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PubMed1998

Core function-related local public health practice effectiveness.

This article assesses the extent to which the U.S. population in 1995 was being effectively served by public health's three core functions (assessment, policy development, and assurance). A random sample of local health departments (LHDs) stratified by population size and type of jurisdiction was asked to provide their opinion of, as well as indicate performance on 20 core function-related measures of local public health practice. The article concludes that, in 1995, the nation fell far short of its year 2000 national objective, which called for 90 percent of the population to be served by an LHD effectively carrying out public health's core functions. Considerable capacity building and performance improvement is needed within the public health system.

Humans↗

PubMed1999

Current HIV prevention activities for women and gay men among 77 ASOs.

Community-based AIDS service organizations (ASOs) are important providers of HIV prevention services in cities throughout the United States. This study examined the types of HIV prevention programs that are being undertaken by ASOs and assessed the kinds of new programs that ASOs feel are needed as the HIV epidemic continues to evolve. Factors that will need attention as new HIV prevention programs are developed by ASOs include high turnover of personnel in the organizations, capacity building that will be needed for ASOs to offer more intensive or specialized programs, and strategies to provide technical assistance as ASOs develop new types of programs.

Community Health Services↗

PubMed2003

Sharing a vision of hope for diabetes care and prevention among American Indian and Alaska Native communities: the National Diabetes Prevention Center.

The National Diabetes Prevention Center (NDPC) is an emerging model for public health practice and partnership. It is rooted in a "promising practices" framework, one that looks at what works for community diabetes prevention, care, and treatment practices. Working with national and local partners to explore new approaches to diabetes prevention invites us to move beyond traditional models of community public health partnerships. Traditional community partnership models emphasized the technical assistance in research, surveillance, and program development that can be provided by partners from outside the community. While not diminishing the importance of these activities, the NDPC seeks to provide an environment for meaningful language and discourse that adequately honors the innovative and culturally rich approaches to diabetes prevention already being developed within many American Indian and Alaska Native communities, which have some of the highest rates of diabetes in the world. The NDPC strives to provide common ground for the emergent discussions around the power and practice of solid evaluation frameworks, new information technologies, capacity-building philosophies, health systems, and collaborative approaches.

Alaska↗

PubMed2006

Global standards and accreditation in medical education: a view from the WFME.

Globalization of medicine is increasing, as manifested by the growing number of migrating doctors and cross-border education providers. In addition, new medical schools of dubious quality are proliferating. This situation accentuates the need to define standards and introduce effective and transparent accreditation systems. With this background, and reflecting the important interface between medical education and health care delivery, a World Health Organization (WHO)/World Federation for Medical Education (WFME) Strategic Partnership to improve medical education was formed in 2004. In addition to working on reform processes, capacity building, and evaluation of medical education at the regional and national levels, the partnership in 2005 published guidelines for accreditation of basic medical education. Only a minority of countries have quality assurance systems based on external evaluation, and most of these use only general criteria for higher education. The WHO/WFME Guidelines recommend establishing accreditation that is effective, independent, transparent, and based on criteria specific to medical education. An important prerequisite for this development was the WFME Global Standards program, initiated in 1997 and widely endorsed. The standards are now being used in all regions as a basis for improving medical education throughout its continuum and as a template for national and regional accreditation standards. Promotion of national accreditation systems will pivotally influence future international appraisal of medical education. Information about accreditation status--agencies involved and criteria and procedures used--will be essential to future databases of medical schools and will be a foundation for international "meta-recognition" of institutions and programs ("accrediting the accreditors").

Accreditation↗

PubMed2002

Protecting terrestrial ecosystems and the climate through a global carbon market.

