (2008). Can microcredit help improve the health of poor women? Some findings from a cross-sectional study in Kerala, India. International Journal for Equity in Health, 7(2). http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2254417&blobtype=pdf

Mohindra, K. S., Haddad, S. (2008). Evaluating unintended health benefits of poverty alleviation strategies or what is the relevance of Muhammad Yunus to public health? Canadian Journal of Public Health, 99(1), 66-68.

Wilkinson, R. & Pickett, K. (2009). The Spirit Level: Why more equal societies almost always do better. London, Penguin Books.

Gruer, L., Hart, C., Gordon. D., Watt, G. (2009). Effect of tobacco smoking on survival of men and women by social position: A 28 year cohort study. BMJ, 338:b480 doi:10.1136/bmj.b480
Available online at: http://www.bmj.com/cgi/content/full/338/feb17_2/b480

Scott-Samuel, A. (2009).What the Renfrew / Paisley data really tell us about tackling health inequalities: The need to refocus upstream. Available online at: http://www.bmj.com/cgi/eletters/338/feb17_2/b480

Social Epidemiology: Social Determinants of Health in the United States: Are We Losing Ground?

2009-03-24T14:09:00.000-07:00

Lisa F. Berkman. Annual Review of Public Health. Vol. 30 (now available online; see link below).

The United States ranks in the lower tiers of OECD countries in life expectancy, and recent studies indicate that socioeconomic inequalities in health have been widening in the past decades. Over this period, many rigorous longitudinal studies have identified important social, behavioral, and environmental conditions that might reduce health disparities if we could design effective interventions and make specific policy changes to modify them. Often, however, neither our policy changes nor our interventions are as effective as we hoped they would be on the basis of findings from observational studies. Reviewed here are issues related to causal inference and potential explanations for the discrepancy between observational and experimental studies. We conclude that more attention needs to be devoted to (a) identifying the correct etiologic period within a life-course perspective and (b) understanding the dynamic interplay between interventions and the social, economic, and environmental contexts in which interventions are delivered.

Key Words: population health, social networks, inequality, randomized controlled trials, life course

Click here for the full article.

Racial/Ethnic Disparities in Self-Rated Health Status among Adults with and without Disabilities – U.S., 2004-2006

2009-02-24T13:05:00.000-08:00

“Self-rated health status has been found to be an independent predictor of morbidity and mortality (1), and racial/ethnic disparities in self-rated health status persist among the U.S. adult population (2). Black and Hispanic adults are more likely to report their general health status as fair or poor compared with white adults (2). In addition, the prevalence of disability has been shown to be higher among blacks and American Indians/Alaska Natives (AI/ANs) (3). To estimate differences in self-rated health status by race/ethnicity and disability, CDC analyzed data from the 2004 -- 2006 Behavioral Risk Factor Surveillance System (BRFSS) surveys.

This report summarizes the results of that analysis, which indicated that the prevalence of disability among U.S. adults ranged from 11.6% among Asians to 29.9% among AI/ANs. Within each racial/ethnic population, adults with a disability were more likely to report fair or poor health than adults without a disability, with differences ranging from 16.8 percentage points among Asians to 37.9 percentage points among AI/ANs. Efforts to reduce racial/ethnic health disparities should explicitly include strategies to improve the health and well being of persons with disabilities within each racial/ethnic population”.

Click here for full report.

Understanding Population Health and Public Health

2009-02-24T12:56:00.000-08:00

Increased attention to and interest in societal health has many asking about the distinction between, and application of the terms “Population Health” and “Public Health”. Below are a sample of resources that elucidate the usage of the two terms.

Coburn, D., Denny, K., Mykhalovskiy, E., McDonough, P., Robertson, A., & Love, R. (2003). Population health in Canada: A brief critique. American Journal of Public Health, 93(392-396).

Eakin, J., Robertson, A., Poland, B., Coburn, D., & Edwards, R. (1996). Towards a critical social science perspective on health promotion research. Health Promotion International, 11, 157-165.

Evans, R. G., Barer, M. L., & Marmor, T. R. (1994). Why Are Some People Healthy and Others Not?: The Determinants of Health of Populations. New York: Aldine de Gruyter.

Labonte, R. (1996). The population health/health promotion debate in Canada: The politics of explanation, economics and action. Toronto: University of Toronto.

Labonte, R., Polanyi, M., Muhajarine, N., McIntosh, T., & Williams, A. (2005). Beyond the divides: Towards critical population health research. Critical Public Health, 15(1), 5-17.

Raphael, D. (2001). Letter from Canada: an end of the millennium update from the birthplace of the Healthy Cities Movement. Health Promotion International, 16, 99-101.

Raphael, D., & Bryant, T. (2002). The limitations of population health as a model for a new public health. Health Promotion International, 17, 189-199.

Robertson, A. (1998). Shifting discourses on health in Canada: From health promotion to population health. Health Promotion International, 13, 155-166.

