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PubMed2003

Urban form, health, and the law's limits.

Urban form, the law, and health are undoubtedly linked. However, nonlegal factors such as 20th-century reliance on the automobile as well as associated governmental actions and private investment choices have greatly influenced urban form, especially urban sprawl. The American system of federalism, with its traditional allocation of land-use legal authority to local governments, and resulting fragmented legal authority over causes and effects of urban sprawl, renders difficult legal efforts to reshape urban form. Legal frameworks and the dynamics and effects of urban sprawl are largely mismatched. Still, existing legal frameworks and modest legal reforms provide means to encourage or at least allow urban forms that are more conducive to health. However, the law will not easily transform urban form and deter urban sprawl.

Automobiles↗

PubMed2007

[The implementation of decentralized health systems: a comparative study of five cases in Bahia, Brazil].

Understanding the effects of health decentralization policies in Brazil requires different methodological approaches to capture the issue's complexity from distinct angles. Five case studies were thus performed to evaluate the degree of implementation of components related to decentralization of the health system management in selected municipalities (counties) in Bahia State, Brazil. A logical model was elaborated with definitions related to policy goals. A comparative study of the five municipalities, considered "exemplary cases", showed that decentralization alone does not explain the organizational changes in the municipal health systems. Local government characteristics such as the municipal master plan, governing capacity, and governance proved important for heath care changes. The main problems and insufficiencies were found in the system's management and quality of healthcare delivered to the population. The authors discuss their findings and identify critical areas for future interventions with special emphasis on the institutionalization of planning and evaluation and the development of inter-sector projects.

Brazil↗

PubMedDate not supplied

Public health as a catalyst to the growth of municipal departments in early Toronto.

Municipal public health history generally is concerned with the history of the Board of Health and the Department of Public Health. This article, in contrast, examines the role of health concerns as a catalyst to the expansion of municipal services, using City of Toronto Council Minutes and By-laws dating from 1834, and shows close links between the growth of a number of local government departments and concern for the public's health. In particular, 16 of 36 city services (44%) were found to have health concerns as contributors to their establishment and growth; in 10 of the 16, health had a major impact on growth, while in six cases, the influence of health issues was minor. Synthesis of the data revealed sanitation, safety, and the provision of services to be the common health themes which spurred the development of municipal departments. Moreover, three civic services were driven by two or more of these public health themes.

History, 19th Century↗

PubMed2002

Medicare program; supplementary medical insurance premium surcharge agreements. Final rule.

This final rule implements legislation contained in section 1839(e) of the Social Security Act (the Act). That statute authorizes a Medicare premium payment arrangement whereby State and local government agencies can enter into an agreement with the Secretary to make periodic lump sum payments for the Supplementary Medical Insurance (SMI) late enrollment premium surcharge amounts due for a designated group of eligible enrollees. Under this rule, we define and set out the basic rules for the new SMI premium surcharge billing agreement. In order to give States additional time for implementation of the provisions of this final rule, we are delaying the rule's effective date to six months from the date of its publication in the Federal Register.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed2003

Local ordinances that promote physical activity: a survey of municipal policies.

In this Utah-based study, we sought to identify the types of municipal employees responsible for physical activity policies, identify municipal ordinances that may influence physical activity, and determine local governments' intentions to implement policies. In 2001, we mailed a survey to all of the state's municipalities with the goal of measuring 6 physical activity domains: sidewalks, bicycle lanes, shared-use paths, work sites, greenways, and recreational facilities. Data from 74 municipalities revealed that planners made up a small proportion of municipal staff. Relative to cities experiencing slow or medium growth, high growth cities reported more ordinances encouraging physical activity. Physical activity policies can be monitored across municipalities. Moreover, evidence-based public health practice provides direction for limited staff and funding resources.

Bicycling↗

PubMed2003

PRISM (Program of Resources, Information and Support for Mothers) Protocol for a community-randomised trial [ISRCTN03464021].

BACKGROUND: In the year after birth one in six women has a depressive illness, and 30% are still depressed, or depressed again, when their child is 2 years old, 94% experience at least one major health problem (e.g. back pain, perineal pain, mastitis, urinary or faecal incontinence), 26% experience sexual problems and almost 20% have relationship problems with partners. Women with depression report less practical and emotional support from partners, less social support overall, more negative life events, and poorer physical health. Their perceptions of factors contributing to depression are lack of support, isolation, exhaustion and physical health problems. Fewer than one in three affected women seek help in primary care despite frequent contacts. METHODS/DESIGN: PRISM aims to reduce depression and physical health problems of recent mothers through primary care strategies to increase practitioners' response to these issues, and through community-based strategies to develop broader family and community supports for recent mothers. Eligible local governments will be recruited and randomised to intervention or comparison arms, after stratification (urban/rural, size, birth numbers, extent of community activity), avoiding contiguous boundaries. Maternal depression and physical health will be measured six months after birth, in a one year cohort of mothers, in intervention and comparison communities. The sample size to detect a 20% relative reduction in depression, adjusting for cluster sampling, and estimating a population response fraction of 67% is 5740 x 2. Analysis of the physical and mental health outcomes, by intention to treat, will adjust for the correlated structure of the data.