Protecting terrestrial ecosystems through international environmental laws requires the development of economic mechanisms that value the Earth's natural systems. The major international treaties to address ecosystem protection lack meaningful binding obligations and the requisite financial instruments to affect large-scale conservation. The Kyoto Protocol's emissions-trading framework creates economic incentives for nations to reduce greenhouse-gas (GHG) emissions cost effectively. Incorporating GHG impacts from land-use activities into this system would create a market for an important ecosystem service provided by forests and agricultural lands: sequestration of atmospheric carbon. This would spur conservation efforts while reducing the 20% of anthropogenic CO(2) emissions produced by land-use change, particularly tropical deforestation. The Kyoto negotiations surrounding land-use activities have been hampered by a lack of robust carbon inventory data. Moreover, the Protocol's provisions agreed to in Kyoto made it difficult to incorporate carbon-sequestering land-use activities into the emissions-trading framework without undermining the atmospheric GHG reductions contemplated in the treaty. Subsequent negotiations since 1997 failed to produce a crediting system that provides meaningful incentives for enhanced carbon sequestration. Notably, credit for reducing rates of tropical deforestation was explicitly excluded from the Protocol. Ultimately, an effective GHG emissions-trading framework will require full carbon accounting for all emissions and sequestration from terrestrial ecosystems. Improved inventory systems and capacity building for developing nations will, therefore, be necessary.

Air Pollution↗

PubMed2005

Tropical forest cover change in the 1990s and options for future monitoring.

Despite the importance of the world's humid tropical forests, our knowledge concerning their rates of change remains limited. Two recent programmes (FAO 2000 Forest Resources Assessment and TREES II), exploiting the global imaging capabilities of Earth observing satellites, have recently been completed to provide information on the dynamics of tropical forest cover. The results from these independent studies show a high degree of conformity and provide a good understanding of trends at the pan-tropical level. In 1990 there were some 1150 million ha of tropical rain forest with the area of the humid tropics deforested annually estimated at 5.8 million ha (approximately twice the size of Belgium). A further 2.3 million ha of humid forest is apparently degraded annually through fragmentation, logging and/or fires. In the sub-humid and dry tropics, annual deforestation of tropical moist deciduous and tropical dry forests comes to 2.2 and 0.7 million ha, respectively. Southeast Asia is the region where forests are under the highest pressure with an annual change rate of -0.8 to -0.9%. The annual area deforested in Latin America is large, but the relative rate (-0.4 to -0.5%) is lower, owing to the vast area covered by the remaining Amazonian forests. The humid forests of Africa are being converted at a similar rate to those of Latin America (-0.4 to -0.5% per year). During this period, secondary forests have also been established, through re-growth on abandoned land and forest plantations, but with different ecological, biophysical and economic characteristics compared with primary forests. These trends are significant in all regions, but the extent of new forest cover has proven difficult to establish. These results, as well as the lack of more detailed knowledge, clearly demonstrate the need to improve sound scientific evidence to support policy. The two projects provide useful guidance for future monitoring efforts in the context of multilateral environmental agreements and of international aid, trade and development partnerships. Methodologically, the use of high-resolution remote sensing in representative samples has been shown to be cost-effective. Close collaboration between tropical institutions and inter-governmental organizations proved to be a fruitful arrangement in the different projects. To properly assist decision-making, monitoring and assessments should primarily be addressed at the national level, which also corresponds to the ratification level of the multilateral environmental agreements. The Forest Resources Assessment 2000 deforestation statistics from countries are consistent with the satellite-based estimates in Asia and America, but are significantly different in Africa, highlighting the particular need for long-term capacity-building activities in this continent.

Conservation of Natural Resources↗

PubMed1999

Participatory system development. A case study from Urban Health Lahore component DFID second family health project.

To improve effectiveness and efficiency of urban health services there is a need clearly to identify policies and the functions of various stakeholders and individuals in the system. System development, which involves, analysis of situations and the developing of solutions to address the identified issues, is necessary and forms a crucial element of system reforms. Developing systems in a participatory manner along with management capacity building can yield better results in terms of applicability of the system, improved confidence and ability of managers and service providers and sustainability of the reforms.

Decision Making, Organizational↗

PubMed1999

Public nutrition in emergencies: an overview of debates, dilemmas and decision-making.

