Health Equity: July 2009

Friday, July 24, 2009

[EQ] Voices from other fields - non-health policy makers and politicians across Europe on tackling the socio economic determinants of health inequalities

Voices from other fields

DETERMINE is an EU Consortium for Action on the Socio-economic Determinants of Health (SDH). 2009

An account of 40 consultations with non-health policy makers and politicians across Europe on tackling the socio economic determinants of health inequalities.

Available online at: http://www.health-inequalities.eu/pdf.php?id=f40efb2b87649ac8c6b7e25abbf1215b

This working document presents the results of consultations that DETERMINE partners undertook with policy makers from other fields, to assess their awareness of SDH and health inequalities, their readiness and capacity to take action on these issues, and the information and support tools they require. The outcomes of this document contribute to DETERMINE’s awareness raising and capacity building activities.

Table of Contents

Summary

Existing capacity and readiness for intersectoral cooperation

Understanding socio-economic determinants of health inequalities

Challenges

1. Introduction

2. Methodology

3. Respondents’ existing experience of intersectoral Cooperation

4. Respondents’ awareness of health equity and health Inequalities

The perceived importance of tackling health inequalities

Understanding the socio-economic determinants of health inequalities

5. Opportunities and barriers to address the socio-economic determinants of health inequalities

Obstacles to successful cooperation on health inequalities

6. Necessary factors to facilitate integrated policies on the socioeconomic determinants of health inequalities

Table 1: Information requirements

Table 2: Institutional support tools

Box 1: Health Impact Assessment

Take away messages for the health sector: how to successfully coordinate integrated policies

7. Conclusions

Appendix 1: The semi-structured questionnaire that guided these consultations

Policy-Maker Consultation Guide

Select bibliography

For more information on DETERMINE see: www.health-inequalities.eu

* * *

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/ KMS 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”.
------------------------------------------------------------------------------------
PAHO/WHO Website

Follow us on Twitter: http://twitter.com/eqpaho

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] Policies and actions addressing the social determinants of health inequalities

Policies and actions addressing the social determinants of health inequalities:
Examples of activity at EU and member state level in Europe

DETERMINE is an EU Consortium for Action on the Socio-economic Determinants of Health (SDH). 2009

Available online at: http://www.health-inequalities.eu/pdf.php?id=3d14434d4f7ba34b262eab73cdfe0a50

“…..The first working document is based on an analysis of 16 questionnaires in 10 policy fields, and identifies and explores actions being taken at the regional, national and EU level on the SDH which contribute to reducing health inequalities. The results reflect that although there is no systematic way to address the SDH to reduce health inequalities, many different measures are being taken in other policy areas that can contribute to this goal. The report points to different kinds of mechanisms, such as inter-sectoral committees and impact assessments that facilitate inter-sectoral work

“….The aim of this analysis was to get a better insight into EU governments’ experiences with cross-sectoral collaboration to address the social determinants of health inequalities, in order to build on these experiences.

The outcomes point to a wide range of action on the social determinants of health across Europe. Some of the factors which appear likely to contribute to action include:

• Where addressing SDHI is a stated government priority e.g. in the case of Scotland.

• Where there is a cross departmental strategy to address SDHI e.g. the Investing for Health strategy in Northern Ireland.

• Where there is reference to SDHI in policy documents – many examples are available.

• Where there are cross-government mechanisms in place which support the establishment and maintenance of partnerships
– e.g. Social Partnership Agreement in the Republic of Ireland.

• Where there are policy tools in place to facilitate action, such as IA and evaluation.

• Where there is evidence available which demonstrates clear links between health and social inequalities – e.g. Netherlands, UK, Scandinavia

• Where there is leadership at both EU and national level – e.g. Finland and UK in EU presidency….”

Table of Contents

Introduction

Clarification of terms

Building on the existing knowledge base

Task 1 outline

Overview of findings

Section one: Policy

Health Inequalities Strategies

Health Strategies referring to SDHI

Addressing SDHI in education strategies

Addressing SDHI in employment strategies

Addressing SDHI in economic strategies

Addressing SDHI in environment strategies

Addressing SDHI in urban and regional planning

Addressing SDHI in neighbourhood renewal and housing policy

Social Inclusion strategies

Section two: Structures

Ministerial and Cabinet Groups

Offices and Committees located within or driven by health ministries

Offices and Committees located within or driven by non-health ministries

Consultation and collaboration in developing policy

Tools and methodologies

Section three: EU level

EU Health Strategy and Public Health Programmes

Tools and Mechanisms

Internal Market

Conclusion

Appendix 1: Work Package Partners

Appendix 2: Abbreviated questionnaire

Appendix 3: Other policies

For more information on DETERMINE see: www.health-inequalities.eu

* * *

Follow us on Twitter: http://twitter.com/eqpaho

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] Experiences with Primary Health Care in Canada

Experiences with Primary Health Care in Canada

The Canadian Institute for Health Information (CIHI) - July 2009

Available online at:
http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_2250_E&cw_topic=2250&cw_rel=AR_2991_E

Every day a large number of Canadians receive primary health care (PHC) services. PHC is usually the first place people go when they have health concerns, often to a general practitioner (GP) or family physician (FP). PHC typically includes routine care, care for urgent but minor or common health problems, mental health care, maternity and child care, psychosocial services, liaison with home care, health promotion and disease prevention, nutrition counseling and end-of-life care. PHC is also an important source of chronic disease prevention and management and may include other health professionals such as nurses, nurse practitioners, dietitians, physiotherapists and social workers.

