Thursday, February 11, 2010

[EQ] European Forum for Primary Care

Position paper of the European Forum for Primary Care
Primary care and care for chronic cancer patients in Europe

Pavlič, Danica Rotar1; de Graaf, Pim2; Buntinx, Frank3; Lionis, Christos4

Quality in Primary Care, Volume 17, Number 6, December 2009 , pp. 431-443(13)
PDF free online at: http://www.ingentaconnect.com/content/rmp/qpc/2009/00000017/00000006/art00010

 

The European Forum for Primary Care and the European Commission
Consultation Process on the European Workforce for Health:
some emerging messages

van den Heuvel, Annemarie1Aarendonk, Diederik2; Groenewegen, Peter P.3; De Maeseneer, Jan4

Quality in Primary Care, Volume 17, Number 5, November 2009 , pp. 307-309(3)
PDF Free online at: http://www.ingentaconnect.com/content/rmp/qpc/2009/00000017/00000005/art00002


Conference of the European Forum for Primary Care
Pisa Italy, 30/31 August; 2010

Call for research abstracts (researchers), policy posters for debate (policy makers) and multi-media practice presentations (practitioners)

 Deadline for submission 1 May 2010

The conference will explore a number of critical themes for primary care related to the main theme:
From Innovation to Organisational Change in Primary Care.

 Its aim is to enable participants to identify, define and appreciate the significance of questions -ranging from policy to organization, management and clinical care
 - which are likely to determine the future of primary care in Europe.
The Forum is looking to support contributions which address, in particular, issues of equitable access, cost-effectiveness, service delivery, clinical quality and the maintenance of continuity of care. Both urban and rural settings are relevant, with their differing but equally important modern pressures.

The conference scientific committee invites
submissions of abstracts for oral, poster and multi-media presentations
http://www.nivel.nl/oc2/page.asp?PageID=12284&path=/Startpunt/NIVEL%20international/EFPC/EFPC-congres-2010/Call%20for%20abstracts

Conference themes:

- Chronic disease management

- Interdisciplinary collaboration & leadership development
-
Managing properly the medicalization of health problems

- Monitoring primary care performance
-
Health indicators including patient-related health outcomes and experiences
- Research, funding and service improvement in primary care

 


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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/ KMC Area]

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[EQ] The Marmot review final report - Fair Society, Healthy Lives - England's health inequalities 'unfair and unjust'

The Marmot review final report – Fair Society, Healthy Lives 
proposes new ways to improve everyone's health and reduce inequalities that it describes as 'unfair and unjust'.

Professor Sir Michael Marmot
University College London - Department of Epidemiology & Public Health, LondonUK -
February 11, 2010

It concluded that, although health inequalities are normally associated with the poor, premature illness and death affects everyone below the wealthiest tier of English society.

Most people in England don't live as long as the rich and suffer more ill health, according to a major UCL-led review published today.

Website:  http://www.ucl.ac.uk/gheg/marmotreview/Documents

“……People living in the most deprived neighbourhoods will on average die seven years earlier than people living in the richest neighbourhoods. Even more disturbing, people living in poorer areas not only die sooner, but spend more of their lives with disability – an average total difference of 17 years. The review has estimated the cost of health inequalities in England:

·         Productivity losses of £31 – 33 billion every year

·         Lost taxes and higher welfare payments in the range of £20 – 32 billion per year

·         Additional NHS healthcare costs well in excess of £5.5 billion per year

The review also predicts an increase in the cost of treating the various illnesses that result from inequalities in obesity alone to rise from £2 billion per year to nearly £5 billion per year by 2025.

The review calls for health inequalities to sit alongside tackling climate change as one of society’s core priorities. Creating a sustainable future is, the review argues, compatible with action to reduce health inequalities: sustainable local communities, active transport, sustainable food production, and zero carbon houses will all have health benefits across society.

The six main recommendations of the review are:

·         Giving every child the best start in life

·         Enabling all children, young people and adults to maximize their capabilities and have control over their lives

·         Creating fair employment and good work for all

·         Ensuring a healthy standard of living for all

·         Creating and developing sustainable places and communities

·         Strengthening the role and impact of ill-health prevention

Professor Marmot, whose commission included the President of the Royal College of Physicians, Professor Ian Gilmore, and the Chief Executive of the Economic and Social Research Council, Professor Ian Diamond, said: "There will be those who say that our recommendations cannot be afforded, particularly in the current economic climate. We say that it is inaction that cannot be afforded, the economic and more importantly human costs are simply too high.

