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In Australia we have become preoccupied with the potential adverse impact of our ageing population on our health and social systems. The projected cost of having increasing proportions of our population in the over 70s, retired, chronically ill category of the demographic profile is emerging as a major challenge for governments and private insurers: so much so in fact that the government is now urging older people to stay at work longer. In America, new approaches to the management and self-management of chronic diseases have been invoked to encourage and support older people to improve their quality of life and reduce their recourse to and dependence upon health care technologies, clinical interventions and health care management systems. Unless this is achieved, it is argued, the cost of looking after this emerging ‘bubble’ of elderly people will become increasingly unsustainable as fewer and fewer (proportionately) younger people work to pay the taxes that support ageing, retired, sick and dependent populations. This paper argues that we are at real risk of having our economic wealth and productivity impeded and truncated by the financial burden of looking after high demand and high cost dependants at the aged end of the social demographic. This paper offers an alternative view of our ageing population, as well as highlighting some of the assets we have in our elderly populations, and providing suggestions as to an alternative view of the phenomenon of ageing that incorporates elements such as flexible working arrangements and the application of new, enabling technologies. This approach to our ageing population dilemma is predicated on a concept of lifelong learning and social participation along with better preventive and early intervention systems of health care. [ABSTRACT FROM AUTHOR]

The U.S. Department of Health and Human Services implemented the Healthy People initiative to set national health objectives for four different decades since 1979. This national effort has promoted a shared vision for improving the health of all Americans in a very fragmented health care delivery system. The current Healthy People 2020 initiative being implemented by the Department's Office of Disease Prevention and Health Promotion differs from previous efforts in several important ways. This paper explores one of these changes: implementation of a new communication strategy based in modern information technology. This strategy conceptualized a Healthy People 2020 online space that would be a user-focused, 'one-stop shop' for public health and health care professionals, policymakers, and community members to learn about the objectives, plan interventions, and implement strategies to reach the 2020 objectives. The communication strategy incorporated new digital media, including building a following on LinkedIn and Twitter. At present, membership in the Healthy People LinkedIn group is more than 7700 people, and the Healthy People Twitter account (@gohealthypeople) has nearly 50 000 followers. In addition to the growth in number of users, the success of the communication strategy is also confirmed by the consistently high customer satisfaction rankings the site receives from the American Customer Satisfaction Index E-government Satisfaction Index. New developments in digital communication technology have the potential to advance three principal functions originally conceptualized for Healthy People 2020 online: benchmarking, advocacy, and connecting with others. Several exciting digital tools can be used to implement each of these key Healthy People 2020 functions, including mobile Web site optimization, smartphone/tablet apps, social media, and cloud computing. Ultimately, HHS can conduct research with Healthy People target audiences and stakeholders to inform the types of digital tools that will be most helpful to Healthy People 2020 users. [ABSTRACT FROM AUTHOR]

There is a very clear need for the expanded application of information technology (IT) in healthcare. Clinical workflow still depends largely on manual, paper-based medical record systems in an activity that is economically inefficient and produces significant variances in medical outcomes. IT spend currently represents around 1.3% of total healthcare spend on average. As shown in Table ES.1, this equates to a global market for healthcare information products and services of $47.5 billion in 2002. The value is forecast to grow by an average of 9.4% per annum to reach $74.5 billion in 2007. As may be expected, the US dominates the market, taking just under 50% of the 2002 global revenues, but will marginally fall back to take under 49% of the total by 2007. During this period, the US market is forecast to grow by an average of 8.9% per annum from $23.7 billion in 2002, to $48.7 billion in 2007. In contrast, the European market will grow at an average of 10.1% per annum, Japan by 8.5% per annum, but the rest of the world, which is currently under-provided with IT, by 10.5% per annum. Table ES.1. World healthcare IT market by region, 2002 and 2007. Year 2002 2007 Region Revenues ($ billion) Total (%) Revenues ($ billion) Total (%) Average per annum growth (%) Source: Author's estimates. US 23.7 49.9 36.3 48.7 8.9 Europe 14.3 30.1 23.2 31.1 10.1 Japan 3.9 8.2 5.9 7.9 8.5 Rest of the world 5.6 11.8 9.2 12.4 10.5 World total 47.5 100.0 74.6 100.0 9.4 [ABSTRACT FROM AUTHOR]

After 30 years of public health policy based on a rational-choice model of behaviour, women in the USA continue to have sex, get pregnant and give birth to children in ways that do not conform to the behavioural prescriptions of family planning programmes. Traditionally, USA social science research has attempted to explain why women deviate from public health behavioural models. In this paper, narrative theory is employed to reorient the study of women's sexual behaviour. Specifically, reproductive life histories are analysed to illuminate how women interpret their reproductive experiences and how culturally available interpretative materials, in particular prescriptive ideals and explanatory narratives, may prospectively influence women's reproductive experiences. [ABSTRACT FROM AUTHOR]