“……Access to a Regular Source of Primary Health Care

Access to a regular source of care is an important aspect of PHC. Canadians identify the following features of primary care as important: access, comprehensiveness, continuity, coordination, interpersonal communication, patient-centred care, technical quality, outcomes and satisfaction. As just one of many examples, continuity of care has been shown to be associated with patient experiences (such as patient satisfaction)….”

Additional Resources

Primary Health Care (PHC) Indicators Chartbook: An Illustrative Example of Using PHC Data for Indicator Reporting

http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=AR_2490_E&cw_topic=2490

Pan-Canadian Primary Health Care Indicator Development Project

http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=GR_1489_E

Primary Health Care Information

http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=indicators_phc_e

Health Indicators

http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=indicators_e

Reducing Gaps in Health: A Focus on Socio-Economic Status in Urban Canada

http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_1690_E&cw_topic=1690&cw_rel=AR_2509_E

* * *

Follow us on Twitter: http://twitter.com/eqpaho

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] Are Americans Feeling Less Healthy? The Puzzle of Trends in Self-rated Health.

Are Americans Feeling Less Healthy?
The Puzzle of Trends in Self-rated Health.

Salomon JA, Nordhagen S, Oza S, Murray CJL
Am J Epidemiol 2009;170:343-351 (doi:10.1093/aje/kwp144)

American Journal of Epidemiology Advance Access originally published online on June 29, 2009

Open Access: http://aje.oxfordjournals.org/cgi/content/abstract/170/3/343?etoc

“…….Although self-rated health is proposed for use in public healthmonitoring, previous reports on US levels and trends in self-ratedhealth have shown ambiguous results. This study presents a comprehensivecomparative analysis of responses to a common self-rated healthquestion in 4 national surveys from 1971 to 2007: the NationalHealth and Nutrition Examination Survey, Behavioral Risk FactorSurveillance System, National Health Interview Survey, and CurrentPopulation Survey.

In addition to variation in the levels ofself-rated health across surveys, striking discrepancies intime trends were observed. Whereas data from the BehavioralRisk Factor Surveillance System demonstrate that Americans wereincreasingly likely to report "fair" or "poor" health over thelast decade, those from the Current Population Survey indicatethe opposite trend. Subgroup analyses revealed that the greatestinconsistencies were among young respondents, Hispanics, andthose without a high school education. Trends in "fair" or "poor"ratings were more inconsistent than trends in "excellent" ratings.

The observed discrepancies elude simple explanations but suggestthat self-rated health may be unsuitable for monitoring changesin population health over time. Analyses of socioeconomic disparitiesthat use self-rated health may be particularly vulnerable tocomparability problems, as inconsistencies are most pronouncedamong the lowest education group. More work is urgently neededon robust and comparable approaches to tracking population health….”

* * *

Follow us on Twitter: http://twitter.com/eqpaho

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.

Thursday, July 23, 2009

[EQ] How citation distortions create unfounded authority: analysis of a citation network

How citation distortions create unfounded authority:
analysis of a citation network

Steven A Greenberg, associate professor of neurology

1 Children’s Hospital Informatics Program and Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA

BMJ Published 21 July 2009, doi:10.1136/bmj.b2680

Available online at: http://www.bmj.com/cgi/content/full/339/jul20_3/b2680

Objective To understand belief in a specific scientific claim by studying the pattern of citations among papers stating it.

Design A complete citation network was constructed from all PubMed indexed English literature papers addressing the belief that β amyloid, a protein accumulated in the brain in Alzheimer’s disease, is produced by and injures skeletal muscle of patients with inclusion body myositis. Social network theory and graph theory were used to analyse this network.

Main outcome measures Citation bias, amplification, and invention, and their effects on determining authority.

Results The network contained 242 papers and 675 citations addressing the belief, with 220 553 citation paths supporting it. Unfounded authority was established by citation bias against papers that refuted or weakened the belief; amplification, the marked expansion of the belief system by papers presenting no data addressing it; and forms of invention such as the conversion of hypothesis into fact through citation alone. Extension of this network into text within grants funded by the National Institutes of Health and obtained through the Freedom of Information Act showed the same phenomena present and sometimes used to justify requests for funding.