This paper introduces and discusses the main themes and issues arising from the workshop 'International Public Nutrition in Emergencies: The Potential for Improving Practice'. Good co-ordination within the nutrition sector of the international humanitarian response system has led to a range of achievements in recent years. Major constraints to improving programme impact remain, however, including misconceptions about the scope of nutrition among the wider humanitarian system, which tends to give it a narrow focus on malnutrition and feeding people. In contrast to this limited view, the Public Nutrition approach brings a more broad-based emphasis to assessing and responding to nutritional problems in emergencies, and takes into account the wider social, economic and political causes of malnutrition. Six case study presentations illustrated the various components of a Public Nutrition approach, including in-depth assessment, analysis and tailoring programmes accordingly. Additional presentations considered the nature of vulnerability, the concept of Public Nutrition, the responsibilities for addressing nutritional problems and some of the operational tools and frameworks in current use. Participants agreed on the necessity of raising levels of awareness and understanding among all actors in the humanitarian sphere about the impact of their actions on nutrition. Strategies for achieving this included developing better multi-sectorial working relationships and also strengthening relationships with donors and key decision-makers in the humanitarian system. Other related strategies included institutional learning, training and capacity building, particularly in relation to institutions based in developing countries and building upon initiatives such as the Sphere Project, which has successfully brought together the various actors within the humanitarian system in order to improve quality of response.

Decision Making↗

PubMed2003

The application of geographic information systems and global positioning systems in humanitarian emergencies: lessons learned, programme implications and future research.

Geographic information systems (GIS), global positioning systems and remote sensing have been increasingly used in public health settings since the 1990s, but application of these methods in humanitarian emergencies has been less documented. Recent areas of application of GIS methods in humanitarian emergencies include hazard, vulnerability, and risk assessments; rapid assessment and survey methods; disease distribution and outbreak investigations; planning and implementation of health information systems; data and programme integration; and programme monitoring and evaluation. The main use of GIS in these areas is to provide maps for decision-making and advocacy, which allow overlaying types of information that may not normally be linked. GIS is also used to improve data collection in the field (for example, for rapid health assessments or mortality surveys). Development of GIS methods requires further research. Although GIS methods may save resources and reduce error, initial investment in equipment and capacity building may be substantial. Especially in humanitarian emergencies, equipment and methodologies must be practical and appropriate for field use. Add-on software to process GIS data needs to be developed and modified. As equipment becomes more user-friendly and costs decrease, GIS will become more of a routine tool for humanitarian aid organisations in humanitarian emergencies, and new and innovative uses will evolve.

Altruism↗

PubMed2001

Ethics committees. Research ethics: beyond the guidelines.

There is international recognition of the need for sustainable research ethics committees to provide ethical review of human subjects research in developing countries, but many developing countries do not have such committees (often called 'IRBs'). Theoretical and practical uncertainties encountered by an IRB on the Caribbean island of Grenada offer insight into ethical review of research in developing countries. Theoretical uncertainties include questions about whether means of ensuring confidentiality and obtaining informed consent will be effective in local settings, and whether deviations from Western norms are justifiable. International guidelines are helpful in addressing these concerns, but are subject to interpretation. Guidelines are less helpful in practical areas like selecting members or chairs. They do not address what sort of procedures and paperwork will work in a developing country, or IRBs' relationships to governments that have no mandate for them. Experiences presented here show that IRBs in developing countries can sustainably adhere to international standards. Sustainability requires knowledge, personal commitment, and an official mandate to uphold international standards. Capacity building must therefore focus on educational programs to make developing country leaders knowledgeable about the value of international guidelines to their nations. Such knowledge is needed before people will become motivated to promote, implement, and uphold their guidelines. People in developing countries must help design bridges to help their nations put international standards into practice. The structure of such bridges may, of necessity, very in different settings.

Committee Membership↗

PubMed2003

Forest fire risk management and public participation in changing socioenvironmental conditions: a case study in a Mediterranean region.

Under current conditions of accelerated socioenvironmental change in the Mediterranean forested landscapes, fire is one of the most critical and difficult risks to tackle within the region. This article summarizes the lessons learned from a project based on the participatory integration of qualitative local stakeholders' knowledge with expert GIS fire simulations carried out in the County of El Bages, Catalonia, Spain. First, in this article, a theoretical model--the forest fire circle--is presented in order to explain the reasons for the rise in the damage and frequency of forest fires in this Mediterranean area. Second, it describes the methodology developed and the stages followed during the project. Results show that: (1) the advocacy of old forest reactive management paradigm assumptions and practices based on uncontrolled forest succession can put vast wooded areas of the Mediterranean basin at critical risk; and (2) forest fire management approaches that ignore the crucial role of long-term prevention and local capacity building strategies have failed. In the final section, the content and the specific dimensions of the old reactive paradigm that has characterized forest fire risk management in Catalonia are discussed and contrasted with the possibly emerging preventative paradigm.

