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PubMed2001

Research capacity and closing the health gap.

In January 2000, the Healthy People 2010 initiative was introduced by the US Department of Health and Human Services (DHHS), which set the nation's health goals for the coming decade. In 1990, a previous DHHS administration had released the Healthy People 2000 initiative, which set goals to be met by the year 2000. In 1979, the first set of health goals for the nation was released, titled Healthy People. Thus, Healthy People 2010 is the third iteration of such goals. This effort has achieved momentum and indeed is paying off handsomely. The framework of the Healthy People initiatives, however, is just one gauge of US public health care status; it and a myriad of other programs and studies in recent decades reflect the gains and shortcomings of our complex health care system. In several areas, minority health disparities continue to be the weakness in our capacity building to achieve the nation's health goals.

Health Planning↗
PubMed2001

Bogalusa Heart Study: a long-term community study of a rural biracial (black/white) population.

The Bogalusa Heart Study, a long-term population study with a continued relationship with a community, addresses the problem of capacity building in minority health research. The study was originally funded as a Specialized Center of Research-Arteriosclerosis (SCOR-A) by the National Heart Lung and Blood Institute (NHLBI). These centers were to conduct research on atherosclerosis, coronary artery disease (CAD), hypertension, diabetes mellitus, and complications of cardiovascular-renal disease as the major causes of deaths in the United States. From earlier research on atherosclerosis, we became interested in the underlying characteristics in early life that would eventually lead to clinical morbidity and mortality from heart disease. An observation at autopsy showed the degree of atherosclerotic involvement in human aortas, from young to older individuals (Figure 1). For example, at age 40 years, marked individual variability occurred in the severity and involvement with atherosclerotic disease. Some individuals showed very little disease, while almost 70% of the surface was diseased in others. Further studies on arterial wall matrix showed aortas from young individuals varied with the extent of disease and its chemical composition. This background stimulated an interest in studying children for early clinical evidence of major adult heart diseases. The Bogalusa Heart Study was begun in 1972 as an epidemiology study of cardiovascular risk factors in children and adolescents; it eventually evolved into observations of young adults. Bogalusa, LA, is a biracial (black/white) rural community 70 miles north of New Orleans, comparable to many other communities in southeastern United States.

Adolescent↗
PubMed2001

Gestational diabetes mellitus: a kitchen table approach.

The issue of gestational diabetes mellitus within disadvantaged communities is being addressed by Healthy Start for Mom & Me, a highly collaborative and multi-faceted prenatal nutrition program targeting at-risk women and teens in Winnipeg, Manitoba. The program s kitchen table approach focuses on the core concepts of education, community participation, and capacity-building to develop effective methods for community-based practice in this population. A qualitative case study of the program was conducted in 1999. This study showed that health education practices in the program are sensitive to marginalized women s needs and enhance service providers understanding of the context of participants lives. Community dietitians roles in this prenatal program are evolving, and are significant for other dietitians charting a new course of community-based practice.

Canada↗
PubMed2001

Assessment of community mental health care in the Federation of Bosnia-Hercegovina (FBH) after the 1992-95 war.

Bosnia-Hercegovina is in the process of reforming its health care system. One realises that this is a complex matter that will cost a great deal of time and effort. The findings suggest that the highest priority now is the development of the 'mental health strategic and action 'plan', which includes (as a component of the overall PHC strategy) legislation, financing mechanisms, a clear statute for the CMHCs and staff, and to define the relationship with other PHC services. In addition, it is recommended that the authorities should take a more decisive co-ordinating and leading role. To this end, a special Mental Health Task Force assisted by a professional advisory group on mental health and/or professional consultants could be established. In order to realise a real cost-effective community-based care, it is inevitable to allocate enough funds to these primary mental health care services and initiatives such as sheltered living and family support initiatives (eventually to reallocate funds from expenditures on hospital-based care). A mental health reform does not happen in a vacuum and therefore can not be accomplished without 'negotiating' with other sectors/ministries, e.g., Ministries of Finances, Social Affairs/Displaced Persons and Refugees, International Trade and Economy. A multi-sector approach is considered indispensable. Overall management of CMHCs should be strengthened. In addition, it is important that CMHCs exchange information and promote standardised protocols and procedures to enhance comparability and structured referral. The planned Management Information System is a good example, but should be implemented as soon as possible in all CMHCs. Other initiatives to improve professional networking might include (community mental health) newsletters, round table conferences, etc. Further skills training of CMHC staff and management might be difficult to define as long as it is not clear what practical skills are required. Technical Assistance to the (mental) health sector should primarily focus on the overall framework and policy. Training should be tailored to the actual needs and focus primarily on local capacity building via training-of-trainers. Health prevention and promotion, i.e. information provision to the general public and community participation in terms of support for self-help groups and consumer groups, deserve more attention than it has received so far.

