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The aim of this paper is to contribute technical arguments to the debate about the importance of health examination surveys and their continued use during the post-pandemic health financing crisis, and in the context of a technological innovation boom that offers new ways of collecting and analysing individual health data (e.g. artificial intelligence). Technical considerations demonstrate that health examination surveys make an irreplaceable contribution to the local availability of primary health data that can be used in a range of further studies (e.g. normative, burden-of-disease, care cascade, cost and policy impact studies) essential for informing several phases of the health planning cycle (e.g. surveillance, prioritization, resource mobilization and policy development). Examples of the use of health examination survey data in the World Health Organization (WHO) European Region (i.e. Finland, Italy, Malta and the United Kingdom of Great Britain and Northern Ireland) and the WHO Region of the Americas (i.e. Chile, Mexico, Peru and the United States of America) are presented, and reasons why health provider-led data cannot replace health examination survey data are discussed (e.g. underestimation of morbidity and susceptibility to bias). In addition, the importance of having nationally representative random samples of the general population is highlighted and we argue that health examination surveys make a critical contribution to external quality control for a country's health system by increasing the transparency and accountability of health spending. Finally, we consider future technological advances that can improve survey fieldwork and suggest ways of ensuring health examination surveys are sustainable in low-resource settings. [ABSTRACT FROM AUTHOR]

Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage. [ABSTRACT FROM AUTHOR]

The political and economic turmoil that occurred in south-eastern Europe in the last decade of the twentieth century left a legacy of physical damage. This aspect of the conflict has received considerable coverage in the media. However, surprisingly less has been reported about the effects of that turmoil on the health of the people living in the region. In an attempt to identity and synthesize data on these effects, were carried out a systematic review and used the results to put together a searchable online database of documents, reports, and published material, the majority of which have not previously been easily accessible (http://www.lshtm.ac.uk/ecohost/see/index.php). The database covers the period from the early 1990s to 2003 and will be of considerable interest to policy-makers. It contains 762 items, many of them annotated and available for downloading. This paper synthesizes the main findings obtained from the material in the database and emphasizes the need for concerted action to improve the health of people in south-eastern Europe. Furthermore, we also recommend that agencies working in post-conflict situations should invest in developing and maintaining online databases that would be useful to others working in the area. [ABSTRACT FROM AUTHOR]

European Union (EU) Member States are interested in using health impact assessment (HIA) as a means of safeguarding their obligations to protect human health under the 1997 Treaty of Amsterdam. However, several have encountered difficulties institutionalizing HIA with the policy-making process. As a consequence, the World Health Organization (WHO) Regional Office for Europe has suggested coupling HIA with strategic environmental assessment (SEA). Traditionally, the incorporation of HIA into other forms of impact assessment has been resisted, for fear of losing its focus on health issues to environmental concerns, and compromising its social model of health with the introduction of biophysical indicators. But can these fears be substantiated? In this paper, we investigate the grounds for such concerns by reviewing the relevant policy documents and departmental guidelines of four non-European countries that have considered the use of integrated assessment. We found that the case for associating HIA with SEA in Europe is strong, and offers potential solutions to problems of screening, theoretical framework, causal pathways and ready entry to the policy process. Coupling HIA with SEA may thus be the next step forward in a longer journey towards institutionalizing HIA as an independent policy-linked device.

Patient advocacy is based on the premise that people have the right to make their own choices about their health care. Personal advocacy is centred on the experiential expertise of the individual affected by the condition, whereas group advocacy is grounded on patient-centred strategies and actions. The first patient advocacy groups for arthritis were set up over 20 years ago in the USA and have subsequently spread to many other countries. This paper discusses the growth and impact of personal advocacy as well as recent developments in group advocacy in the Asia-Pacific region, Europe, and North America, in terms of arthritis awareness, research, corporate partnerships, and the Bone and Joint Decade global initiative.

