Tuesday, November 30, 2010

[EQ] Healthy Lives, Healthy People: Our strategy for public health in England

Healthy Lives, Healthy People: Our strategy for public health in England

Presented to Parliament by the Secretary of State for Health by Command of Her Majesty

London UK - 30 November 2010

Available online PDF [98p.] at: http://bit.ly/e5jzOE

This White Paper outlines a radical shift in the way we tackle public health challenges. We have to be bold because so many of the lifestyle-driven health problems we see today are already at alarming levels.

Britain is now the most obese nation in Europe. We have among the worst rates of sexually transmitted infections recorded, a relatively large population of problem drug users and rising levels of harm from alcohol. Smoking alone claims over 80,000 lives every year. Experts estimate that tackling poor mental health could reduce our overall disease burden by nearly a quarter.
Health inequalities between rich and poor have been getting progressively worse. We still live in a country where the wealthy can expect to live longer than the poor.

The dilemma for government is this: it is simply not possible to promote healthier lifestyles through Whitehall diktat and nannying about the way people should live. Recent years have proved that onesize-fits-all solutions are no good when public health challenges vary from one neighbourhood to the next. But we cannot sit back while, in spite of all this, so many people are suffering such severe lifestyle-driven ill health and such acute health inequalities.

We need a new approach that empowers individuals to make healthy choices and gives communities the tools to address their own, particular needs. The plans set out in this White Paper put local communities at the heart of public health. We will end central control and give local government the freedom, responsibility and funding to innovate and develop their own ways of improving public health in their area. There will be real financial incentives to reward their progress on improving health and reducing health inequalities, and greater transparency so people can see the results they achieve.

We are simplifying the way we organise things nationally, too, with a dedicated new public health service – Public Health England – taking the place of the complex structures that exist today. The new dedicated service will support local innovation, help provide disease control and protection and spread information on the latest innovations from around the world…..”

Content:
Foreword

Executive Summary: Our strategy for public health in England

1. Seizing opportunities for better health

2. A radical new approach

3. Health and wellbeing throughout life

4. A new public health system with strong local and national leadership

5. Making it happen

Annex: A vision for the role of Director of Public Health

Glossary

Notes

* * *
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/ KMC Area]
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[EQ] Advocating for safe and healthy public transportation

Advocating for safe and healthy public transportation:
Increasing Health Participation within a Multisectoral Framework

Mirta Roses-Periago, Director Pan American Health Organization -PAHO/WHO

Socorro Gross-Galiano, Assistant Director Pan American Health Organization PAHO/WHO

Luiz Augusto C. Galvão, Manager Sustainable Development and Environmental Health Area PAHO/WHO

Alberto Concha-Eastman, Senior Advisor Violence and Injury Prevention

Eugênia Maria Silveira Rodrigues, Regional Advisor Road Safety

Andrés Villaveces

Pan American Health Organization, PAHO/WHO, 2010 - Washington, D.C.

Available online :
English : http://bit.ly/f9UVPl

Portuguese: Pela defesa do transporte público seguro e saudável: maior participaçao da saúde em uma estrutura multissetorial.

http://bit.ly/fdcnTq

Spanish: Defensa del transporte público seguro y saludable: fomento de la participación del sector sanitario en un marco multisectorial.

http://bit.ly/gzcAYY

“….Efficient and healthy transportation systems that consider the wellbeing of populations are a desired and needed goal. A healthy and safe transportation system is one that is based on a legal framework which incorporates multisectoral work for its planning, design, and development; addresses equity at the population level; is affordable, reliable, and efficient; and has a low impact on the physical environment while providing safety to its users…”

“…this document highlights the negative health consequences of inappropriate transportation systems and presents useful strategies for overhauling and transforming them, while at the same time advocating for the continued development of well-designed, integrated, and economically viable public transportation systems that promote human health and overall quality of life….”

