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In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines [...]

Introduction In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of [...]

Introduction In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and vaccine combinations [...]

In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and vaccine combinations against [...]

In accordance with its mandate to provide guidance to Member States on health policy matters, WHO is issuing a series of regularly updated position papers on vaccines and vaccines combinations [...]

This paper reports on a critical systems inquiry into the complexities of the implementation of a District Health System in the KwaZulu-Natal province of post-Apartheid South Africa. The inquiry process, which was `governed' by Checkland's Soft Systems Methodology (SSM) and followed the four-phase learning cycle developed by Kolb, produced `conceptual models' which enabled participant stakeholders to gain fresh perspectives on the context and, in so doing, to get the implementation process `unstuck'. At the theoretical/methodological level the paper contributes to the growing literature on the combination of systems methods by illustrating how conceptual models of purposeful human activity, a method intrinsic to SSM, were constructed from the participatory use of Concept Maps and Sign-graph Diagrams. We also reflect on the interrelationship between methodology/method combination and two other aspects of the intervention that we considered to be important for maintaining the `systemicity' of the intervention, viz., the inquiry context and boundary critique. Keywords boundary critique; health systems; learning cycle; policy, INTRODUCTION The difficulties that public agencies have in achieving the goals of social policies are often rooted in the limitations of conventional managerial approaches in dealing with the `messy' problems [...]

What drives people towards tobacco use? What prevents people from doing physical exercise or adopting preventive measures during a pandemic? What increases the likelihood that someone will adhere to treatment [...]

The US Department of Education's Principles of Effectiveness require recipients of Safe and Drug-Free Schools and Community Act funds to: a) base drug and violence prevention programs on needs assessment data, b) develop measurable program goals and objectives, c) implement programs with research evidence of effectiveness, and d) periodically evaluate programs relative to their goals and objectives. This paper reports the extent of awareness of the Principles of Effectiveness and plans for their implementation among public school districts and schools in the United States in the year following their announcement. Results showed a greater percentage of public school districts than individual schools knew about the principles and planned for implementation, but baseline levels of awareness for both districts and schools were relatively low. Schools were more likely to know about the principles when their associated school district also knew. Results suggest a need for greater communication about the principles to school districts, and in turn, a need for greater communication between district and school-level substance use prevention staff., On July 1, 1998, the US Department of Education promulgated the Principles of Effectiveness and made compliance with the principles prerequisite for public schools to continue receiving funds through the [...]

In recent years community involvement and increasingly local partnerships with community groups have become central themes in debates and policies surrounding urban regeneration. The paper attempts to explore the contribution that operational research and systems research could make to these debates. The potential contribution will be illustrated by a case study on developing community involvement in the context of a local area health initiative, namely the Health Action Zone Programme. The case study describes work undertaken over a period of two years, ending in April 2001, and reflects on how community involvement as a strategy was formed through paying attention to local relationships, and institutions. A range of participatory techniques was used as well as methods from operational research and the systems field. A framework for community involvement was developed from the work and will be presented. Keywords community involvement; regeneration; systems thinking; community OR, INTRODUCTION Probably the most important theme of the UK government's regional policy for health is regeneration. It is claimed that the processes and partnerships put in place to regenerate areas [...]

prior authorization (PA) is one of the several techniques employed by pharmacy benefit management firms to control drug costs. There are no rigorous tests of the underlying assumptions inherent in its process or its effect on the utilization of drugs and subsequent costs of care. This paper discusses an early investigation into PA programs used by different organizational types found within managed care. We sought to obtain information regarding several aspects of PA programs including the decision rules used to determine both the need for a PA for a particular drug product, the costs of the process and the means used to audit and ensure its cost-effectiveness. Findings from 20 semi-structured telephone interviews with a purposive sample of individuals identified as employees of organizations actively using prior authorization for formulary management (PBMs, health maintenance organizations and preferred provider organizations) are reported. Although none of the represented organizations had evaluated their PA program, interviewees were unanimous in their opinion that PA had achieved the desired effects of lowering utilization of selected drugs and reducing overall pharmacy costs. PA programs have continued as a formulary management strategy with only minimal understanding of the implications positive or negative., Currently in the US there is a strong emphasis being placed on health policy that ensures access to high quality medical care but with due consideration of costs. Unfortunately, economic [...]

