Health Equity: 11/14/08

Friday, November 14, 2008

[EQ] Models.Evidence, and Health Inequities: three new articles from J Epidemiol Community Health

Three articles in the current issue of : J Epidemiol Community Health

1 December 2008; Vol. 62, No. 12

URL: http://jech.bmj.com/content/vol62/issue12/?etoc

Editorials

Iconography and Commission on the Social Determinants of Health (and health inequity)

Tony Blakely

J Epidemiol Community Health 2008;62 1018-1020

http://jech.bmj.com/cgi/content/extract/62/12/1018?etoc

“…. The report by the World Health Organization’s (WHO) Commission on Social Determinants of Health (CSDH) (Closing the gap in a generation: health equity through action on the social determinants of health)1 was launched on 28 August this year. In this issue, timed to coincide with a conference of the same name being held in London in November, we include two papers relevant to the CSDH’s work. First, a paper by Marmot (Chair of the CSDH) and Friel (CSDH staff) reflecting on some media responses in the first week following the report’s launch on how social justice is appropriately an explicit foundation for the work of the CSDH, and the process of collating evidence on how to address the social determinants of health (inequity). (see page 1095)2 Second, we include a paper by Krieger on the use of iconography ("the illustration of a subject by drawings or …”.

Theory and methods

Ladders, pyramids and champagne: the iconography of health inequities

N Krieger

J Epidemiol Community Health 2008;62 1098-1104

http://jech.bmj.com/cgi/content/abstract/62/12/1098?etoc

“… Conceptual models are crucial for theorising, depicting and explaining population distributions of health inequities. This is because a visual conceptual model, like a map, can simultaneously organise and spur ideas and observations. Incorporating both imagery and metaphor, visual models not only illustrate key constructs and causal relationships specified by scientific theories but also provide an important tool for integrating and evaluating rapidly emerging findings and for guiding new research.

It therefore is instructive to consider and contrast different sets of images appearing in the public health, policy and popular literature pertaining to (1) social stratification, (2) determinants of population health and (3) determinants of health inequities. At issue is how different types of images illuminate, or obscure, the relevant causal processes that need to be altered to improve population health and reduce health inequities.

Of particular concern are conceptual confusions created when (a) models inaccurately depict the distribution of population and resources and (b) models of determinants of population health, rather than of determinants of health inequities, are used in discussions about social inequalities in health. Although perhaps a pragmatic argument can be made for use of less politically controversial imagery in policy-oriented documents, I would argue that the public’s health will be better served by an iconoclastic iconography, one that clearly and unequivocally delineates the social facts of skewed distributions of power and resources and depicts the societal processes that generate and maintain these distributions and their embodiment in population levels and distributions of health, disease and well-being….”

Evidence-based public health policy and practice

Global health equity: evidence for action on the social determinants of health

M Marmot and S Friel

J Epidemiol Community Health 2008;62 1095-1097

http://jech.bmj.com/cgi/content/abstract/62/12/1095?etoc

“….More than 30 years ago, the older of us published a paper with the proposal that all scientific papers should start with a statement along the lines of: "These are the opinions on which I base my facts". Why pretend? To take a topical example, if you are on the nature side of the nature/nurture debates, is it likely that your next paper will be an apologia: "I take it all back; genes don’t matter at all; it is all environment"? Unlikely. Similarly, if you are on the other side. (We know. It’s both.) Here, we are not in any way arguing for a relativist credo that would say opinions are all. Along with other readers of this journal, we spend a good part of our working lives gathering, analysing and interpreting empirical evidence. Evidence matters. But everyone has values and they do affect our positions….”

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[EQ] Home care in Europe - The solid facts

Home care in Europe. The solid facts

Edited by Rosanna Tarricone and Agis D. Tsouros

WHO Regional Office for Europe - Copenhagen Denmark, 2008

Available online as PDF file [46p.] at: http://www.euro.who.int/Document/E91884.pdf

When people are not feeling well, most want to be at home. This systematic overview provides evidence for the effectiveness of home care, shows how it can be improved and explains the need for health systems to ensure equitable access to it.

“…..Demographic, epidemiological, social, and cultural trends in European countries are changing the traditional patterns of care. The next decades will see increasing rates of care-dependent older people and noncommunicable diseases as the leading cause of chronic illness and disability. The break-up of the traditional large family group and urbanization will also lead to gaps in the care of older or disabled family members. These changes in needs and social structure require a different approach to health and social sector policy and services since a disease-oriented approach, alone, is no longer appropriate. An answer to these issues could be home care, a sustainable approach to prevent the need for unnecessary acute or long-term institutionalization and maintain individuals in their home and community as long as possible.

Technological innovation together with new and modern forms of service delivery organization can represent a viable solution to developing home care in Europe provided that health care systems can further enhance integration and coordination. This publication presents evidence for health policy- and decision-makers in a clear and understandable form. It explains why health and social services should provide high-quality and targeted home care for disabled and older people. It provides evidence for the effectiveness of home care, shows how it can be improved and explains the need to ensure equitable access. The publication also explores the varied cultural and care contexts in different countries and reveals how to educate professionals and the public about these issues. This booklet seeks to broaden awareness, stimulate debate and promote action….”

Content:

Forewords

1. Home care in Europe: an overview

2. An emerging need for home care in Europe

3. The supply side of home care in Europe

4. The challenges for health policy- and decision-makers

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    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.