The health and wellbeing of today’s children, and of those children when they become adults, depend on us having the courage and imagination to do things differently, to put sustainability and well-being before a narrow focus on economic growth and bring about a more equal and fair society."

“…….Health Secretary Andy Burnham said the review would help the Government put in place a strategy to tackle health inequalities over the next decade.
“It is not right that where we live can dictate the state of our health. Everyone should have an equal chance at good health. I am passionate about getting to the heart of this issue and ensuring that young people can look forward to the same life expectancy regardless of where they are born. This report will help us make that historic achievement," Mr Burnham said….”…

            From: David McDaid

The Marmot Review Final Report

Fair Society, Healthy Lives Full Report (pdf, 25Mb)

Fair Society, Healthy Lives Executive Summary (pdf, 8Mb)

Fair Society, Healthy Lives Table of Contents (pdf, 60Kb)

Fair Society, Healthy Lives Tables and Figures (pdf, 57Kb)

Fair Society, Healthy Lives Chapter 1 - Introduction (pdf, 2Mb)

Fair Society, Healthy Lives Chapter 2 - Health inequalities and the social determinants of health (pdf, 3Mb)

Fair Society, Healthy Lives Chapter 3 - Lessons to be learnt from the current Health Inequalities Strategy, targets and indicators (pdf, 2Mb)

Fair Society, Healthy Lives Chapter 4 - Policy objectives and recommendations (pdf, 8Mb)

Fair Society, Healthy Lives Chapter 5 - Making it happen: a framework for delivering and monitoring reductions in health inequalities along the social gradient (pdf, 2Mb)

Fair Society, Healthy Lives Chapter 6 - Key policies over the life course (pdf, 2Mb)

Fair Society, Healthy Lives Annex 1 - Structure and organisation of the review (pdf, 60Kb)

Fair Society, Healthy Lives Annex 2 - Framework for indicators to assess performance improvement in delivering Review recommendations (pdf, 120Kb)

Fair Society, Healthy Lives Abbreviations (pdf, 50Kb)

Fair Society, Healthy Lives References (pdf, 350Kb)

Fair Society, Healthy Lives Index (pdf, 80Kb) 

 

            Content:

 Executive summary

 Chapter 1 Introduction

 1.1 The central themes for the Review

 1.1.1 Health inequalities are a matter of social justice

1.1.2 There is a social gradient in health and health inequalities

1.1.3 Addressing health inequalities is a matter of fairness

1.1.4 The economic context

1.1.5 Tackling health inequalities involves tackling social inequalities

1.1.6 Tackling health inequalities means tackling climate change

1.2 Conceptual framework and action on the social determinants of health inequalities

1.2.1 A framework for the Review’s recommendations

1.2.2 Policy objectives and the life course

1.2.3 Policy objectives and the social gradient

1.2.4 Health and well-being

Chapter 2 Health inequalities and the social determinants of health

2.1 Health inequalities in England – the figures

2.2 The current PSA target

 2.3 Regional variation in mortality

 2.4 Other indicators of health

 2.5 Health risks

 2.5.1 Smoking

 2.5.2 Alcohol

 2.5.3 Obesity

 2.5.4 Drug use

 2.6 The social determinants of health

 2.6.1 Early years and health status

 2.6.2 Education and health

 2.6.3 Work, health and well-being

 2.6.4 Income and health

 2.6.5 Communities and health

 2.7 Human and economic costs of inequalities

 2.7.1 Loss of years of life

 2.7.2 Loss of years of healthy life

 2.7.3 Economic costs

 Chapter 3 Lessons to be learned from the current health inequality strategy, targets and indicators

 3.1 Introduction

 3.2 Current health inequalities policy

 3.3 Lessons learnt: policy designs and approach

3.3.1 The social determinants of health

3.3.2 Investing in prevention of ill health

3.3.3 Cross-cutting action and all-policy focus on health equity

 3.3.4 Need to focus on the gradient in health inequalities

3.3.5 Small-scale policies and short timescales

3.3.6 The hunt for quick wins

3.4 Lessons learnt from delivery systems

3.4.1 Barriers to the national delivery system

3.4.2 Barriers to local-level delivery systems

3.5 Appropriateness of the targets

3.6 Issues in the construction of the targets

3.6.1 Not all dimensions of equality and inequality are covered

3.6.2 Being clear about outcomes

3.6.3 Use of national targets at local levels

3.6.4 Use of local area information to monitor inequalities

3.7 Monitoring progress in reducing health inequalities

 3.7.1 Over-simplification

 3.7.2 Problems arising from targeting

 3.7.3 Absolute and relative inequalities

 3.7.4 Unintended consequences and perverse incentives

 3.7.5 The availability of monitoring information

 3.8 Delivering across the whole system

 Chapter 4 Policy objectives and recommendations

 4.1 Introduction

     A Policy Objective A: Give every child the best start in life

     A.2 Recommendations

     A.2.1 Increased investment in early years

    A.2.2 Supporting families to develop children’s skills

    A.2.3 Quality early years education and childcare

    A.3 Policy Recommendations

    B Policy objective B: Enable all children, young people and adults to maximize their capabilities and have control over their lives.