To understand the relationship between demographic characteristics of schools and school health policies and programs, this study analyzed data from the School Health Policies and Programs Study (SHPPS) 2000. SHPPS 2000 provides nationally representative data on eight components of school health. Data were collected from school faculty and staff using onsite, computer-assisted personal interviews, then linked with extant data on school characteristics. Results from a series of regression analyses indicated that the presence of most policies and programs examined differed according to school type (public, private, or Catholic), urbanicity, school enrollment size, per-pupil expenditure, percentage of White students and, among high schools, percentage of college-bound students. No one type of school, however, was more likely than another type to have all key aspects of a school health program in place. Regardless of school characteristics, all schools are capable of implementing quality school health programs. (J Sch Health. 2003;73(4):143-149), School health programs can play a critical role in reducing health-risk behavior and promoting healthy behavior among young people. Allensworth and Kolbe described eight components of a comprehensive school health [...]

The cage was a mete and a half high, two metes long and covered in dense netting attached to metal bars. It was padlocked at the top. 'Like a cage [...]

Influenza is a major cause of morbidity and mortality among residents of nursing homes. (1) Many nursing homes therefore aim at high vaccination rates. To meet this aim some homes [...]

The public health white paper for England Choosing Health: Making Healthy Choices Easier (Department of Health (DH) 2004) was published last November. The RCN welcomed the white paper, which signalled [...]

Ministers have spelled out their plans to make community based senior nurses central to delivering their public health agenda. The Department of Health published its public health white paper, Choosing [...]

On Sunday March 14 the Sunday Express and the Sunday Times carried stories on the government's plans to curb the UK's 'binge drinking' culture. Social factors such as violence and [...]

On Sunday November 30 the Sunday Mirror reported on the poverty trap many pensioners are caught in--struggling to buy food and clothes. Community nurses see the effects of this hardship [...]

Immigrants represent 28% of the Canadian population over 65, and older immigrants--more of them are women--now comprise the majority of the aging population in Canada's large metropolitan cities. Despite ample research about abuse of older adults in general, few Canadian studies have focused on abuse of older immigrant women. This paper reports policy-relevant findings from a project that aimed to develop a shared program of research to prevent abuse of older immigrant women in Canada. The project involved a review of the literature on elder abuse and immigrant women, local meetings with key stakeholders in seven provinces, a public event in Toronto, and a two-day interdisciplinary symposium with provincial stakeholders. Two significant themes emerged from these activities: the value of bringing together professionals representing multiple disciplines and service sectors as well as older immigrant women and the need for changes in social policies to reduce older immigrant women's vulnerability to abuse and support their resilience. This paper examines relevant social policy contexts and highlights the previously-over-looked implications of the ideology of familism within policies concerning prevention of abuse and the importance of intersectoral collaboration. Les immigrants constituent 28 % de la population canadienne de plus de 65 ans. Les immigrants ages, dont la plupart sont des femmes, representent desormais la majorite de la population vieillissante des grandes metropoles canadiennes. Malgre de multiples recherches sur les violences envers les personnes agees en general, peu d'etudes canadiennes se sont concentrees sur les violences envers les immigrantes agees. Ce document presente les conclusions d'un projet visant a elaborer un programme commun de recherche pour prevenir la violence envers les immigrantes agees au Canada. Ce projet comprenait l'examen des publications existantes sur les violences envers les atnes et les immigrantes, des reunions locales avec les intervenants cles de sept provinces, un evenement public a Toronto et un colloque interdisciplinaire de deux jours avec les intervenants provinciaux. Deux themes majeurs ont emerge au cours de ces activites : d'une part l'interet de rassembler des professionnels representant de multiples disciplines et secteurs de services, et d'autre part les immigrantes agees et la necessite de faire evoluer les politiques sociales afin de reduire la vulnerabilite des immigrantes a la violence et de soutenir leur resilience. Ce document etudie les contextes sociopolitiques pertinents et met en avant les implications auparavant negligees de l'ideologie de la famille dans les politiques relatives a la prevention de la violence, ainsi que l'importance de la collaboration intersectorielle., Introduction Canada's population is becoming older and more diverse. Presently, immigrants comprise 28% of the Canadian population aged 65 years or older, and the proportion of older immigrants is larger [...]

