Health Equity: 08/01/11

Monday, August 1, 2011

[EQ] How should we define health?

How should we define health?

Machteld Huber, J André Knottnerus, Lawrence Green, Henriëtte van der Horst, Alejandro R Jadad, Daan Kromhout, Brian Leonard, Kate Lorig, Maria Isabel Loureiro, Jos W M van der Meer, Paul Schnabel, Richard Smith, Chris van Weel, Henk Smid ***

BMJ 2011;343:doi:10.1136/bmj.d4163 (Published 26 July 2011)

Available at: http://bit.ly/ntDVhi

“…..Just as environmental scientists describe the health of the earth as the capacity of a complex system to maintain a stable environment within a relatively narrow range,21 we propose the formulation of health as the ability to adapt and to self manage.

This could be a starting point for a similarly fresh, 21st century way of conceptualising human health with a set of dynamic features and dimensions that can be measured. Discussion about this should continue and involve other stakeholders, including patients and lay members of the public….”

What is health?

Fiona Godlee

BMJ 2011;343:doi:10.1136/bmj.d4817 (Published 27 July 2011)

Available at: http://bit.ly/rgh8aq

“…….Edwin Heathcote is the architecture correspondent for the Financial Times. He describes one approach to maximising human health—the development of “age friendly” cities (doi:10.1136/bmj.d4418). This initiative aims to reverse the trend of removing or excluding older people from active life in cities. How can these people be brought back so that not only they but also the city survive and flourish? The answer, it turns out, is not the current vogue for ramps, big bold signs, benches, and lots of green space.

This week’s articles are the start of six weeks’ coverage building up to the UN summit on non-communicable diseases in September. Other articles will focus on how we should be tackling the key shared risk factors behind the global epidemic of chronic disease—poor diet, alcohol, tobacco, and physical inactivity…”

*** Authors:

1 Louis Bolk Institute, Department of Healthcare and Nutrition, Driebergen, Netherlands

2 Department of General Practice, Maastricht University, Scientific Council for Government Policy, The Hague, Netherlands

3 Department of Epidemiology and Biostatistics, School of Medicine, University of California at San Francisco, USA

4 Department of General Practice, VU Medical Center, Amsterdam, Netherlands

5 Centre for Global eHealth Innovation, Toronto General Hospital, Toronto, Canada

6 Department of Public Health Research, Wageningen University, The Hague, Netherlands

7 Pharmacology Department, National University of Ireland, Galway, Ireland

8 Stanford Patient Education Research Center, Palo Alto, CA, USA

9 National School of Public Health/New University of Lisbon, Portugal

10 General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands

11 Netherlands Institute for Social Research, The Hague, Netherlands

12 UnitedHealth Chronic Disease Initiative, London, UK

13 Department of Primary and Community Care, Radboud University Nijmegen Medical Centre

14 Netherlands Organisation for Health Research and Development, The Hague, Netherlands

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[EQ] Making Shared Decision-Making a Reality

Making Shared Decision-Making a Reality

No decision about me, without me

Angela Coulter, Alf Collins

The King’s Fund - London UK – July, 2011

Available online PDF [45p.] at: http://bit.ly/nGvM02

“……Shared decision-making is a process in which clinicians and patients work together to select tests, treatments, management or support packages, based on clinical evidence and the patient’s informed preferences. It involves the provision of evidence-based information about options, outcomes and uncertainties, together with decision support counselling and a system for recording and implementing patients’ informed preferences.

“……The government wants shared decision-making to become the norm in the NHS, but there is confusion about why it is important, what it involves and what the implications might be for patients, clinicians and the wider health service. This report clarifies the concept and outlines the actions needed to make the aspiration a reality.

Shared decision-making is viewed as an ethical imperative by the professional regulatory bodies which expect clinicians to work in partnership with patients, informing and involving them whenever possible….”

Content:

Summary

Why shared decision-making is important

What shared decision-making involves

What are the implications for patients, clinicians and the NHS?

Introduction

What is shared decision-making?

Two sources of expertise

Decision aids

Decision support and health coaching

Recording and implementing decisions

Shared decision-making and commissioning

When is shared decision-making appropriate?

An ethical imperative

Decision points

Applying shared decision-making in different clinical settings

What does shared decision-making look like?

Consulting style

Working with patients who have low confidence to engage

Why is shared decision-making not yet the norm?

Patchy implementation

Patients want involvement

People from disadvantaged groups have most to gain

Informed and involved patients demand less, not more

Making time to do it

Shared decision-making is effective

Incentives to improve clinical decision-making

Conclusion

References

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[EQ] Communicating the Social Determinants of Health

Communicating the Social Determinants of Health

Scoping Paper

This report was prepared for the Canadian Reference Group on social determinants of health (CRG), supported by the Strategic Initiatives and Innovations Directorate, Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada.
The views expressed within are not necessarily the views of the Public Health Agency of Canada, March 2011

Available online PDF [35p.] at: http://bit.ly/oHZxQN

“……..Barriers to media coverage of the SDH must be overcome, including a lack of knowledge of the concepts, a perceived difficulty in telling stories that capture the social determinants in tangible, measurable terms, and the perception that the social determinants are not new and therefore not newsworthy. Media have also expressed concern over stigmatizing the poor, unemployed, and less educated in society through reporting on SDH research.

Constraints on advocacy activity among public health practitioners may also hinder support among this important audience. Some have suggested that public consultation in health issues amounts to little more than tokenism, as policy-makers are under heavy pressure to achieve specific national policy targets, and may feel that community involvement slows the process down and results in a loss of control….”

Next Steps

Effective communications strategies are required to gain traction towards implementing a SDH approach. These strategies may include:

- Coordinated intersectoral action and community involvement. Communication for Social Change (CFSC) has been identified as a successful process that combines community dialogue and collective action for social change to improve the health and welfare of the community

- Advocacy, including media advocacy - working with and training journalists to ‘‘frame’’ news stories to build public support and influence decision-makers and policy-makers

- Effectively-framed messages, in politically-neutral language that make sense to people, as well as provocative statements that highlight the costs of doing nothing

- Stories about successful programs and initiatives (possibly building on the examples provided in Section 6.3 – Promising Approaches).

- Images and graphics that translate research into compelling narratives.

- Use of video and social media to reach the public directly.

Contents

Executive Summary

1.0 Introduction and Background

2.0 Key Audiences

2.1 Policy-makers and Politicians

2.2 Public health practitioners

2.3 Media

2.4 Community Groups/Activists

2.5 General Public

2.6 Additional Audiences of Interest

3.0 Current Positioning of SDH in Canada

3.1 Media Coverage

3.2 Public Understanding and Assimiliation of SDH Message

4.0 Strategies and Approaches to Communicating the SDH Message

4.1 Coordinated, Intersectoral Action

4.2 Advocacy

4.3 Communicating for Social Change

5.0 Challenges and Barriers to Increasing Awareness of SDH

5.1 Framing the Message

5.2 Barriers to Media Coverage

5.3 Individual, Political and Corporate Views

5.4 Constraints on Advocacy Activity

6.0 Potential opportunities

6.1 Social Media and Public Education

6.2 Complexity Theory

6.3 Promising Approaches

7.0 Communication and educational tools for key audiences

8.0 Next Steps

Appendix A

Appendix B

References

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