Bosnia and Herzegovina↗
PubMed2002

Tobacco control: consensus report of the National Medical Association.

ISSUES: Tobacco Control remains one of the greatest determinants for reducing the morbidity and mortality of African Americans. OBJECTIVE: To examine the scope and consequences of tobacco use among African Americans and characterize its implications for the National Medical Association physician membership and their patients, and identify policy, education, advocacy and research issues in Tobacco Control for the organization. CONSENSUS PROCESS: Literature review using the MEDLINE database from January 1966 to August 1999 Week 1, searching Medical Subject Heading (MeSH) reading combined with text words "Black" or "African American" and "Tobacco" as a search term, identified 130 articles/110 abstracts published between 1988 and February 1999. The panel selected 61 appropriate articles and a paper summarizing the literature review was developed. The summary paper was used as background material for a formal consensus panel discussion on July 16-17, 1999. Consensus among committee members was reached via mail, fax and e-mail using the summary review paper, annotated bibliographies key informant surveys, and previous NMA resolutions on tobacco control. A formal working session was held on July 16-17, 1999 in which four areas of concentration of issues were determined: Policy, Advocacy, Education and Research. All committee members approved the final report. SUMMARY: Because tobacco control issues in African Americans are both complex and poorly understood, the panel views the NMA's role as pivotal in the coordination of resources and capacity-building to address all four areas identified. Stronger partner-ships with traditional federal and nonprofit agencies associated with tobacco control/advocacy in African Americans as well as nontraditional organizations (i.e., churches, academia, marketing and media organizations) also must occur to strengthen the infra-structure needed to assess needs, design appropriate interventions and evaluate the appropriateness, effectiveness and efficacy of tobacco control efforts in African American communities.

Black or African American↗
PubMed2001

Research capacity and closing the health gap.

In January 2000, the Healthy People 2010 initiative was introduced by the US Department of Health and Human Services (DHHS), which set the nation's health goals for the coming decade. In 1990, a previous DHHS administration had released the Healthy People 2000 initiative, which set goals to be met by the year 2000. In 1979, the first set of health goals for the nation was released, titled Healthy People. Thus, Healthy People 2010 is the third iteration of such goals. This effort has achieved momentum and indeed is paying off handsomely. The framework of the Healthy People initiatives, however, is just one gauge of US public health care status; it and a myriad of other programs and studies in recent decades reflect the gains and shortcomings of our complex health care system. In several areas, minority health disparities continue to be the weakness in our capacity building to achieve the nation's health goals.

Health Planning↗
PubMed2001

Bogalusa Heart Study: a long-term community study of a rural biracial (Black/White) population.

The Bogalusa Heart Study, a long-term population study with a continued relationship with a community, addresses the problem of capacity building in minority health research. The study was originally funded as a Specialized Center of Research-Arteriosclerosis (SCOR-A) by the National Heart Lung and Blood Institute (NHLBI). These centers were to conduct research on atherosclerosis, coronary artery disease (CAD), hypertension, diabetes mellitus, and complications of cardiovascular-renal disease as the major causes of deaths in the United States. From earlier research on atherosclerosis, we became interested in the underlying characteristics in early life that would eventually lead to clinical morbidity and mortality from heart disease. An observation at autopsy showed the degree of atherosclerotic involvement in human aortas, from young to older individuals (Figure 1). For example, at age 40 years, marked individual variability occurred in the severity and involvement with atherosclerotic disease. Some individuals showed very little disease, while almost 70% of the surface was diseased in others. Further studies on arterial wall matrix showed aortas from young individuals varied with the extent of disease and its chemical composition. This background stimulated an interest in studying children for early clinical evidence of major adult heart diseases. The Bogalusa Heart Study was begun in 1972 as an epidemiology study of cardiovascular risk factors in children and adolescents; it eventually evolved into observations of young adults. Bogalusa, LA, is a biracial (black/white) rural community 70 miles north of New Orleans, comparable to many other communities in southeastern United States.

