PubMed · 16103827
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Heidi Deutsch, Julia Joh Elligers, Radha Rajan. Next steps for MAPP.. https://doi.org/10.1097/00124784-200509000-00019
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Launched by the International League of Associations for Rheumatology (ILAR) and the World Health Organization (WHO), the Community oriented program for control of rheumatic diseases (COPCORD) aims to fill the gaps in the knowledge on the global burden of rheumatic musculoskeletal disorders (RMS). During the population survey (Stage I), data on symptoms (pain and disability in focus), rather than diseases or syndromes, is collected. The survey may be followed by a planned stage to impart health education, identify risk factors, and devise preventive and control strategies. Several countries in the Asia Pacific and Pan-America have completed COPCORD survey. Africa has recently joined. Only COPCORD Bhigwan (India) has continued into the tenth year. COPCORD Bhigwan is a fast-track model that has provided significant data on rheumatic disorders. Using COPCORD Bhigwan model, the Bone and Joint Decade (BJD) India has launched several population surveys to measure the RMS burden. There is an urgent need for a COPCORD data repository. Several COPCORD have differed in their methods. Differences pertain to population sample size, techniques for data collection and recording, chronology of events and phases, and classification of symptoms/diseases/disorders. The COPCORD model in current global use needs to be revised. Based on the COPCORD Bhigwan model, a future design for COPCORD is proposed. COPCORD needs to have a uniform and standardized core program with a flexibility to cater to regional needs. It must imbibe some of the recent advances in rheumatology while retaining its socioeconomic appeal. It must have a planned follow-up/longitudinal observational phase. Above all, it must serve and benefit community. WHO-ILAR COPCORD and the global BJD initiative must join hands to serve a common cause of controlling rheumatic musculoskeletal disorders. COPCORD is also a reflection of the ILAR mission statement "think global, act local."
The Robert Wood Johnson Foundation's Communities in Charge (CIC) program funded projects in fourteen communities that aimed to expand health insurance coverage and improve care for their uninsured residents. Our examination of seven program sites suggests that despite solid community leadership and carefully crafted plans, political, economic, and organizational obstacles precluded much expansion of coverage and constrained reforms. Redistribution of financial and organizational resources among both mainstream and safety-net institutions in these communities was hard to achieve. CIC's record offers little evidence that communities are better equipped than are other sectors of U.S. society to solve the problem of uninsurance.
Most communities support their safety-net facilities, but few supply health coverage for uninsured residents. In 1991 Hillsborough County, Florida, created a health care plan that raised the sales tax by a half-cent, used the proceeds to cover about 30,000 uninsured county residents, and assured the public that this would save money. In time, however, various conflicts combined to call into question the plan's ends and means. These challenges reinvigorated advocacy by the plan's supporters, who steered the adoption of changes that seemed to have "institutionalized" it. Community-based reformers might find this local innovation instructive as they ponder how to build enduring programs.