Adult↗

PubMed2004

Inequality of water fluoridation in Southern Brazil--the inverse equity hypothesis revisited.

The purpose of this ecological study was to investigate the association between social and economic indicators at the municipal level and the presence of water fluoridation and time when water fluoridation was implemented in the 293 municipalities of Santa Catarina State in Southern Brazil. Several social and economic indicators were obtained from official Brazilian agencies as well as from UNICEF. Questionnaires were sent to local authorities and to the local government water supply Company to obtain information about the presence or not of a fluoridated water supply and the year when fluoridation was implemented. Differences in social and economic indicators between municipalities with and without fluoridated water and between those that have had this service for different lengths of time were compared by the Mann-Whitney U test. In addition, multiple logistic regression analyses was performed to identify associations between social and economic indicators at the municipal level and presence and time of implementation of water fluoridation. Results indicated that larger populations are associated with municipalities with fluoridated water. Larger populations, higher child development indexes and low illiteracy rates are associated with a longer time since the implementation of water fluoridation. The finding that less developed municipalities delayed the provision of water fluoridation corroborates the inverse equity hypothesis.

Brazil↗

PubMed2004

Tobacco industry litigation to deter local public health ordinances: the industry usually loses in court.

BACKGROUND: The tobacco industry uses claims of state preemption or violations of the US Constitution in litigation to overturn local tobacco control ordinances. METHODS: Collection of lawsuits filed or threatened against local governments in the USA; review of previously secret tobacco industry documents; interviews with key informants. RESULTS: The industry is most likely to prevail when a court holds that there is explicit preemption language by the state legislature to exclusively regulate tobacco. The industry has a much weaker record on claims of implied preemption and has lost all challenges brought under equal protection claims in the cases we located. Although the tobacco industry is willing to spend substantial amounts of money on these lawsuits, it never won on constitutional equal protection grounds and lost or dropped 60% (16/27) of the cases it brought claiming implied state preemption. CONCLUSIONS: Municipalities should continue to pass ordinances and be prepared to defend them against claims of implied preemption or on constitutional grounds. If the ordinance is properly prepared they will likely prevail. Health advocates should be prepared to assist in this process.

Local Government↗

PubMed2001

An ecosystem approach to malaria control in an urban setting.

We conducted a research project aimed at strengthening local government and the community for a sustainable malaria control strategy. The project began with a baseline diagnosis of malaria prevalence, a KAP survey, entomology, and health services delivery, after which an epidemiological study was performed to identify risk factors associated with malaria, thereafter used to plan intervention measures. A program evaluation was conducted five years later. By using an ecosystem approach to reanalyze data, this paper discusses how malaria arises from a complex interaction of cultural, economic, ecological, social, and individual factors. Intervention measures require an intersectorial and transdisciplinary approach that does not exist at the moment. Health sector leadership is limited, and there is no true community participation. Implications for research, including the use of qualitative and quantitative methods, study design, and complexity of data analysis are discussed. Finally, implications for malaria control are discussed, stressing the differences between the ecosystem and integrated disease control approaches.

Animals↗

PubMed2006

Exemption policies and community preferences for tropical endemic diseases in the Bamako initiative programme in Nigeria.

We determined the actual written policies/guidelines and practices of fee exemptions aimed at the primary health-care level for tropical diseases treatment within the Bamako initiative system and the community's and decision makers' preferences for exemption in Nigeria. Health policy documents from the federal and state ministries of health were reviewed to determine the guidelines for exemptions, services, goods and category of people to receive exemptions. The records of the local government areas, health centres and community health committees were also reviewed to check who had received exemptions and modalities for doing so. In addition, household surveys using questionnaires was conducted. There is no clear-cut national policy regarding exemption. In areas where exemption exists, these are largely unofficial, as no official documents exist to support exemption. A total of 1594 individuals were surveyed. Community members prefer pregnant women, children and patients with TB, malaria, onchocerciasis and leprosy to be exempted from payment of fees: decision makers prefer the poor, children and patients with malaria, TB and leprosy to be exempted from payment for drugs, registration, consultation and preventive services such as immunization and antenatal services. One area of divergence between the preferences of the community and decision makers is the issue of exempting people with malaria and HIV/AIDS.