Of related interest:

*NEW* Social Determinants of Health: Canadian Perspectives, 2nd edition, edited by Dennis Raphael Forewords by Carolyn Bennett and Roy Romanow http://tinyurl.com/5l6yh9

Poverty and Policy in Canada: Implications for Health and Quality of Life by Dennis Raphael Foreword by Jack Layton http://tinyurl.com/2hg2df

Staying Alive: Critical Perspectives on Health, Illness, and Health Care, edited by Dennis Raphael, Toba Bryant, and Marcia Rioux Foreword by Gary Teeple http://tinyurl.com/2zqrox

See a lecture! The Politics of Population Health http://msl.stream.yorku.ca/mediasite/viewer/?peid=ac604170-9ccc-4268-a1af-9a9e04b28e1d

Also, presentation on Politics and Health at the Centre for Health Disparities in Cleveland Ohio http://video.google.com/videoplay?docid=-4129139685624192201&hl=en

Reducing Health Inequities through Action on the Social Determinants of Health

2009-02-24T10:57:00.000-08:00

WHO 124th Session EB124.R6 - Agenda item 4.6 - 23 January 2009
WHO Executive Board, Having considered the Secretariat's report on the final report of the Commission on Social Determinants of Health, RECOMMENDS to the Sixty-second World Health Assembly the adoption of the following resolution:
".........Confirming the importance of addressing the wider determinants of health and considering the actions and recommendations set out in the series of international health promotion conferences, from the Ottawa Charter on Health Promotion to the Bangkok Charter for Health Promotion in a Globalized World making the promotion of health central to the global development agenda as a core responsibility of all governments (resolution WHA60.24);
"........URGES Member States:
(1) to develop and implement goals and strategies to improve public health with a focus on health inequities;
(2) to take into account health equity in all national policies that address social determinants of health and to ensure equitable access to health promotion, disease prevention and health care;
(3) to ensure dialogue and cooperation among relevant sectors with the aim of integrating a consideration of health into relevant public policies;
(4) to increase awareness among public and private health providers on how to take account of social determinants when delivering care to their patients;
(5) to contribute to the improvement of the daily living conditions contributing to health and social well-being across the lifespan by involving all relevant partners, including civil society and the private sector;
(6) to contribute to the empowerment of individuals and groups, especially those who are marginalized, and take steps to improve the societal conditions that affect their health;
(7) to generate new, or make use of existing, methods and evidence, tailored to national contexts in order to address the social determinants and social gradients of health and health inequities;
(8) to develop, make use of, and if necessary, improve health information systems in order to monitor and measure the health of national populations, with data disaggregated according to the major social determinants in each context (such as age, gender, ethnicity, education, employment and socioeconomic status) so that health inequities can be detected and the impact of policies monitored in order to devise appropriate policy interventions to minimize health inequities........"
Click here for the full article.

A Glimmer of Hope for Microbicide Research

2009-02-24T10:41:00.000-08:00

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After years of disappointments, AIDS researchers have announced results from a trial in which a vaginal microbicide appeared to offer promise in preventing HIV infection in women. According to findings from a clinical trial involving more than 3,000 women in Malawi, South Africa, Zambia, Zimbabwe and the United States, the microbicide PRO 2000 gel was 30 percent effective.

"This is the first time in the history of microbicide research that we have found something that works, even if its 30 percent," Gita Ramjee, principal investigator of the trials in South Africa, told journalists on 9 February in the country's east coast port city of Durban.

Ramjee described the results as a "glimmer of hope" that the microbicides concept could become an effective HIV prevention tool for women.

Although the results were "promising" they are not statistically significant, as there was a one-in-ten chance that the 30 percent reduction in HIV infections seen in women who used PRO 2000, versus those who used a placebo, was due to chance, Ramjee explained.

Scientifically, results are not regarded as "significant" unless the chance they are wrong is 0.05 percent or less than one in 20. "If we had seen a 33 percent reduction it would have been statistically significant," Ramjee said.

Women in the trial were randomly assigned to one of four groups: one group involved women who received a 0.5 percent dosage of PRO 2000 gel; in the second, women were treated with BufferGel, a second microbicide candidate; and in the third and fourth groups women received a placebo gel or no gel at all.

The study, conducted by the US-based Microbicide Trials Network, also found more regular gel use, corresponded to a higher level of HIV protection.

Click here for full article.

Bill Gates on Changing the World

2009-02-24T10:35:00.000-08:00

(image source: Photo: TED and James Duncan Davidson)

“Bill Gates hopes to solve some of the world's biggest problems using a new kind of philanthropy. In a passionate and, yes, funny 18 minutes, he asks us to consider two big questions and how we might answer them”.

Watch his presentation at TED here: http://www.ted.com/talks/bill_gates_unplugged.html

Blind Optimism: Challenging the Myths about Private Health Care in Poor Countries

2009-02-24T10:27:00.000-08:00

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The stakes could not be higher. Every minute a woman dies in pregnancy or childbirth for want of simple medical care; every hour 300 people die of AIDS-related illnesses; and every day 5,000 children are killed by pneumonia. The world is badly off-course to achieve the internationally agreed health Millennium Development Goals (MDGs). To get back on-course and achieve universal and equitable health care for all requires a massive expansion of health services. To fail in this endeavor will be to abandon hundreds of millions of people to an early death and a life blighted by sickness. The critical question is how can such a massive scale up be achieved?