ON PAPER, care coordination looks simple: primary care physicians and specialists collaborating to provide the best treatment for patients. Virtually all primary care physicians engage in coordinated care to some [...]

The "age-friendly cities " concept proposed by the World Health Organization (WHO) is a multi-sectoral policy approach to address demographic aging in urban settings. Canadian governments at all levels, seniors' organizations and non-governmental organizations have embraced this model for creating environments to support healthy, active aging. This paper describes how Canadian governments and partners have advanced the Age-Friendly Communities (AFC) initiative starting with the original development by WHO in 2006-07 to its current status five years later, involving the federal government, eight provinces, and 850 municipalities. With evidence of actions taken at the three levels of government, it is argued here that the successful evolution of AFC in Canada is the fruit of the national, collaborative leadership role played the Public Health Agency of Canada, the commitment of provincial partners to implement AFC fully in their jurisdiction, and the engagement of municipalities in creative and comprehensive community development with and for seniors. Le concept de << villes-amies des aines >> propose par l'Organisation mondiale de la Sante (OMS) est une approche politique multisectorielle qui vise a repondre au vieillissement demographique en milieu urbain. Tous les ordres de gouvernement au Canada, les organismes s'occupant des aines et les organismes non gouvernementaux ont adopte ce modele pour creer des milieux propices a un vieillissement actif et en bonne sante. Ce document decrit comment les gouvernements canadiens et leurs partenaires ont fait progresser l'initiative des communautes-amies des aines, depuis sa creation par l'OMS en 2006-2007 jusqu'a la situation actuelle, cinq ans apres, avec la participation du gouvernement federal, de huit provinces et de 850 municipalites. Compte tenu des mesures mises en place par les trois ordres de gouvernement, ce document explique que le developpement reussi des communautes-amies des aines au Canada est le fruit de plusieurs facteurs : le role moteur national et collaboratif joue par l'Agence de la sante publique du Canada, l'engagement des partenaires provinciaux a mettre pleinement en place le concept de communautes-amies des aines sur leur territoire, et l'implication des municipalites en faveur d'un amenagement creatif et global de leur collectivite pour et avec les aines., Introduction Population aging and urbanization are two of the most significant trends shaping the 21st century. The number of persons aged 60 and over as a proportion of the global [...]

The beginning of the AIDS epidemic in the 1980s placed tremendous strain on the Food and Drug Administration, regulator of one quarter of the domestic US economy and protector of the nation's drug supply. Much has already been written on the AIDS epidemic, and this body of literature continues to expand, but careful consideration of this subject matter is of crucial significance to understanding the interaction between regulatory agencies, the executive branch, industry, and the public. Periodically, the FDA has gone through phases in which various priorities dominated. At one point or another it has distinguished itself as a regulatory agency, law enforcement agency, and science agency, depending on the political party in power, the ideology of the FDA Commissioner, and the influence of external stakeholders. The AIDS epidemic, which gave rise to a new and robust coalition of AIDS activists, reformers, and libertarians, tested the agency's institutional identity. To some commentators, the FDA's management of the AIDS crisis was a serious blunder, akin to the Reagun administration's failure. This paper contends, however, that despite the absence of presidential leadership, the FDA succeeded in rising to the challenge of the AIDS epidemic in the 1980s by refashioning its existing regulatory rules, reaching out to the AIDS movement and the pharmaceutical industry, and maintaining its strong commitment to consumer protection. Le debut de l'epidemie du sida dans les annees 1980 imposa un stress enorme sur la Food and Drug Administration (FDA), agence qui regle un quart de l'economie domestique americaine et qui protege la provision des medicaments de la nation. L'epidemie du sida a deja fait couler beaucoup d'encre et cette bibliographie continue a augmenter. Toutefois, une etude soigneuse de ce sujet est d'une importance capitale pour comprendre l'interaction entre les agences regulatrices, l'organe executif du gouvernement, l'industrie et le public. Periodiquement, le FDA a traverse des phases qui etaient dominees par des priorites diverses. A un moment donne ou un autre, il a brille en tant qu'agence regulatrice, service charge de faire respecter la loi et organisme scientifique selon le parti politique au pouvoir, l'ideologie du directeur du FDA et l'influence des actionnaires externes. L'epidemie du sida qui provoqua une nouvelle et vigoureuse coalition d'activistes du sida, de reformateurs et de libertaires, mirent a l'epreuve l'identite institutionnelle de l'agence. Pour certains commentateurs, la gestion par le FDA de la crise du sida fut un gachis considerable analogue au fiasco de l'administration Reagan. Dans cette analyse, nous pretendons qu'en depit de l'absence de direction presidentielle, le FDA reussit a relever le defi de l'epidemie du sida dans les annees 1980 en refaconnant ses statuts existants, en approchant le mouvement sideen et l'industsrie pharmaceutique tout en maintenant son engagement serieux a proteger le public., While there has been much effort to refocus the FDA toward patients the past eight years, there has been relative silence from one man: Ronald Reagan. Wall Street Journal, 13 [...]