This paper proposes a new framework for describing well-being and hardship among low-income families. We describe previously unmeasured costs of being poor as latent, those costs that are hidden and not counted in other poverty measures, and sequential, those costs that are consequential and have subsequent cost implications. Using data from in-depth interviews with cash assistance recipients and working poor heads of household, we explore latent and sequential costs of poverty related to health. Families experience a wide variety of latent and sequential costs associated with their dental, vision, and general health needs. [ABSTRACT FROM AUTHOR]

The interdisciplinary education of health professionals in the USA has increasingly been tied to renewed efforts directed toward quality improvement in the healthcare system, where problems with communication, collaboration, and cooperation are seen as endemic. Many of the published reports and recommendations on interdisciplinary programming, however, have omitted or downplayed the difficulties and challenges of developing and sustaining efforts in this area. Through the presentation of a detailed case study and the exploration of two laws of interdisciplinary programming proposed from it, this paper explores the fundamental difficulties of developing and, more importantly, sustaining interdisciplinary health professions programs in higher educational settings. The utilization of strategies based on emerging forces in the healthcare system and in higher education itself is suggested for initiating interdisciplinary projects, and structural and procedural factors are explored as critical in guaranteeing the long-term sustainability of such programs. Recommendations for the successful development and implementation of interdisciplinary programs in higher educational contexts are suggested, focusing particularly on the role of an advocate in the top down and bottom up development and maintenance of the resources needed for the success of such programs. [ABSTRACT FROM AUTHOR]

In 1905, Massachusetts General Hospital initiated the first medical social work program in the United States. Based on the writings of its leaders, this paper presents the early history of medical social work in the United States. Inspired by developments in European health care that emphasized the community context of disease, medical social work pioneers saw a need to individualize the patient while also promoting public health measures in the community, improving the patient's environment to eliminate the causes of disease. In addition, since they served patients because of their diseases rather than their poverty, medical social workers were among the first to provide social work services to the non-poor. In spite of their emphasis on environmental change, many of early medical social work leaders had an anti-institutional bias; they were suspicious of large-scale solutions for what they saw as fundamentally individual problems. Consequently, methods for promoting individual adaptation developed more rapidly than methods for promoting environmental change. Ironically, the medicalization of social problems in contemporary times has resulted in a focus on individual pathology rather than social and lifestyle causation in health, even as the rising cost and complexity of the system challenges health care consumers in the United States. Reaffirming the environmental emphasis of medical social work pioneers provides a way for today's health care social workers to incorporate environmental modification into their practice and promote the health of all citizens. [ABSTRACT FROM PUBLISHER]

Twice in recent times, the federal government mailed critical health-related information to every household in the United States. The mailings, the 1988 brochure Understanding AIDS and the 2001 postcard A Message to Americans, were designed to provide the general public with important information about needed action. This paper compares the development process undertaken for each mailing. The authors assess content and format in light of communication principles and the functional literacy skills of average adults. The authors, noting that the reading grade level of the postcard exceeds the reading ability of the average adult, recommend that plain language guidelines be combined with health and risk communication principles in all future efforts to alert the public. [ABSTRACT FROM AUTHOR]

Health and health care delivery continue as dominant domestic issues in the United States. Health also represents a highly sophisticated social work practice area, requiring specific expertise for intervention with complex biopsychosocial patient care issues. Current social work curriculum content must reflect contemporary practice issues and educational resources must be improved to meet the documented need for adequately prepared health care professionals. This paper proposes a curriculum template for practice education and offers additional recommendations to enhance the educational process through increased field and academic collaboration. [ABSTRACT FROM AUTHOR]

There has been considerable progress in reducing barriers to care for African and Hispanics Americans. Yet current research indicates that overall African and Hispanic Americans are disproportionately encountering barriers to care. Unfortunately very little is known regarding the status of African and Hispanic Americans with disabilities. The purpose of this paper is to assess by using data from the 1987 National Medical Expenditure Survey (NMES), the degree of disability for African, Hispanic and Native Americans and the extent to which it is correlated with the use of services. The findings report that as in the case of other African and Hispanic Americans, African and Hispanic Americans with disabilities dis-proportionately encounter barriers to care. They are more likely than whites to lack insurance, a regular provider and less likely to see a doctor during the year. The implications of these findings for the care of persons with disabilities are discussed. [ABSTRACT FROM AUTHOR]