For over two decades, the World Bank advocated a solution based on investment and growth of the private health-care sector. Decrying the failure of public health services in poor countries, failure in which the Bank’s enforced public sector spending cuts and wide-scale restructuring have played a significant role, the argument was that the private sector could do a better job. Although in recent years the World Bank has acknowledged the key role of the government in health care, this is largely as a regulator and ‘steward’ rather than as a provider of services.

Despite the poor performance of private sector-led solutions, there has been a noticeable increase in efforts in recent months by a number of donors and influential organizations, to encourage and fund an expansion of health care by the private sector. The idea is that those who can afford it should buy their own health care in the private sector and governments should contract private providers to serve those who can’t. The approach is promoted not only as a matter of ‘common sense’ but as essential to reverse the lack of progress in health care and to save the lives of poor people.

This paper examines the arguments made in favor of increased private for-profit provision of health services as a means of scaling-up to achieve health care for all. It finds the evidence in favour of private-sector solutions is weak. On the contrary, there is considerable and increasing evidence that there are serious failings inherent in private provision which make it a very risky and costly path to take. All too often these risks are not taken into account.

At the same time, a growing body of international research reaffirms that despite their serious problems in many countries, publicly financed and delivered services continue to dominate in higher performing, more equitable health systems. No low- or middle-income country in Asia has achieved universal or near-universal access to health care without relying solely or predominantly on tax-funded public delivery. Scaling-up public provision has led to massive progress despite low incomes. A Sri Lankan woman, for example, can expect to live almost as long as a German woman, despite an income ten times smaller. If she gives birth she has a 96 per cent chance of being attended by a skilled health worker.

Six of the most common arguments made in support of private-sector health-care provision are examined in this paper.

Click here for full article.

Study finds Persistence of Diversity Problems in Academic Medicine

2009-02-19T14:13:00.000-08:00

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By Christen Brownlee
Johns Hopkins Medicine

A survey study believed to be one of the first efforts to put hard numbers around long-held beliefs about diversity in medical school faculties has affirmed that awareness and sensitivity to racial and ethnic diversity are believed to be poor by most faculty, and even poorer among faculty who are members of underrepresented minorities.

The survey was conducted at the Johns Hopkins University School of Medicine but is likely a reflection of diversity issues thought to persist at academic medical institutions across the country, said principal investigator Lisa Cooper, a professor of medicine in the Johns
Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health.

"What we are seeing at Johns Hopkins is likely to be the case in medical schools everywhere, namely that enhancing racial and ethnic diversity in medicine in general, and in academic medicine in particular, remains a challenge," Cooper said. The study results appear in the January issue of Academic Medicine.

Click here for full article.

Please Help Improve our Blog

2009-01-13T16:52:00.000-08:00

In an effort to best cater to our readers and users, we hope you'd be able to take a minute to answer a three question survey by following the link in this post. The survey is completely anonymous and will redirect you back to this blog once you are done. We'd like to know who our readers are and what they'd like to see on this blog.

Thank you!

TAKE SURVEY HERE.

Managing Chronic Conditions: The Experience of Eight Countries

2009-01-13T11:25:00.000-08:00

Editors: Ellen Nolte, Cécile Knai, Martin McKee

“One of the greatest challenges facing health systems in the 21st century is the need to develop effective approaches to address the growing burden of chronic disease. Chronic diseases are complex and require a long-term, multifaceted response that coordinates inputs from a wide range of health professionals, essential medicines and – where appropriate – monitoring equipment, all of which is optimally embedded within a system that promotes patient empowerment.

With many health systems still largely built around an acute, episodic model of care, health professionals, policy-makers and patient organizations struggle to respond in ways that meet the needs of people with complex chronic health problems. This book examines the health system response to the rising burden of chronic disease in eight countries: Denmark, England, France, Germany, the Netherlands, Sweden, Australia and Canada

It provides a detailed assessment of the current situation, a description of the policy framework and future scenarios, as well as evaluation and lessons learned.

It shows that many different strategies are being implemented, with different models of care at varying degrees of development, and with differing comprehensiveness. Perhaps not surprisingly, the approaches adopted often reflect the characteristics of each health system, each with its own governance mechanisms and relationships between, and responsibilities of, different stakeholders. Nonetheless, there are many lessons for those seeking to develop effective responses to this common challenge. …”

Download the book here:
http://www.euro.who.int/Document/E92058.pdf

Geocoding Best Practices Guide

2009-01-13T11:23:00.000-08:00

Geocoding Best Practices Guide is a new publication written by Dan Goldberg and edited by the GIS Committee of the North American Association of Central Cancer Registries. It can be downloaded for free at: http://www.naaccr.org/filesystem/pdf/Geocoding_Best_Practices.pdf

Alltop: Health News on One Page

2009-01-13T11:22:00.000-08:00

http://health.alltop.com is a website where you will find aggregated health news/headlines from other sites and blogs. The website seeks to enhance your online reading by both displaying stories from the sites that you’re already visiting and helping you discover sites that you didn’t know existed. Check it out today!