Adult↗

PubMed2003

An in depth study of the effects of socio-economic conditions on household waste recycling practices.

Waste is never consistent. Different areas use different materials, which give rise to waste streams that can vary widely in composition. With the increasing pressure on landfill operators and local governments over the amount and type of waste going to landfill, moves have to be taken to reduce, divert and recover materials. To undertake this function it is necessary to identify the composition of the waste stream. This paper contains the results of a household waste analysis conducted in a typical unitary authority of South Wales, a traditional industrial community. The waste analysis was conducted to determine whether there was a connection between an area's socio-economic standing and the quantities of waste produced. A selection of three different household categories were chosen, as described by the UK's ACORN geodemographical system. The three areas chosen were terracedd, council and semi-detached properties and were selected as they were the most dominant and easily recognised types of dwellings found in the study area. The results of the full waste analysis have been compared against a number of previous household waste characterisation studies.

Conservation of Natural Resources↗

PubMed2002

Chicago area methyl parathion response.

The Illinois Department of Public Health participated in the Chicago, Illinois, area methyl parathion (MP) response with several other federal, state, and local government agencies beginning in April 1997. This response was initiated on evidence that hundreds of homes in the Chicago area were illegally treated for cockroaches with MP over a period of several years. Through applicator receipt books and information reported by property owners and tenants, 968 homes were identified as having been treated with MP. Upon implementation of a response plan developed by the Methyl Parathion Health Sciences Steering Committee, environmental sampling and urine monitoring were provided for eligible households. Environmental sampling was conducted in 903 homes, with MP detected above levels of concern in 596 residences. Residents of these homes were offered urine sampling to determine the extent of exposure to MP. Urine samples were collected and analyzed for p-nitrophenol in 1,913 individuals. Implementation of the protocol resulted in 550 residents being relocated during the remediation of 100 households.

Adolescent↗

PubMed2002

Threats and violence in Swedish care and welfare--magnitude of the problem and impact on municipal personnel.

The problem of threats and violence at work has received increasing attention in Sweden in recent years. Exposure is especially high among health-care personnel in social services. A nationwide survey of prevalence, work environment and risk situations was conducted. A questionnaire was sent to a stratified sample of 2800 local government employees in the care and welfare sector, working mainly with the elderly or persons with developmental impairments. Seven occupational groups, including supervisors, specialists and other categories of carers, were included, and represented a population of more than 170 000 employees. The response rate was 85%. The results indicated that as many as 51% of the population had been affected by threats/violence, either verbally or physically, over the previous year. Moreover, the results suggest that over 9% of the employees in the care sector experienced acts of violence or threats on a daily basis, and several times a month by 67%. The most vulnerable groups were assistant nurses and direct carers. Verbal threats appear more common (79%), but 66% appear to have experienced physical assaults. Stratified estimates suggest that feelings of anger (41%) and helplessness (31%), but also minor physical injuries (18%), are frequent reactions. Organizational change in the workplace and high workload entailed increased risk. Threats and violence in health-care settings are a major work-environment issue. Greater knowledge of consequences for organization, work situation and health of personnel is needed.

Adaptation, Psychological↗

PubMed2006

Social inequalities in antidepressant treatment and mortality: a longitudinal register study.

BACKGROUND: Despite an increased prevalence of depression among people of low socio-economic position, it remains unclear whether their treatment with antidepressants appropriately matches their increased need compared with people from more affluent backgrounds. This study examined socio-economic differences in antidepressant prescriptions and mortality related to depressive disorders. METHOD: A longitudinal register study of 17947 male and 47458 female local government employees with linked information on socio-economic indicators (education and occupational status) and data on antidepressant use and mortality associated with depressive disorder (suicide, alcohol-related deaths) during the years 1994 to 2000. RESULTS: In men, antidepressant treatment was less common among low educational groups than among high educational groups (OR 0.87, 95% CI 0.76-0.99) and a corresponding difference was seen between occupational statuses (OR for manual v. upper non-manual 0.72, 95% CI 0.62-0.84). In women, socio-economic position was not associated with antidepressant use. However, both among the men and women, employees with low socio-economic position had increased risk for mental-health-related mortality, as indicated by suicides, deaths from alcohol-related causes, and all-cause mortality. CONCLUSIONS: These data suggest a mismatch in the treatment of depression relative to apparent clinical need, with the lowest levels of treatment concentrated in the lower socio-economic groups, despite evidence of their increased prevalence of depression and suicide.