    B.2.1 Reduce the social gradient in educational outcomes

   B.2.2 Reduce the social gradient in life-skills

   B.2.3 Ongoing skills development through lifelong learning

   B.3 Policy Recommendations

   C Policy Objective C: Create fair employment and good work for all work

   D Policy Objective D: Ensure healthy standard of living for all

   E Policy Objective E: Create and develop healthy and sustainable places and communities

   F Policy Objective F: Strengthen the role and impact of ill health prevention

 Chapter 5 Making it happen: a framework for delivering and monitoring reductions in health inequalities along the social gradient

 5.1 Delivery systems

 5.1.1 Taking a whole-system approach

 5.1.2 Empowering people: securing community solutions

5.1.3 The role of national government

5.1.4 The National Health Service

5.1.5 The role of local government

5.1.6 The role of the third sector

5.1.7 The role of private sector employers

5.1.8 Enhancing partnerships

5.1.9 Partnerships for implementation

5.2 Framework for targets and indicators to assess performance improvement

5.2.1 The framework

5.2.2 Existing sets of indicators

5.2.3 Components of the framework

5.2.4 Selection of indicators

5.3 National targets

5.4 Issues in implementing the framework

5.4.1 What dimensions of inequality should be covered?

5.4.2 To what timescale should targets relate?

5.4.3 On what type of areas or individual characteristics should indicators and targets be based?

5.4.4 Measuring the social gradient in health

5.5 Data availability

5.5.1 Limitations of the data infrastructure, both nationally and at local level

5.5.2 Improving timeliness

5.6 Addressing the problems with area based measures

5.7 Evaluating the impact of interventions

5.7.1 The need for evaluation

5.7.2 Evaluating an impact on the social gradient

Chapter 6 Key polices over the life course

 Annex 1 Structure and organisation of the review

Annex 2 Framework of indicators to assess performance improvement in delivering

Review recommendations

References

 


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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/ KMC 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] Decline in US breast cancer incidence rates after the Women's Health Initiative: socioeconomic and racial/ethnic differentials

Decline in US breast cancer rates after the Women's Health Initiative:
socioeconomic and racial/ethnic differentials.

Krieger N, Chen JT, Waterman PD.

Am J Public Health [epub advance access Feb 10, 2010]; doi:10.2105/AJPH.2009.181628 [NIHMS # 171687]

ABSTRACT
http://ajph.aphapublications.org/cgi/content/abstract/AJPH.2009.181628v1?maxtoshow=&hits=10&RESULTFORMAT=1&author1=Krieger+N&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

 

Objectives. We investigated whether there were socioeconomic and racial/ethnic disparities in recent reported declines in overall US breast cancer incidence rates attributed to post-2002 declines in hormone therapy use following publication of the Women’s Health Initiative study.

 

Methods. We analyzed 1992-2005 US breast cancer incidence data from the US Surveillance, Epidemiology and End Result (SEER) 13 Registries Database, stratified by race/ethnicity, county income level, age, and estrogen receptor (ER) status.

 

Results. As we hypothesized, between 1992 and 2005, the temporal pattern of rising and then falling US breast cancer incidence rates occurred only among White non-Hispanic women who lived in high-income counties, were aged 50 years and older, and had ER-positive tumors. No such trends were evident - regardless of county income level, ER status, or age - among Black non-Hispanic, Asian/Pacific Islander, Hispanic, or - where numbers were sufficient to conduct meaningful analyses - American Indian/Alaska Native women.

 

Conclusions. The recent decline in US breast cancer incidence was not equally beneficial to all women, but instead mirrored the social patterning of hormone therapy use. Joint information on socioeconomic resources and race/ethnicity is vital for correctly understanding disease distribution, including that of breast cancer.

(Am J Public Health. Published online ahead of print February 10, 2010: e1-e8. doi:10.2105/AJPH.2009.181628)


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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/ KMC 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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    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.