Health Equity: 10/18/07

Thursday, October 18, 2007

[EQ] Population Health: Challenges for Science and Society

Population Health: Challenges for Science and Society

David Mechanic, Institute for Health, Health Care Policy and Aging Research, Rutgers University
The Milbank Quarterly - Volume 85 Issue 3 - Page 533-559, September 2007

Website: http://www.blackwell-synergy.com/doi/full/10.1111/j.1468-0009.2007.00498.x

PDF file [27p.] at: http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1468-0009.2007.00498.x

“…….The emphasis on risk factor intervention at the individual level has predominated in efforts to reduce mortality and promote health. Interest in social and other nonmedical interventions, particularly socioeconomic status (SES) influences, has increased in recent years.

This article focuses on the interaction of social structure and socioeconomic status with other influences in complex pathways to affect health, and their contribution to health disparities. It examines both social class as an explanation of health differences and competing hypotheses concerning prenatal and early nutrition and cognitive capacity.

Although education is associated with income, wealth, occupation, and other SES indicators and may not be the most important SES determinant, it influences a variety of pathways to health outcomes and offers strategic leverage for intervention because of social and political consensus on its value beyond health….”

Annual Matilda White Riley NIH Lecture in the Behavioral and Social Sciences

2006 National Institutes of Health Bethesda, Maryland

Available as .Doc file: http://obssr.od.nih.gov/NR/rdonlyres/0ACBBE62-4B36-4004-8399-9DC56F274FC7/0/Mechanic2006.doc

Slides at: http://obssr.od.nih.gov/NR/rdonlyres/6D3BFAD5-C677-49A0-9E61-7D2D859FEFDD/0/Mechanic2006Slides.ppt

“….I begin by discussing the importance of social selection, and then illustrate how varying influences from early nutrition to broad social factors affect population health and social disparities. I conclude with some thoughts on intervention strategies.

Studies of population health depend substantially on epidemiological inquiries of different cohorts under varying social and environmental circumstances and careful theory and hypotheses are essential.

In this era of computer power and data mining, there is much descriptive epidemiology that is atheoretical, and often lacks even biological and psychosocial plausibility. Such work has rightfully earned a compromised reputation. Alvan Feinstein has noted that such efforts are unable to distinguish truth from false alarms and contribute to an epidemic of apprehension. Underlying many false results is failure to deal realistically with the influence of social selection.

In population health research, where randomized controlled trials are usually impossible, impractical or unethical, we depend on longitudinal studies using multivariate statistical designs, instrumental variables as commonly used in economics, or on natural experiments when such opportunities become available. Taking account of selection biases is imperative but it is important as well to understand how selection processes shape health outcomes…..”

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ IKM Area]

"Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members".
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[EQ] Health effects and risks of transport systems

Health effects and risks of transport systems

The HEARTS project

The Regional Office for Europe of the World Health Organization

Available online as PDF file [97p.] at: http://www.euro.who.int/document/E88772.pdf

“…… The health effects of urban transport have received increasing attention in the last years. This report provides a framework for integrated assessment of health impacts from urban transport.

Promoting healthy and sustainable transport options to prevent the negative effects of transport systems on human health is an important goal of modern policy development. This means ensuring that health issues are considered when transport policies are being formulated and creating the conditions to develop integrated assessments, monitor progress, account fully for social and environmental costs and identify the strategies with the greatest net benefits.

Integration initially requires combining scientific knowledge, methods and results into one long list.

Further, integration comprises selecting the procedures and practices that contribute most to the overall objective of a healthy and sustainable transport system. Overcoming the shortcomings of fragmented and even inconsistent approaches is also important. More importantly, integration also means promoting a dialogue and developing shared language and tools between various sectors of civil society (such as health, transport and environment) and stakeholders. Nevertheless, analytical tools to pursue an integrated assessment of transport scenarios have been unavailable, inadequate or scantily produced.

Characterizing transport-related exposure requires detailed information on the spatial and temporal trends of various risks, people’s mobility patterns, the ability to predict exposure in unmonitored settings and considering the policy dimension in terms of the involvement of relevant sectors. This information is developed by and is available from various professions with little experience of collaboration. A main challenge is therefore to bring together within a coherent framework a diversity of inputs to appraise the effects of transport systems on health…..”

Contents

Executive summary

1. Introduction

2. Material and methods

2.1 Reviews

2.2 Road traffic and emissions

2.3 Air pollution

2.4 Noise pollution

2.5 Road crashes

2.6 Population exposure

2.7 Health effects

2.8 Case studies

3. Results

3.1 Traffic emissions

3.2 GIS-based exposure modelling: the STEMS model

3.3 A probabilistic approach to simulating microenvironmental exposure

3.4 Case studies

4. Discussion

Policy implications - Future developments - Final considerations

5. References

* * * *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ IKM Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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PAHO/WHO Website: http://www.paho.org/
EQUITY List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.

[EQ] Financing health promotion

Financing health promotion

Dorjsuren Bayarsaikhan & Jorine Muiser

World health Organization WHO, 2007

Available online as PDF file [25p.] at: http://www.who.int/health_financing/documents/dp_e_07_4-health_promotion.pdf

“…..Health promotion is a complex, multi-sector activity. Within the health system, it is organized vertically in the form of public health campaigns or integrated in other health care interactions. Furthermore, health promotion can be encouraged on the health care market, for example through the introduction of financial incentives.

This paper advocates for health promotion in any form as a necessary intervention for improving and maintaining population health. It is considered equally relevant for developed and developing countries, although different countries may want to employ different strategies. While still under-funded in many high-income countries the lack of funding for health promotion is generally most notorious in middle and low-income countries. In

many of the latter groups, health promotion is also not included in health system financing arrangements.

This paper explores how health promotion can be integrated in health system financing schemes. The analysis departs from the health systems financing framework and is based on the health financing functions: revenue collection, pooling and purchasing. Examples from different countries are presented to illustrate a number of innovative financing options for health promotion…..”

Content:

Executive Summary

1. Introduction

2. Health promotion framework

3. Health systems financing and health promotion

3.1 The revenue collection function (performance indicators: population coverage and method of finance)

3.2 The pooling function (performance indicators: composition of risk pool(s) and the quality of risk equalization)

3.3 The purchasing function (performance indicators: provider payment mechanisms and consumer incentives)

4. Conclusion

5. References

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“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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EQUITY List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.