The State of Food Insecurity in the World 2008

2009-01-13T11:17:00.000-08:00

“In mid-2008, as international food prices peaked following two years of rapid increases, the international community was mobilized to avert an imminent global food-security crisis. FAO estimates that between 2003–2005 and 2007 high food prices contributed to an increase of 75 million in the number of undernourished people, bringing the total number to 923 million.

Soaring food prices resulted in the highest single increase in hunger since 1990–92, the base period for the World Food Summit’s and the Millennium Summit’s hunger reduction targets. This sharp increase in hunger has also thrown into reverse earlier progress towards achieving the first Millennium Development Goal (MDG 1) in that the proportion of undernourished in all major developing regions in the world has now risen.

Who are the primary victims of the dramatic increases in food prices? The vast majority of poor households – both urban and rural – are net buyers of food and have been hit hardest by the sharp increase in food prices. Among the poor, landless and female-headed households are the most vulnerable. On the other hand, rural households specializing in agriculture and with access to land have been able to cope better with food price increases.

KEY MESSAGES
• World hunger is increasing. FAO’s most recent estimates put the number of hungry people at 923 million, an increase of more than 80 million since the 1990–92 base period.
• High food prices share much of the blame. FAO estimates that between 2003–05 and 2007, 75 million more people were added to the total number of undernourished.
• The poorest, and landless and female-headed households are the hardest hit. The vast majority of both urban and rural households in the developing world rely on food purchases for most of their food and stand to lose from high food prices.
• Ad hoc policy measures to deal with the effects of high food prices, such as price controls and export restrictions, are likely to be ineffective and unsustainable. They also exacerbate market volatility.
• High food prices present opportunities for agriculture. Most developing countries have not taken advantage of such opportunities.
• A comprehensive twin-track approach is required to address the impact of high food prices on hunger: (i) measures to enable the agriculture sector to respond to the high prices; and (ii) targeted safety nets and social protection programmes for the most food-insecure and vulnerable.

Click for the full report.

Canada: Racism undermines HIV Prevention and Treatment

2009-01-13T11:07:00.000-08:00

AIDS 2005 Tackling the toxic mix
Dal prof aims to spark dialogue on HIV/AIDS in black NS communities
Jess McDiarmidAssistant News Editor

Racism, religion, stigma and the taboo surrounding sex are among the key factors that have led to a lack of HIV/AIDS information and essential services in Nova Scotia’s black communities, says Dalhousie’s chair of black Canadian studies.

“You’ve got agencies that have been accused of being racist, agencies which are staffed by people who don’t look like the individuals they’re trying to service, agencies which have… stereotypical ideas about black people and tend to reflect those stereotypes in practice,” says David Divine. “That leads to difficulties.”

Stigma surrounding homosexuality and HIV/AIDS, as well as societal ‘taboo’ of sex in general, has resulted in a lack of vitally needed openness to discuss the disease in black communities, suggests Divine. “When you’ve got all these in the melting pot, in addition to historical dis-servicing of certain people because of colour, then you have got a toxic mix,” he says.

Click here for the full story.

Mr. Bush’s Healthcare Legacy

2009-01-13T10:59:00.000-08:00

The NYT Editorial has criticized the Bush administration’s weak performance on many important health care matters: its failure to address the problem of millions of uninsured Americans or stem the rising costs of health care, its refusal to expand eligibility for the State Children’s Health Insurance Program, its devious maneuvers to cut Medicaid spending, its support of unjustified subsidies for private health plans, to name a few.

It is only fair to note that President Bush can also lay claim to some signal achievements in health care — achievements that we urge President-elect Barack Obama to continue and develop further.

As we have argued in the past, Mr. Bush deserves high praise for significantly increasing American support for the global effort to control AIDS. We were pleased that Congress has now authorized even more money than Mr. Bush proposed: almost $50 billion to fight AIDS, malaria and tuberculosis around the world over the next five years. But there is little doubt that the president has played a key role in providing drug treatments or supportive care to millions of patients who would otherwise have gone untended.

It is a remarkable record for the leader of a party that had been reluctant in the Reagan era to deal with a disease whose victims at the time in this country were primarily gay men and injection drug users.

Click here for full article.

A Parting Shot at Women’s Rights

2009-01-13T10:48:00.000-08:00

Undermining women’s reproductive rights and access to health care has been a pervasive theme of the outgoing administration. On his first full day in office, President Bush imposed the “global gag rule,” which prohibits taxpayer dollars from going to international family-planning groups that perform abortions using their own funds or that advocate for safe abortion laws.

So it was unsurprising, but still dismaying, that the secretary of health and human services, Michael Leavitt, chose to extend that dismal record at the last minute with yet another awful regulation. A parting gift to the far right, the new regulation aims to hinder women’s access to abortion, contraceptives and the information necessary to make decisions about their own health. What makes it worse is that the policy is wrapped up in a phony claim to safeguard religious freedom.

The law has long allowed doctors and nurses to refuse to participate in an abortion. Mr. Leavitt’s changes elevate the so-called right to refuse beyond reason to an increased number of medical institutions and a broad range of health care workers and services — including abortion referrals, unbiased counseling and provision of emergency contraception, even to rape victims. The impact will be hardest on poor women who rely on public programs for their health care.