Journal Article↗

PubMed2005

A 'principled' approach to complex emergencies: testing a new aid delivery model in the Nuba mountains.

This paper provides an analysis of the Nuba Mountains Programme Advancing Conflict Trans-formation (NMPACT) as an example of an operational response in a complex emergency that innovatively addressed an incipient food security crisis. NMPACT is notable for having brought together an array of actors around a common principled agenda and for being the only operational programme in the Sudan to which both warring parties subscribed during the conflict. The key features of the programme are presented and the main innovative elements are reviewed, including the role of the principles of engagement and the 'political humanitarianism' of NMPACT. The paper looks at how NMPACT broke from traditional externally driven responses to food insecurity, and, drawing on lessons from Operation Lifeline Sudan, adopted an approach that focuses on capacity building, sustainable agriculture and market revitalisation, alongside conflict transformation and peace-building. The limitations of the model are also assessed, and preliminary lessons regarding its replication in other complex emergency contexts are presented.

Altruism↗

PubMedDate not supplied

The nursing role in ICU outreach: an international exploratory study.

It is widely acknowledged that many critically ill patients are managed outside of designated critical care units. One strategy adopted in Australia and England to assess and manage risk in these patients is the intensive care unit (ICU) outreach or liaison nurse service. This article examines how ICU outreach/liaison roles in Australia and England operate in the context of Manley's theoretical framework for advanced nursing practice. Descriptive case study design using semi-structured interviews and job descriptions as sources of evidence. Findings of interviews with six Australian ICU Liaison nurses are already published; this study replicated the Australian study with four ICU Consultant Nurses in England and mapped interview and job description data from both countries onto Manley's conceptual framework for advanced practice/consultant nurse. Four themes emerged from the English data: patient interventions, support for ward staff, liaison between ward and ICU staff and hospital-wide impact. The first three of these comprised the core service common to the roles in both countries. Manley's four subroles (expert practitioner, consultant, educator and researcher) were present across both countries. However, the interview and job description data demonstrated that there were lower expectations in Australia that the roles would lead to staff development and build capacity across the hospital system. Similarly, formal education for ward staff such as ALERT and CRiSP courses were more developed in UK. Our data demonstrate that the role undertaken in England and Australia is sufficiently comparable to use as a research intervention in international studies across the two countries. However, the macro service level differs. Job descriptions across both countries emphasized the need to influence hospital policy; however, the ICU consultant nurses in England might be considered better placed to achieve this through role title and access to the hospital executive. In both countries, the roles would benefit from systematic evaluation of the impact on outcomes. This is particularly important for longer-term integration of the role in the health services in both countries.

Aftercare↗

PubMed2004

Involving people with learning disabilities in research: issues and possibilities.

Advances in the social position of people with learning disabilities have led to a situation where research and evaluation studies are increasingly required to include the views and opinions of people with learning disabilities. One key outcome of this shift is that some of the major funding bodies now insist on the inclusion of people with learning disabilities as a condition of research funding. This has produced new possibilities and new challenges for researchers, and it has real consequences for people working in health and social care. The present paper sets out to explore some of the developments and challenges in research with people with learning disabilities. The author provides a selective overview of developments with the aim of demonstrating the richness, ingenuity and potential of research involving people with learning disabilities. The paper is divided into three broad sections that focus on: (1) the ethics and philosophy of participatory research; (2) the methodologies employed at particular points in the research process that are designed to ensure the involvement of participants in research; and (3) building capacity in participatory research as a precondition to the further development of this approach. An investment in capacity would enable this approach to move into the mainstream of research activity involving people with learning disabilities.

Ethics, Research↗

PubMed2004

A community survey of loneliness.

BACKGROUND: Loneliness is associated with an increased incidence of a wide range of physical and mental health problems. The detection, prevention and amelioration of loneliness is an important public health issue for nurses. METHODS: This study reports findings from the 2002 Central Queensland Social Survey. The aims of the study were to (i). establish the extent of loneliness in a community sample; and (ii). to identify the factors that are predictors of loneliness. A random sample of 1241 subjects were interviewed by Computer-Assisted Telephone Interviewing. This interview included the Loneliness Scale formulated by De Jong Gierveld and Kamphuis. FINDINGS: Loneliness is a common phenomenon and risk factors include experience of domestic violence in current relationship, not having recent paid employment, not being married/partnered, and the number of children under 18 years in a household. Loneliness is not associated with higher rates of health care professional consultations. CONCLUSION: Loneliness is a very common problem and should be seen as a major public health issue. Nurses, through a community capacity building framework, have a major role to play in the prevention of loneliness.