Content:

Introduction

Transportation Systems and Their Complexity

Public Transportation within Transport Systems

Crash Events and Public Health

Links of Different Modes of Transportation to Risks and Benefits

Overall Consequences to Health Linked to Transportation

Road Safety

Global Magnitude of Road Traffic Injuries

Magnitude of the Problem in the Americas

Modes of Transportation and Road Safety

Characteristics of Public Bus Systems in Latin America

Noise and Health

Pollution and Health (Respiratory Conditions)

Stress and Mental Health

Obesity and Health

Other Health Consequences

Preventive Interventions

Enhancement of Road Safety: Focus on Safe Public Transportation

within a Healthy Transport System

General Environmental Benefits

Noise Reduction

Air Quality

Physical Benefits of Increased Walking and Exercise

Overcoming Social Isolation and Inequalities

Social and Economic Benefits

Policy Implications and Suggested Directions

Conclusions

References





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Monday, November 29, 2010

[EQ] Clinical and service integration: the route to improved outcomes

Clinical and service integration:
the route to improved outcomes

Natasha Curry and Chris Ham
The King's Fund 2010 - ISBN 978 1 85717 605 6

Available online PDF [64p.] at: http://t.co/gdQZgQm

“…..Does integration of care act as a barrier to choice and competition?
This question has long been debated and highlights the complexities and nuances of the issue.
The debate should be informed by evidence on the performance of integrated systems – and by greater clarity on the terminology used.

Clinical and system integration makes a significant contribution to that debate by:

- describing integrated care and identifying the different forms it takes

- exploring the different levels within the system at which it operates

- setting out the evidence for the different systems.

Integration can take a variety of forms, involving either providers, or providers and commissioners, who work together to deliver better outcomes at a number of levels within the system.

This report summarises relevant evidence about high-profile integrated systems in the United States, such as Kaiser Permanente and Geisinger Health System and outlines examples of integrated care in North America and Europe for particular groups, such as older people or patients with long-term conditions – for example, the integrated health and social care teams in Torbay. It also explores the range of approaches to improving co-ordination for individual patients and carers – for example, the Care Programme Approach in mental health.

The report focuses on examples that are most relevant to the NHS in England in the context of the coalition government's programme. ......”

Content:

Executive summary

Introduction

Definitions and forms of integration

Macro-level integration

Meso-level integration

Micro-level integration

Implications for the NHS

References





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[EQ] Cross border care EU: How to choose the best hospital?

Cross border care EU: How to choose the best hospital?

- A study of hospital information portals in five EU countries

Helena Cordasev, M.A., Arne Björnberg, Ph.D. and Oscar Hjertqvist

Health Consumer Powerhouse - Report - November 2010

Available online PDF [88p.] at: http://bit.ly/e8CJSw

“………a research on hospital information portals in five European countries: the Netherlands, Denmark, Germany, the United Kingdom and Sweden.
These IT portals were analysed on aspects such as user-friendliness and quality of care information (QCI). Furthermore, a questionnaire about the use and effectiveness of such hospital information portals from the patients’ point of view was distributed in 32 European countries and evaluated afterwards. The survey indicates huge patient interest in issues of information and choice in healthcare.

The main conclusions that we draw together in this report reflect today’s picture of QCI in all major European countries. The Internet as an information source, which is available 24 hours and 7 days a week, plays a leading role in all thinkable areas of a consumer’s life. In healthcare however, it is still in its baby shoes and QCI has a long way to go before it can become a serious alternative to other information sources.

Throughout our survey we've come to see that the impact of hospital IT-portals as a source of information for patients remains low. In healthcare, people still tend to make their choices based on other grounds, such as the traditional family GP or the hospital around the corner.

One possible explanation for this might be that the consumer is generally in doubt about the reliability and credibility of Internet information in healthcare. Also the question remains unanswered, on what ground patients are ready to make active decisions about an often complicated question such as hospital treatments: independently or in close dialogue with healthcare professionals, peers and relatives. Emotional barriers from a lay-person's perspective, as fear and a general feeling of powerlessness, seem to be one of the reasons why patients tend to stick to their traditional choices.

The type of information presented on hospital information portals should evolve around at least four pillars: quality of treatment, waiting times, patient experience and patient satisfaction…..”