Click here for full article.

The Evil behind the Smiles

2009-01-13T10:37:00.000-08:00

By Nicholas D. Kristof

Western men who visit red-light districts in poor countries often find themselves surrounded by coquettish teenage girls laughingly tugging them toward the brothels. The men assume that the girls are there voluntarily, and in some cases they are right.

But anyone inclined to take the girls’ smiles at face value should talk to Sina Vann, who was once one of those smiling girls.

Sina is Vietnamese but was kidnapped at the age of 13 and taken to Cambodia, where she was drugged. She said she woke up naked and bloody on a bed with a white man — she doesn’t know his nationality — who had purchased her virginity.
After that, she was locked on the upper floors of a nice hotel and offered to Western men and wealthy Cambodians. She said she was beaten ferociously to force her to smile and act seductive.

“My first phrase in Khmer,” the Cambodian language, “was, ‘I want to sleep with you,’ ” she said. “My first phrase in English was” — well, it’s unprintable.

Click here for the full article.

When the Ship of State hits an Iceberg: The Recession and your Health

2009-01-13T10:24:00.000-08:00

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By Stephen Bezruchka

Selective socialism bails out capitalism so no bankers are left behind in our epic recession. What about automaker CEOs? Will they get to keep their private jets but have us pay for them? What about the millions of homeowners facing foreclosure or those others who’ve already lost their dwellings? What caused all this? What good can come of this? What will be the health impacts?

The cause is the increasing inequality we were pressured into accepting as being good for us. Let the rich take all they can while we borrow money we don’t have to spend on stuff we don’t need so the rich get richer. Our trade deficit and financial deregulation spawned the crisis. Panic rules took hold. In an emergency, whatever you do, don’t panic. If you do panic, panic first! The bankers panicked quickly and got their trillion. The automakers waited to panic and will get much less. Is it too late for you to panic? Not if we mass together.

None of our leaders or their advising captains noticed that we had struck an iceberg and were taking on water in most economic compartments. The vessel had been listing for years before any expert pilot on the watch noticed. Now, adrift, no one has any idea where we are headed, whether it is towards a huge mine floating in the sea of panic that will blast us apart, or whether there is another iceberg that will widen the gap. Is it yoyo politics (You’re On Your Own), with every man and woman for themselves, or can we steer the lifeboat together? Our rescue lies in solidarity.

Click here for the full article.

Number of Children Immunized has been Inflated for Years

2009-01-13T10:15:00.000-08:00

By David Brown
Many of the world's poorest countries have for decades routinely exaggerated the number of children being immunized against disease, apparently driven by political pressure and, more recently, financial incentives.

That is the finding of a huge analysis that has provoked heated discussion even before its publication in the Lancet, a European medical journal. Since 1986, progress in childhood immunization in the developing world has been about half that officially reported by governments in the developing world. Not only are year-to-year improvements overstated, but the total percentage of children immunized is far lower than publicly acknowledged, the study found.

The two-decade trend masks extreme variations, with some countries overstating their gains four- and fivefold, and a few countries understating them. The analysis -- which compares official immunization coverage with what was found in house-to-house surveys -- casts a shadow on the emerging strategy of "pay for performance" in global health assistance. Specifically, it suggests that the pioneering Global Alliance for Vaccines and Immunizations (GAVI) may have paid out twice as much in performance rewards as it should have: $290 million instead of $150 million.

Click here for full article.

The U.S. Commitment to Global Health

2009-01-13T09:50:00.000-08:00

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The Institute of Medicine-with the support of four U.S. government agencies and five private foundations-formed an independent committee to examine the United States' commitment to global health and to articulate a vision for future U.S. investments and activities in this area.

The committee considered the following key areas of U.S. government engagement in global health:
• The financial and technical resources provided to countries to expand public health infrastructure and improve access to health interventions;
• The governance structures across U.S. agencies responsible for delivering these benefits;
• The research effort that focuses on health problems endemic to poor countries; and
• The relationship of the United States with the World Health Organization (WHO), the leading global agency in the field of health policy.

While the scope of this report was limited to U.S. government efforts in the realm of global health, this topic is inevitably linked to broader discussions on U.S. commitments to global economic development and the environment. This report does not, however, cover the related areas of food security, water and sanitation, climate change, educational and economic opportunity, and gender equity. Similarly, the committee was not tasked with evaluating or recommending action on broader international development reforms..."

Contents
• Summary
• Charge to the committee
• A prominent role for health in U.S. foreign policy
• Progress in global health can be achieved now
• Urgent opportunity for action
• Restructure the U.S. global health enterprise
• Mobilize financial resources for health
• Focus U.S. government efforts on health outcomes
• Advance U.S. strengths in global health knowledge
• Support and collaborate with the WHO
• Call to action

Click here to access full report.

A Piece of the Stimulus Pie

2009-01-13T09:34:00.000-08:00

Higher Education campaigns to be a critical part of the stimulus package

With the incoming Obama administration contemplating a massive infusion of no-or few-strings-attached federal money to try to stimulate the foundering U.S. economy, you’d be hard pressed to find an industry or interest group not seeking a piece of the action. Health care, biotech companies, — heck, even librarians have their hands out. No surprise, then, that higher education is lining up to do the same.