Tobacco use is a global problem and the health consequences are far reaching. Systemic approaches are needed to help investigate policies to reduce the adverse health effects of tobacco use. This paper provides an overview of the system dynamics model that has been developed to assist the Ministry of Health to evaluate the dynamic consequences of tobacco control policies in New Zealand. The model consists of six sectors: population; smoking prevalences; tobacco consumption; second hand smoke; relative risks and tobacco attributable deaths. The model is simulated for 20-30 years into the future. The simulation package used is 'iThink', and a user interface is presented for policy analysis. A range of illustrative scenarios are provided, including: business as usual; fiscal strategies involving less affordable cigarettes; harm minimization strategies involving either less addictive cigarettes or less toxic cigarettes and combinations of the above policies. The main output variables (performance measures) include current smoking prevalence, tobacco consumption and tobacco attributable mortality. Finally some areas for future model enhancement are identified. Copyright [C] 2009 John Wiley & Sons, Ltd. Keywords system dynamics; dynamic simulation; tobacco policy model; tobacco control policies; scenario analysis, INTRODUCTION 'Tobacco smoking has long been known to be a major cause of death and ill health. Smoking is the main cause of lung cancer and chronic obstructive pulmonary disease, [...]

This paper investigates the case of H5N1 bird flu in Southeast Asia, and develops a basic model of simulation using agent-based modelling to study the dynamic interaction between human activities in Bandung City, West Java province, Indonesia. It evaluates the effectiveness of several policies for Bandung City based on the infection process model for pandemic, depending on social and culture simulation using Spot Oriented Agent Role Simulator or SOARS. The results of these simulations suggest that the government should take action not only from a medical perspective, but also from the perspective of social interactions and their influences on the spread of H5N1 in Bandung City. Keywords bird flu pandemic; agent-based simulation; infection models; social preventive policies; SOARS, INTRODUCTION The objective of this research is to evaluate the effectiveness of incorporating social factors into a program to prevent a bird flu pandemic in Bandung City. First, we propose [...]

Abstract This paper attempts to analyse sexual inequality as it affects the health of women in Nigeria. Various theories that inform the study of women are briefly discussed along with [...]

This paper compares the responses of city officials in Montreal, New York, and Philadelphia to the cholera epidemic of 1832. In the absence of a medical consensus on the cause or contagious nature of the disease, physicians recommended a variety of preventive/protective measures ranging from quarantine to isolation hospitals to city sanitation. Significantly, prejudices toward immigrants, the working class, and particular ethnic groups influenced the city leaders' response to the epidemic as much as the opinion of medical experts. Of the three cities, Philadelphia experienced the lowest death rate during the epidemic--a success that contemporaries attributed to the city's hygienic/sanitation program but was due to the clean supply of drinking water from the city's state-of-the-art waterworks. Cette etude met en relief les reactions de fonctionnaires municipaux des villes de Montreal, New York, et Philadelphie devant l'epidemie de cholera de 1832. Vue le desaccord entre medecins au sujet de la cause et de la nature de la contagion, les professionels medicaux de l'epoque ont prone diverses mesures contradictoires pour effectuer la protection et prevention que tout le mondere cherchait, telles des quarantaines, l'isolement des hopitaux, et le nettoyage et l'assainissement generaux des villes. Certains prejuges a l'egard d'immigres, de classe, et d'ethnicite ont sensiblement pese dans les actions prises par les leaders municipaux--souvent autant que les opinions des experts medicaux. Des trois villes etudiees, Philadelphie a enregistre le taux de mortalite le moins eleve de l'epidemie--une reussite attribuee a l'epoque au programme municipal d'hygiene et d'assainissement. Erreur--elle avait resulte plutot de l'eau potable venue de la station de pompage ultramoderne recemment construite pour approvisionner la ville., As cholera spread through North America in the spring and summer of 1832, cities found themselves forced to combat the epidemic with minimal support from federal, provincial, or state governments. [...]