At a Meeting of Investigators on Epidemiological Studies of Atherosclerosis Determinants and Precursors, which was held in Geneva on 7-9 November 1983, representatives from 26 countries reviewed the current status of epidemiological studies in this area. Particular interest was shown in the following determinants of cardiovascular disease: blood pressure, blood lipid levels, body weight, pathological studies, and tobacco use. Working papers on each determinant were prepared, and recommendations were made on areas for research, and on the need for prevention programmes and pathological studies. This article summarizes the work of the meeting.

This paper describes a technique for the analysis of the interaction between rabies control measures and the annual turnover of a fox population. The basic conditions are deduced from data on the turnover of a steady fox population, which have been found to be representative for large parts of central Europe. These conditions, together with field data on the critical density for rabies transmission and the recovery of reduced fox populations, provide a model for the prediction and evaluation of various measures of rabies control. The method is simplified by the introduction of a semigraphical procedure using the relative density of a reduced fox population, defined as the ratio of the actual population density to that of a non-reduced population.Simulation of epidemics and control measures over consecutive population cycles shows the limited effect of population control in a rabies-free area and demonstrates the questionable impact of measures that reduce a regular fox population by less than 40%, even when such reduction is effected annually.The method is easy to apply in the field and helps in assessing a number of disease and service indicators, as well as ecological factors in the planning and evaluation of comprehensive rabies control programmes.

An International Reference Preparation for Human Serum Immunoglobulins G, A, and M has been established by the World Health Organization and international units have been assigned to it. This paper describes international collaborative assays carried out by 10 specialized laboratories, which attempted to define the immunoglobulin contents of the International Reference Preparation by weight. For all immunoglobulins the estimates of contents by weight were imprecise, largely owing to heterogeneity of estimates between laboratories. Mean estimates of immunoglobulin contents by weight are given, but it is considered that the results of assays of immunoglobulin against the International Reference Preparation or related preparations are more precisely expressed in terms of international units.

The paper describes the design of, and the procedures used in a double blind randomized trial to determine whether the incidence of ischaemic heart disease can be lowered by the reduction of high and moderately high lipid levels in healthy men aged 30-59 years. The trial started in Edinburgh in 1965 and was extended to Prague and Budapest in 1966 and 1967. It is coordinated and controlled by a committee of investigators convened by the World Health Organization. The subjects were selected on the basis of a preliminary determination of serum cholesterol level. Half of the men in the upper third of the distribution of cholesterol values have been assigned at random to a treated group and take 1.6 g of clofibrate daily; the other half make up a control group and take identical capsules containing 300-350 mg of olive oil. A second control group, chosen at random from the lowest third of the cholesterol distribution, also receives the olive oil capsules. The study is designed to have a 90% chance of detecting, in the treated group, a reduction of one-third in the incidence of ischaemic heart disease if this should occur. The subjects are examined at the beginning of the trial, then at 6-month intervals for 2 years, and thereafter annually for at least 3 further years. The criteria of ischaemic heart disease are defined and the different control procedures are described. The required 15 000 subjects have now been admitted to the trial and their characteristics are described, but it is too early to report any results.

This paper reviews current methods of standardizing laboratory investigations in blood clotting, points out their shortcomings, and suggests ways of improving them. Procedures requiring standardization include the diagnosis of haemorrhagic diathesis and thrombotic tendency; the quantification of liver function; and monitoring of the effect of haemostatic replacement therapy and therapeutic anticoagulation. Care in collecting, storing, and handling blood for investigation is of primary importance. Achievements in the standardization of reagents are reviewed and examples of standardized methods are given. Although knowledge of the haemostatic process and experimental methods for its investigation have reached an advanced stage, their clinical application is still unsatisfactory owing to the inadequacy of national and international regulations. To improve the situation, one or more internationally approved laboratories for standardization and quality control, operating according to rules elaborated by experts in the field, should be designated in each country. The need for international reference laboratories is urgent.