Mid-last month, a broad coalition of college associations jointly released a letter urging Congress to “make higher education a critical part of the economic stimulus package,” through a combination of increased need-based aid for students, additional relief for student loan borrowers, and grants to states to help colleges pay for the sort of “ready-to-go” facilities that would create jobs and stimulate economic activity. A week later, chancellors and board chairs from more than two dozen major public universities released a letter (organized by the Carnegie Corporation of New York) arguing that five percent of the total stimulus package should be directed to renovating and building campus classroom and research facilities. Those proposals follow others released by the Association of American Universities and an assortment of groups that advocate for students.

Click here for the full article.

Abortion Surveillance

2009-01-13T09:10:00.000-08:00

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CDC began conducting abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions.

This report is based on abortion data for 2005, provided voluntarily to CDC's National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health.

For 2005, CDC compiled data that were voluntarily provided from 49 reporting areas in the United States: 47 states (excluding California, New Hampshire, and Louisiana), the District of Columbia (DC), and New York City (NYC). Legal induced abortion was defined as a procedure, performed by a licensed physician or someone acting under the supervision of a licensed physician, that was intended to terminate a suspected or known intrauterine pregnancy and to produce a nonviable fetus at any gestational age. The total number of legal induced abortions was available from all reporting areas; however, not all of these areas collected data on some or all characteristics of women who obtained abortions, and the availability of such data varied by reporting area. Abortion data were compiled using suggested table shells that were sent to the reporting areas. Not all reporting areas used the suggested tables.
See full report at: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5713a1.htm?s_cid=ss5713a1_e

NEW: Feeds!

2008-12-12T11:02:00.000-08:00

We've linked to a couple pertinent feeds in order to provide more news and opportunities to our readers. At the bottom of the news posts, we now have the following listings:

UNIVERSITY OF WASHINGTON SCHOOL OF PUBLIC HEALTH AND COMMUNITY MEDICINE JOB LISTINGS
Contains job listings and positions for public health or from public health agencies. Listings are from all over the world.

and

CDC'S MORBIDITY AND MORTALITY WEEKLY REPORT
Weekly report from the CDC covering health issues affecting lifespan and health quality

WHO-UNICEF World Report on Child Injury Prevention: An International Forum on the Health of Children

2008-12-11T11:49:00.000-08:00

December 11, 2008; 1:30 to 5 p.m., Hogness Auditorium, University of Washington

On behalf of the Harborview Injury Prevention and Research Center and the University of Washington's Department of Global Health, Drs. Ebel and Rivara would like to invite your participation in an important effort to create safer communities and promote the health of children across the globe.

After three years of international research and collaboration, the World Health Organization and UNICEF will release the World Report on Child Injury Prevention in December, 2008. This landmark report, edited by an international group of experts, including DR. FRED RIVARA, focuses on preventing child injuries caused by burns, drowning, road traffic crashes, falls and poisoning, hoping to avoid millions of deaths and disabilities in low and middle income countries. Worldwide, injury is a rapidly-growing cause of death for children under 18 years of age.

Drs. Ebel and Rivara will host the introduction of the World Report on Child Injury Prevention with an international forum at the University of Washington on Thursday, December 11 from 1:30 to 5:00 p.m. in Hogness Auditorium. The event will provide an overview of children's injuries worldwide, and discuss new strategies for action. Featured speakers will include international health experts, joined by representatives from the World Health Organization, UNICEF, and the Centers for Disease Control and Prevention. Attendance is complimentary and open to individuals who share an interest in global children's health. The hosts will be confirming the speaker schedule in the coming weeks, and will share more details as they become available. In the meantime, mark your calendars, and plan to join them for this important effort.

Appreciation is extended to Partner Sponsors, Seattle Children's Hospital and the University of Washington Department of Pediatrics.

For further information about the event, or sponsorship opportunities, please contact our event coordinator Kellie Tormey at 206.744.9476 or ktormey AT u.washington.edu

To register for the event, please contact Hyun Rae at 206-744-9430 or hiprc2 AT u.washington.edu

For additional background on the World Report on Child Injury Prevention, please visit:
http://www.who.int/violence_injury_prevention/child/injury/world_report/en/index.html
or
http://www.who.int/violence_injury_prevention/child/en/

Blueprint for a Healthier America: Modernizing the Federal Public Health System to Focus on Prevention and Preparedness

2008-12-02T11:44:00.000-08:00

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Trust for America's Health Releases Blueprint for Modernizing Public Health for the Presidential Transition and Next Congress

For more info and to see the complete document, visit: http://healthyamericans.org/newsroom/releases/?releaseid=145

Action Summary: Improving Health Equity via the Social Determinants of Health in the EU

2008-12-02T11:26:00.000-08:00

Release of the first year report on the work of the DETERMINE Consortium, November 2008