Conclusion Citation is both an impartial scholarly method and a powerful form of social communication. Through distortions in its social use that include bias, amplification, and invention, citation can be used to generate information cascades resulting in unfounded authority of claims. Construction and analysis of a claim specific citation network may clarify the nature of a published belief system and expose distorted methods of social citation

What this study adds:

How scientific data evolve into entire published biomedical belief systems around specific claims can be studied through a device called a claim specific citation network and the use of social network theory

Editorials

Inappropriate referencing in research

Has serious consequences, and the research community needs to act

http://www.bmj.com/cgi/content/full/339/jul20_3/b2049

“……During the preparation and writing of manuscripts, protocols, grant submissions, technical reports, and conference abstracts, authors must consider carefully the selection, completeness, and appropriateness of the articles referenced. Improper citation is not a benign practice; adequate and accurate citation is a necessity of scientifically and methodologically sound research.

Rather than treating citation errors in a particular journal article as isolated incidents, we must appreciate that such errors can be replicated in further articles and, therefore, cause considerable damage over time. Incorrect information can be promoted, alternative evidence ignored, and redundant research undertaken following inappropriate use of references, impairing scientific progress and affecting patient care….”

Supplementary materials

Files in this Data Supplement: Adobe PDF - gres611285.ww1.pdf

Supplementary Materials for: How Citation Distortions Create Unfounded Authority: Analysis of a Citation Network

Supplementary Notes

Note-1: Statements regarding a “key” or “central” role of beta-amyloid in IBM pathogenesis

Note-2: Methods

Note-3: Network properties of the claim-specific citation network

Note-4: Duplicate publication

Note-5: Specificity of antibodies used to claim the presence of beta-amyloid

Note-6: Data papers

Note-7: Lenses: the most influential papers and citations in the network

Note-8: Amplification: its definition, quantitation, and implications

Note-9: Authority emerges from bias and amplification

Note-10: Invention: conversion of hypothesis into fact by citation alone

Note-11: Back-door invention: claims systematically enter the belief system through a backdoor

Note-12: Title invention

Note-13: The claim-specific citation network extended from PubMed to NIH funded grants

Note-14: Self-serving citation and persuasive citation

Note-15: The loss of scientific implications of isolated data

Note-16: Authority of animal model papers and amplification using circularity

Note-17: Limitations of and alternatives for these analyses

Supplementary References

Supplementary Tables

Supplementary Table 1: Query results from PubMed

Supplementary Table 2: Papers with statements regarding amyloid or beta-amyloid

Supplementary Table 3: Papers, statements, and citations

Supplementary Table 4: Claim-specific citation table

Related studies:

Reporting and other biases in studies of Neurontin for migraine, psychiatric/bipolar disorders,

nociceptive pain, and neuropathic pain

Kay Dickersin, MA, PhD - August 10, 2008 http://dida.library.ucsf.edu/pdf/oxx18r10

* * *

Follow us on Twitter: http://twitter.com/eqpaho

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] Defining Comorbidity: Implications for Understanding Health and Health Services

Defining Comorbidity:
Implications for Understanding Health and Health Services

Jose M. Valderas1, Barbara Starfield2, Bonnie Sibbald,1; Chris Salisbury,3; Martin Roland,1

1National Institute for Health Research School for Primary Care Research, The University of Manchester, Manchester, UK

2Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

3National Institute for Health Research School for Primary Care Research, University of Bristol, Bristol, UK

Annals of Family Medicine ✦ www.annfammed.org ✦ vol. 7, no. 4 ✦ July/August 2009

Available online at: http://www.annfammed.org/cgi/reprint/7/4/357

"……Comorbidity is associated with worse health outcomes, more complex clinical management, and increased health care costs. There is no agreement, however, on the meaning of the term, and related constructs, such as multimorbidity, morbidity burden, and patient complexity, are not well conceptualized.

In this article, we review definitions of comorbidity and their relationship to related constructs. We show that the value of a given construct lies in its ability to explain a particular phenomenon of interest within the domains of:
(1) clinical care,
(2) epidemiology, or
(3) health services planning and financing.

Mechanisms that may underlie the coexistence of 2 or more conditions in a patient (direct causation, associated risk factors, heterogeneity, independence) are examined, and the implications for clinical care considered. We conclude that the more precise use of constructs, as proposed in this article, would lead to improved research into the phenomenon of ill health in clinical care, epidemiology, and health services….."

"….We have defined the various constructs underpinning the co-occurrence of distinct diseases (comorbidity of an index disease, multimorbidity, morbidity

burden, and patient complexity), described how these are interrelated, and shown how different constructs might best be applied to 3 different research areas (clinical care, epidemiology, health services)………."

* * *

"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".
------------------------------------------------------------------------------------
PAHO/WHO Website

Follow us on Twitter: http://twitter.com/eqpaho

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.