Adult↗

PubMed2004

A study of the effects of active listening on listening attitudes of middle managers.

The present study was conducted to clarify the direct effects of active listening (AL) training given to middle managers in a local government. Altogether, 345 middle managers participated in 13 AL training sessions over two years. We developed the Inventive Experiential Learning (IEL) method, and used it as the central training method in this study. To investigate how well the participants learned AL, we asked the middle managers to answer a shorter version of the Active Listening Attitude Scale (ALAS) consisting of two subscales-i.e. "Listening Attitude" and "Listening Skill"-before training, one month after and three months after training. Altogether, 284 middle managers answered the questionnaire three times. The scores of each subscale were analyzed by repeated measurement analysis of variance. The participants were divided into three groups using the percentile values of the original sample of ALAS, i.e. low-score group (-24%), medium-score group (25-75%) and high-score group (76%-), and the proportionate changes were examined. The results showed both the "Listening Attitude" and "Listening Skill" subscales increased significantly after training. Analysis of the percentiles showed that the proportion of the low-score group decreased and that of the high-score group increased in both subscales, from one to three months after training. These changes are considered to indicate that the participants have learned AL although they attended AL training for only one day.

Analysis of Variance↗

PubMed2005

Boundary workers and the management of frustration: a case study of two Healthy City partnerships.

Partnerships between local governments, health districts and non-governmental and community-based organiza-tions are an increasingly important part of health promotion practice, as well as other policy and programme areas. Two inherent tensions in partnership working have been widely described. First, partnerships are generally set up as 'top down' initiatives, which advocate a 'bottom up' approach, with the inevitable power imbalances that this implies. Secondly, the gains made by partnerships tend to be limited compared with the claims made for them. Despite these tensions, individuals and organizations continue to devote considerable effort to making partnerships 'work'. This paper describes a study, which explored the implications of these apparent contradictions of power imbalance and potential disillusionment within partnerships. The study explored partnership working between community and statutory organizations within two very different Healthy Cities initiatives, one in the UK and the other in South Africa. This paper focuses on why the partners contributed continued effort and energy into maintaining the partnerships, despite their awareness of the constraints. Findings suggest that partners dealt with the tensions first by assuming a discrete identity as an 'entity of boundary people' that operates at the interface between the statutory sector authorities and the communities in question; and secondly, by reducing their activities to specific 'boundary' issues that do not threaten the main agenda of the authorities.

Community Participation↗

PubMed2000

Integrated Resource Management: Moving from Rhetoric to Practice in Australian Agriculture.

/ Implementing the concept of sustainability through integrated approaches to natural resource management poses enormous challenges for both the rural communities and government agencies concerned. This paper reviews the underlying rhetoric of sustainable agricultural systems and the integrated resource management paradigm and identifies some of the challenges being experienced in translating this rhetoric into practice. A relatively recently implemented community-based integrated catchment management (ICM) process in a rural community in northeast Australia is examined in terms of some of the lessons learned that may be relevant to other similar integrated resource management (IRM) processes. It reveals a pragmatic, opportunistic, and evolving implementation process based on adaptive learning rather than a more traditional "rational" planning approach. Some essential characteristics of a community-based IRM process are identified, including fostering communication; providing a structure that fosters cooperation and facilities coordination among community, industry, and government agencies; the integration of IRM principles into local government planning schemes; and an emergent strategic approach to IRM program implementation. We conclude by identifying some essential characteristics of an IRM process that can assist a community to adapt to, and manage change for, sustainable resource use.

Journal Article↗

PubMed2004

From disaster to sustainable civil society: the Kobe experience.

Nine years after the Kobe earthquake in Japan, social issues are still prominent, and the rehabilitation process is still ongoing. The earthquake caused two major changes in Japanese society: an increase in voluntary and non-government activities, and the enhancement of cooperation between local government and the residents' association. People's participation in the decision-making process was a significant achievement. To sustain the efforts generated after the earthquake, the Kobe Action Plan was formulated and tested in different disaster scenarios. The current study suggests that civil societies in urban areas are sustainable if, first, the activities related to daily services are provided by the resident's associations; and second, these are linked to economic incentives. Leadership plays a crucial role in collective decision-making. Creation of the support system is essential for long-term sustainability of civil-society activities. These observations are exemplified in the case study in Nishi Suma, one of the worst-affected areas in the Kobe city.

Community Health Planning↗