"..........Ensuring fair health opportunities for everyone is crucial if European societies are to uphold the values of equal opportunity, social justice and solidarity, as set out in successive EU Treaties by Member States. This requires strong political commitment and collaboration between health and other policy sectors.
DETERMINE (2007-2010) is an EU-wide project that aims to promote greater knowledge about health equity amongst decision makers and to build capacity to take on the socio-economic determinants of health inequalities (SDHI). It brings together a Consortium of over 50 health bodies from 26 European countries. The Consortium complements the work of the WHO Commission on the Social Determinants of Health.
During its first year, the Consortium focused on what the EU and its Member States are doing to address the SDHI, exploring the existing cross-government approaches, as well as strategies undertaken by other policy areas. DETERMINE's partners have also identified approaches in their countries that make use of private-public partnerships and social marketing, to improve health related behaviors amongst vulnerable groups.
The Action Summary provides an overview of the outcomes of the first year of DETERMINE, and the key messages that have emerged as a result of the Consortium's activities to date. It provides specific examples of what various EU Member States are currently doing in this area with the aim of stimulating greater commitment and further action on fairer and more equitable health for all.
The publication has been translated into Spanish and French, as well as a wide range of other European languages. It is now available on the homepage (top right-hand corner) of the DETERMINE Portal: .........."

Click here to download the document.

Bailouts create Health Pandemic

2008-12-02T11:21:00.000-08:00

By Scott Barnhart and Amy Hagopian

Taxpayers are now left holding the bag for $1 trillion in debt incurred by capitalists run rampant, brought about largely by a frenzy of deregulation over the past decade. These bailouts are as dramatic as a pandemic of influenza resulting in the Department of Health declaring marshal law, closing schools and restricting travel.

Some estimate a pandemic flu outbreak could cause up to a million deaths in the U.S. We argue the financial cost of government bailouts of unregulated corporate excess could cause even more death than a pandemic flu. The poverty, stress and violence caused by loss of jobs, ruination of retirement plans and slashes in health and education secondary to the unraveling of the nation's financial system will be associated with significant increases in rates of illness and death. The current and anticipated bailouts may avert a collapse of the economy but does not eliminate unsupported levels of debt transferred to U.S. taxpayers.

Click here for full story.

A Glossary of Culture in Epidemiology

2008-12-02T11:14:00.000-08:00

D J HRUSCHKA1, C HADLEY2
1 SANTA FE INSTITUTE, SANTA FE, NEW MEXICO, USA
2 EMORY UNIVERSITY, ATLANTA, GEORGIA, USA
JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH - NOVEMBER 2008; 62:947-951
Abstract at: http://jech.bmj.com/cgi/content/abstract/62/11/947?etoc

"....Culture frequently is used to explain population differences in health. This glossary defines key concepts and terms relevant to the concept of culture and describes three challenges-definitional, theoretical, and methodological-in identifying specific pathways by which culture affects health.

Culture is frequently invoked to account for population differences in health and to explain the diverse ways that people interpret and treat similar medical conditions. Underlying many uses of the term is the view of culture as a shared system of learned norms, beliefs, values and behaviors that differ across populations defined by region, nationality, ethnicity or religion.1-3

Culture has been proposed to affect health in three key ways

First, people use culturally specific explanatory models to think about, talk about, and direct care for health problems. This can lead to different patterns of health-seeking and prevention, as well as mismatched provision of care.4-6

Second, cultural habits and practices can protect against, modify or create novel vectors for transmissible disease through, for example, eating culturally preferred raw or undercooked food,7 8 hygienic practices such as hand-washing,9 modes of sexual activity,10 and patterns of social interaction such as mass pilgrimages.11

Third, culture indirectly influences health when learned beliefs, values, and norms affect such daily activities as food consumption,12 physical activity, and drug use13 in a way that increases (or decreases) the risk of non-communicable diseases...."

Fostering Innovation for Global Health

2008-12-02T11:03:00.000-08:00

Global Forum Update on Research for Health Volume 5, 2008Pro-Brook Publishing Limited, 192 pages (English). ISBN 978-2-940401-12-3

"..........Innovation for health is a vital driver of development. Drawing new ideas and discoveries from research, it may cross many sectors and disciplines involved in the development and application of a novel product or process.
The Global Forum for Health Research focuses on promoting an environment that fosters innovative solutions for the health of poor populations. In doing so, it places particular emphasis on health equity as the central goal, i.e. reducing health disparities within and between populations.
The fifth volume of the Global Forum Update on Research for Health provides insights into the newest thinking on innovation for global health. Some 30 leading institutions and professionals from around the world reflect on how policy, social, technological and corporate innovations can be fostered for global health........."

Full text available online [155p.] at:

http://www.globalforumhealth.org/filesupld/global_update5/Update5_FullDoc.pdf

Website:

http://www.globalforumhealth.org/Site/002__What%20we%20do/005__Publications/002__Global%20Forum%20Update%20on%20Research%20for%20Health.php

Time is Ripe for Health Care Reform: An Interview with Paul Krugman

2008-12-02T10:58:00.000-08:00

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“….The global financial crisis has created an environment that is more favorable to government intervention, social protection and health reform in the United States of America (USA) than in recent years. Paul Krugman, this year’s Nobel economics laureate, talks to the Bulletin about the challenges of pushing through health reform and the shape this could take after the 4 November presidential election….”