Adult↗

PubMed2005

Health promoting hospitals: the role and function of nursing.

BACKGROUND: In 1986, the World Health Organisation's (WHO) Ottawa Charter for Health Promotion sought to create a framework that conveyed the notion of capacity building, related to specific settings, and a structured process for health promotion action. It provided the platform from which the health promoting hospital movement was later launched. Nearly two decades on, the health promoting hospital (HPH) movement has grown considerably and continues to expand, against the backdrop of having to adapt to the changing needs and demands of clients and the evolving social context of their communities. Many nurses, it is argued here, are often unaware of health promoting hospitals concepts or, when they are, do little to contribute to them. METHOD: A critical review of the available health promoting hospital and related literature has been conducted for discussion. FINDINGS: The literature revealed that hospitals are being urged to reject practices based purely on health-limiting and limited biomedical frameworks, in favour of moving towards models based on health promoting hospitals and public health-orientated hospitals. This requires radical reform that focuses on the social and health policy context of organizations, the socio-political empowerment of its employers and clients, and the personal/collective positive health and welfare of its employers and clients. Many health service agencies are beginning to emphasize population health within communities as part of a concerted move away from an original primary focus on acute inpatient hospital-based service provision. CONCLUSION: Hospitals need to adapt and expand their efforts to focus on health promotion activities, in collaboration with the ever-widening community networks of health and social agencies. This requires the commitment of all health care professional groups. Nurses who practice in the hospital setting should be aiming to initiate and promote radical health promotion reform as set out in the health promoting hospital movement. This paper argues that nursing per se could be making much larger inroads and efforts to affect and implement wide-ranging health promotion activities in hospital organizations. Nurses should view the HPH movement as another opportunity truly to embrace evolving broad-based health promotion concepts, as a means to forge and own their own health agenda, and also as a means to move beyond the traditional reliance of a limited health education role. RELEVANCE TO CLINICAL PRACTICE: Hospitals and their employees must be seen to advocate, support and implement wide-reaching social and community-based reform, as part of a necessary commitment to 'seamless' health care provision. The health promoting hospital movement represents a collective vehicle for enabling such activities. If nurses wish to be at the forefront of current health service strategies they must be seen to embrace the radical health promotion reforms that are emerging from the current literature and put forward in this article.

Health Care Reform↗

PubMed2005

Gascoyne Growers Market: a sustainable health promotion activity developed in partnership with the community.

OBJECTIVE: To explore the social, health and economic impact of a farmers' market on a small rural community in the north of Western Australia. DESIGN: Qualitative and quantitative research using a random structured intercept survey, and focus group interviews around four domains of social capital: economic impact, governance and capacity building, healthy public places and social and civic participation. SETTING: The Gascoyne Growers Markets in Carnarvon. SUBJECTS: One hundred consumers and 28 market stallholders. RESULTS: Consumers demonstrated community pride and an increase in fruit and vegetable consumption since they commenced shopping at the markets. The stallholders appear to have gained economically, professionally and socially from the market experience. CONCLUSIONS: The Gascoyne Growers Markets demonstrate a sustainable health promotion activity developed in partnership with the community. It has contributed to the local economy, providing local quality fruit and vegetables directly to the community while also increasing social capital and creating a healthy public space.

Community-Institutional Relations↗

PubMed2006

Avian influenza: risk, preparedness and the roles of public health nurses in Hong Kong.

This paper provides an overview of the Hong Kong government's influenza preparedness plan and the key roles of public health nurses in that plan. The part played by Hong Kong public health nurses in the management of the avian influenza outbreak in Hong Kong in 1997 and the sudden acute respiratory syndrome outbreak in 2003, together with the capacity-building work they are now undertaking in preparing for an influenza pandemic, highlight their crucial role in public health. Recent strengthening of public health infrastructure in Hong Kong and heightened public awareness of public health issues have facilitated more proactive and effective public health nursing activities.

Attitude to Health↗