Contents

1. Summary

2. Why bother to make a choice?

3. Study aim and design

4. Hospital benchmarking websites

5. Comparison of existing hospital information portals

5.1 The Netherlands – top of Europe

5.2 Denmark – “small is beautiful”

5.3 Germany – a web revolution

5.4 United Kingdom – where it all started

5.5 Sweden – trailing behind

6. How user-friendly and reliable are the portals?

7. Can I find the best GP on the web?

8. Patient opinions about quality outcomes portals

9. Conclusions and visions

10. References

Appendix 1. Questionnaire used in the survey commissioned from Patient View





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[EQ] Medical education for the 21st century - Health professionals for a new century

Health professionals for a new century:
transforming education to strengthen health systems in an interdependent world

Prof Julio Frenk a, Dr Lincoln Chen b ‡ , Prof Zulfiqar A Bhutta c, Prof Jordan Cohen d, Nigel Crisp e, Prof Timothy Evans f, Harvey Fineberg g, Prof Patricia Garcia h, Prof Yang Ke i, Patrick Kelley g, Barry Kistnasamy j, Prof Afaf Meleis k, Prof David Naylor l, Ariel Pablos-Mendez m, Prof Srinath Reddy n, Susan Scrimshaw o, Jaime Sepulveda p, Prof David Serwadda q, Prof Huda Zurayk r

Available online at: http://bit.ly/edUAoJ

"…..A Lancet Commission highlights a call from 20 professional and academic leaders for major reform in the training of doctors and other healthcare professionals for the 21st century. Changes are needed because of fragmented, outdated, and static curricula that produce ill-equipped graduates. The Commission argues for major reform across the entire medical education system, in order to produce competency-led curricula for the future…"

"…..100 years ago, a series of studies about the education of health professionals, led by the 1910 Flexner report, sparked groundbreaking reforms. Through integration of modern science into the curricula at university-based schools, the reforms equipped health professionals with the knowledge that contributed to the doubling of life span during the 20th century.

By the beginning of the 21st century, however, all is not well. Glaring gaps and inequities in health persist both within and between countries, underscoring our collective failure to share the dramatic health advances equitably. At the same time, fresh health challenges loom. New infectious, environmental, and behavioural risks, at a time of rapid demographic and epidemiological transitions, threaten health security of all. Health systems worldwide are struggling to keep up, as they become more complex and costly, placing additional demands on health workers.

Professional education has not kept pace with these challenges, largely because of fragmented, outdated, and static curricula that produce ill-equipped graduates. The problems are systemic: mismatch of competencies to patient and population needs; poor teamwork; persistent gender stratification of professional status; narrow technical focus without broader contextual understanding; episodic encounters rather than continuous care; predominant hospital orientation at the expense of primary care; quantitative and qualitative imbalances in the professional labour market; and weak leadership to improve health-system performance. Laudable efforts to address these deficiencies have mostly floundered, partly because of the so-called tribalism of the professions—ie, the tendency of the various professions to act in isolation from or even in competition with each other.

Redesign of professional health education is necessary and timely, in view of the opportunities for mutual learning and joint solutions offered by global interdependence due to acceleration of flows of knowledge, technologies, and financing across borders, and the migration of both professionals and patients. What is clearly needed is a thorough and authoritative re-examination of health professional education, matching the ambitious work of a century ago.

That is why this Commission, consisting of 20 professional and academic leaders from diverse countries, came together to develop a shared vision and a common strategy for postsecondary education in medicine, nursing, and public health that reaches beyond the confines of national borders and the silos of individual professions.

The Commission adopted a global outlook, a multiprofessional perspective, and a systems approach. This comprehensive framework considers the connections between education and health systems. It is centred on people as co-producers and as drivers of needs and demands in both systems. By interaction through the labour market, the provision of educational services generates the supply of an educated workforce to meet the demand for professionals to work in the health system. To have a positive effect on health outcomes, the professional education subsystem must design new instructional and institutional strategies….."