Click here for the full interview.

University of Washington School of Public Health Extended Degree Program News and People

Infographic: How Community Health Workers Save Lives in the Developing World

Who is healthier? Please take the GBD 2010 Health Measurement Survey!

Buying Health Care, the Individual Mandate, and the Constitution

Food Safety and Global Health: An International Law Perspective

Scaling Up in International Health: What are the Key Issues?

The Impact of Income Inequalities on Sustainable Development in London

The Biology of Disadvantage: Socioeconomic Status and Health

Deadly Delivery: The Maternal Health Care Crisis in the U.S.

Harnessing the Potential of the Mobile Phone for Health and Agriculture in Uganda (TEDxSeattle - Fiona Lee & David Edelstein)

Ontario Women’s Health Equity Report: Access to Health Care Services

Still on Health Care Reform, see below a call for conference abstracts on Health Care Reform and Health Equity.

Health Care Reform and Primary Care: The Growing Importance of the Community Health Center

CDC: Tobacco Control States Highlights 2010

Improving Access to Language Services in Health Care: A Look at National and State Efforts (Policy Brief)

Resource: Culture Clues™ UW Med Center for Patient and Family Education Services

Resource: Ethnomed

Job Insecurity and Health: A Study of 16 European Countries

TEDx Seattle

Convening Community Through Social Technologies:Stories from Puget Sound to Cape Town

TEDx Seattle is organized by the Master of Communication in Digital Media program at the University of Washington

Black:White Disparities in the United States and Chicago: A 15-Year Progress Analysis

Articles on Racism and Birth Outcomes Disparities

Global Health Justice

PAHO/WHO Online Course on Social Determinants of Health

Racism and Immigrant Health

Equality and Health

Chimamanda Adichie: The danger of a single story

Public Availability of the Health Disparities Calculator

Tackling the Wider Social Determinants of Health: Evidence from Systematic Reviews

Thank You for Your Service

How can Gender Equity be addressed through Health Systems?

Access: How do Good Health Technologies get to Poor People in Poor Countries?

Poverty, Equity, Human Rights and Health

Moving from Them to Us: Challenges in Reframing Violence among Youth

Workplace Safety and Health: Enhancing OSHA's Records Audit Process could Improve the Accuracy of Worker Injury and Illness Data

Epidemiological Approaches to Health Disparities

Healthy People 2020: The Road Ahead

USDA’s Report on Household Food Security in the U.S. in 2008

OPEN COURSE: Winter 2010 - HSERV 561: Health Promotion Planning and Evaluation with Clarence Spigner

OPEN COURSE: WINTER 2010 - Global Health 545: Child Health in Developing Countries with Donna Denno

OPEN COURSE: HSERV 571 - Cultural Competency for Public Health Practice with Sharyne Thornton

OPEN COURSE: WINTER 2010 - EPI 521 Epidemiology of Maternal and Child Health Problems with Marcia Williams

Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement

Analysis of Social Determinants of Health and Health Inequities: A Multi-Country Event on Approaches and Policy

Health Reform Briefing: “Health Equity: A Moral and Economic Imperative!”

Income, Poverty, and Health Insurance Coverage in the United States: 2008

Education Matters for Health

Understanding Health Inequalities

Towards the Elimination of Cancer Disparities

Structural Interventions for addressing Chronic Health Problems

Low Life Expectancy in the United States: Is the Health Care System at Fault?

Population and Health Policies

The Effect of Economic Recession on Population Health

Mapping for Health Advocates

Local Government Actions to prevent Childhood Obesity

The Good Doctors: The Medical Committee for Human Rights and the Struggle for Social Justice in Health Care

The U.S. Government’s Global Health Policy Architecture: Structure, Programs and Funding

Poverty-alleviation program participation and salivary cortisol in very low-income children

Epi + demos + cracy: Linking Political Systems and Priorities to the Magnitude of Health Inequities--Evidence, Gaps, and a Research Agenda

A Time of Opportunity: Local Solutions to Reduce Inequities in Health and Safety

WHO Assembly Resolution on: Reducing Health Inequities through Action on the Social Determinants of Health

Putting Women’s Health Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level

Seattle King County Public Health Reserve Corps

Women’s Mental Health Publications

Unnatural Causes: Social Determinants of Health

Indigenous Children’s Health Report

Why Your Zip Code may be more Important to Your Health than Your Genetic Code

World Bank admits most Health Aid Fails

Human Rights Framework for Financing Health Care

Health Care Reform Proposals: Californians Weigh In

Mental Health and Inequality

Socioeconomic Interventions and Studies on Social Determinants of Health

Social Epidemiology: Social Determinants of Health in the United States: Are We Losing Ground?

Racial/Ethnic Disparities in Self-Rated Health Status among Adults with and without Disabilities – U.S., 2004-2006

Understanding Population Health and Public Health

Reducing Health Inequities through Action on the Social Determinants of Health

A Glimmer of Hope for Microbicide Research

Bill Gates on Changing the World

Blind Optimism: Challenging the Myths about Private Health Care in Poor Countries

Convening Community Through Social Technologies:
Stories from Puget Sound to Cape Town