BACKGROUND: To comprehensively address the childhood and adolescent obesity epidemic, Arkansas enacted Act 1220 of 2003. Among a series of community- and schoolbased interventions, the Act requires each public school student to have his/her body mass index (BMI) assessed and reported annually to parents. The process of implementing this policy on a statewide level and lessons learned are described in this article. METHODS: A confidential, standardized protocol to measure student BMIs and report results to parents was developed. Affordable, reliable, and durable equipment was selected and school personnel who conducted BMI assessments were trained to ensure standardization. To enhance the efficiency and ease of the measurement and reporting process and promote long-term and locally based sustainability, during the first 3 years of implementation, a transition from a paper-based system to a Web-based system was made. Confidential, individualized Child Health Reports have provided students' parents with information about the health of their children. RESULTS: Participation by schools and students has been high as a result of collaboration between the health and education communities and the students and their families. Childhood obesity has not increased since Act 1220 was passed into law. CONCLUSIONS: Parents, schools, school districts, and the state are able to better understand the obesity epidemic and track progress using detailed annual data. Providing a standardized measurement protocol, equipment, and efficient data entry and report generation options has enabled Arkansas to institutionalize the BMI assessment process in public schools. Keywords: public health; school nurses; policy; health policy, child and adolescent health., Prior to the passage of Act 1220 of 2003 in Arkansas, more than 60% of adult Arkansans were either overweight (body mass index [BMI] 25-29.9) or obese (BMI ≥ 30), [...]

Using the research poem as a tool of data representation, this paper presents findings from an analysis of letters sent to President John F. Kennedy regarding the formulation of mental [...]

Health policy was an integral component of the post-war welfare state, which represented a nationally based class compromise providing concessions in the form of income support and service provision outside the ambit of the market. In Australia, development of a universal health system was delayed until the introduction of Medibank, and subsequently Medicare. Since its inception, Medicare has been subjected to retrenchment pressures that have dominated welfare state developments since the mid 1970s. This paper traces developments in the Australian health system, revealing that the major trends, privatisation and the transfer of responsibility from the collective to the private sphere, represent a movement towards a more residual system that threatens the Medicare goal of equitable access to quality medical treatment. Keywords: Health care reform, Medicare, Welfare state, 1. Introduction Along with other aspects of the welfare state, health systems internationally have encountered retrenchment pressures over the past three decades as accelerating costs coincided with the introduction of [...]

Well-designed school health education should provide students with the knowledge and skills to prevent the health risk behaviors most responsible for the major causes of morbidity and mortality. This paper reports the methodology and findings of a West Virginia statewide health education assessment initiative and describes how the findings are used to design professional development training for school health educators. Selected response items from the State Collaborative on Assessment and Student Standards Health Education Assessment Project were used to develop a 40-item assessment instrument for 6 health education content areas. In West Virginia, 51 counties and 242 schools were recruited (county response rate = 93%; school response rate = 53%); 17,549 students were tested in grades 6, 8, and high school health education classes. Mean total scores by grade were 30.61 (grade 6), 26.55 (grade 8), and 26.53 (high school), indicating a slight decline in scores as grade level increased. Females in each grade level scored higher on total Health Education Assessment Project (HEAP) scores and subtest scores than males. The results suggest notable differences across grade levels. High school students failed to meet the standard on any health education content areas, indicating the need for enhanced knowledge and skill development. During professional development training, HEAP scores were examined in the context of results from the West Virginia Youth Risk Behavior Survey to underscore the importance of providing quality skills-based health education in West Virginia schools. (J Sch Health. 2005;75(6): 193-198), The Centers for Disease Control and Prevention (CDC) identified 6 behavioral categories most responsible for the major causes of morbidity and mortality: (1) behaviors that lead to intentional and unintentional [...]