a Harvard School of Public Health, Boston, MA, USA

b China Medical Board, Cambridge, MA, USA

c Aga Khan University, Karachi, Pakistan

d George Washington University Medical Center, Washington, DC, USA

e Independent member of House of Lords, London, UK

f James P Grant School of Public Health, Dhaka, Bangladesh

g US Institute of Medicine, Washington, DC, USA

h School of Public Health Universidad Peruana Cayetano, Heredia, Lima, Peru

i Peking University Health Science Centre, Beijing, China

j National Health Laboratory Service, Johannesburg, South Africa

k School of Nursing, University of Pennsylvania, Philadelphia, PA, USA

l University of Toronto, Toronto, ON, Canada

m The Rockefeller Foundation, New York, NY, USA

n Public Health Foundation of India, New Delhi, India

o The Sage Colleges, Troy, MI, USA

p Bill & Melinda Gates Foundation, Seattle, WA, USA

q Makarere University School of Public Health, Kampala, Uganda

r Centre for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon

"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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Monday, November 22, 2010

[EQ] WHO The world health report - Health systems financing: the path to universal coverage

WHO The world health report
- Health systems financing: the path to universal coverage

World Health Organization WHO, November 22, 2010

Website: http://bit.ly/dotQNz

“…..The objective was to transform the evidence, gathered from studies in a diversity of settings, into a menu of options for raising sufficient resources and removing financial barriers to access, especially for the poor. As indicated by the subtitle, the emphasis is firmly placed on moving towards universal coverage, a goal currently at the centre of debates about health service provision.

The need for guidance in this area has become all the more pressing at a time characterized by both economic downturn and rising health-care costs, as populations age, chronic diseases increase, and new and more expensive treatments become available. As this report rightly notes, growing public demand for access to high-quality, affordable care further increases the political pressure to make wise policy choices.

At a time when money is tight, my advice to countries is this: before looking for places to cut spending on health care, look first for opportunities to improve efficiency. All health systems, everywhere, could make better use of resources, whether through better procurement practices, broader use of generic products, better incentives for providers, or streamlined financing and administrative procedures.

This report estimates that from 20% to 40% of all health spending is currently wasted through inefficiency, and points to 10 specific areas where better policies and practices could increase the impact of expenditures, sometimes dramatically. Investing these resources more wisely can help countries move much closer to universal coverage without increasing spending.

Concerning the path to universal coverage, the report identifies continued reliance on direct payments, including user fees, as by far the greatest obstacle to progress. Abundant evidence shows that raising funds through required prepayment is the most efficient and equitable base for increasing population coverage
such mechanisms mean that the rich subsidize the poor, and the healthy subsidize the sick. Experience shows this approach works best when prepayment comes from a large number of people, with subsequent pooling of funds to cover everyone’s health-care costs.

No one in need of health care, whether curative or preventive, should risk financial ruin as a result.

As the evidence shows, countries do need stable and sufficient funds for health, but national wealth is not a prerequisite for moving closer to universal coverage. Countries with similar levels of health expenditure achieve strikingly different health outcomes from their investments. Policy decisions help explain much of this difference.

At the same time, no single mix of policy options will work well in every setting. As the report cautions, any effective strategy for health financing needs to be home-grown. Health systems are complex adaptive systems, and their different components can interact in unexpected ways. By covering failures and setbacks as well as successes, the report helps countries anticipate unwelcome surprises and avoid them. Trade-offs are inevitable, and decisions will need to strike the right balance between the proportion of the population covered, the range of services included, and the costs to be covered.

Yet despite these and other warnings, the overarching message is one of optimism. All countries, at all stages of development, can take immediate steps to move towards universal coverage and to maintain their achievements. Countries that adopt the right policies can achieve vastly improved service coverage and protection against financial risk for any given level of expenditure. It is my sincere wish that the practical experiences and advice set out in this report will guide policy-makers in the right direction. Striving for universal coverage is an admirable goal, and a feasible one – everywhere…..” [Dr Margaret Chan, Director-General, World Health Organization]

Content

Message from the Director-General

Executive summary

Why universal coverage?

Where are we now?

How do we fix this?

Raising sufficient resources for health

Removing financial risks and barriers to access

Promoting efficiency and eliminating waste

Inequalities in coverage

An agenda for action

Facilitating and supporting change

Practical steps for external partners

A message of hope





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