Adolescent↗
PubMed2002

Contributing to Balkan public health: a school for Skopje.

The absence of social well-being and growing vulnerability are alarming for a large portion of people living in the Balkan countries. The Stability Pact is currently targeting the issue of social cohesion, which holds out promise for as yet unrealized development. Both the World Health Organization and the Council of Europe have called attention to the population vulnerability and growing disparity in health status between that region and Europe. Reversal of present trends demands the support of the international community and the strengthening of all public health institutions, human resource training, and population health research. Given the severity of the problem space of population vulnerability, these actions are more than ever indispensable to the health sector of the region. The paper describes an encouraging dialogue for Balkan health conducted by the National School of Public Health in Athens, Greece over the past decade and emphasizes the work of the newly created Public Health in South Eastern Europe (PH-SEE) Network (www.snz.hr/ph-see), which provides new opportunities for engagement in regional public health through Public Health Schools and Institutes. There is a need for public health curricula development and a closer linkage of all Schools with the Association of Schools of Public Health in the European Region. A curriculum for peace and public health is already under development in institutions in Athens, Greece; Mostar, Bosnia and Herzegovina; and Zagreb, Croatia. Soon to be added to the group of regional institutions is the School of Public Health in Skopje. It is a policy response to considerable need in a country showing pre-conflict conditions in the heart of the South Eastern Europe. Within the general framework of public health development, a School of Public Health in Skopje can be of great national benefit. Suggestions are made for its function under an umbrella of interdisciplinarity and autonomy, and the need to steer a path clear of medical dominance. According to a related mission statement, the School is to be implemented as an academic center of excellence and innovation, with the worthy purpose of improving the health of the population, with particular attention to the disadvantaged, underserved, and vulnerable. It can aid policy enactment, capacity building, and vulnerability research, promote the development of new training curricula for human rights and public health, and contribute to regional public health. The implementation of the School has a symbolism attached to it as a Balkan response for the elimination of the causes for political violence.

Education, Professional↗
PubMed2002

An integrated exploration into the social and environmental determinants of health: the Saskatchewan Population Health and Evaluation Research Unit (SPHERU).

The Saskatchewan Population Health and Evaluation Research Unit (SPHERU) is a new interdisciplinary research institute established by the Universities of Saskatchewan and Regina. SPHERU developed four of its research programs using a hierarchic model of health determining conditions and contexts. In descending order these programs include: Economic and Environmental Globalization, Governance and Health Community/Environment as a Health Determinant Multiple Roles, Gender and Health Determinants of Healthy Childhood Development A fifth program researching the determinants of health of indigenous peoples spans all four levels. Two research projects, one on power, control and health, and another on community capacity building approaches to human service programs, assist SPHERU in developing the theoretical linkages between its programs. This article describes SPHERU's research model and the Unit's approach to research and summarizes each of its current research programs and projects.

Canada↗
PubMed1996

Motivating women. Bangladesh.

The Integrated Family Development Program (IFDP) in Bangladesh is expanding from the original project areas in Panchdona Union and Dhalian Union into four neighboring unions under the initiative of the Family Planning Association of Bangladesh (FPAB). The JOICFP-executed project entered its second cycle this year as part of the UNFPA-supported regional Capacity Building for Sustainable Community-based Reproductive Health/Family Planning (FP) Project Emphasizing Quality of Care. The community-based project has won wide acceptance from people at the grass roots who have helped fuel its expansion into other villages. In particular, villagers have welcomed the comprehensive approach of the project which integrates a range of components such as reproductive health including FP/maternal and child health (MCH), income-generating activities, skills and literacy education for women and children and primary health care including parasite control. The success of the project also convinced the Japanese Embassy in Bangladesh to extend funding under the Japanese government's Grant Assistance for Grass Roots Cooperation Projects. With the funds, FPAB will establish a Women's Multipurpose Training Center in Panchdona Union. The sum of US$68,157 was officially handed over to FPAB on March 29 by Japanese Ambassador Yoshikazu Kaneko. The center, which is to open within this year, will contribute to improving reproductive health and promoting the empowerment of women. Once completed, it will be used for such activities as training in health care, literacy and skills for income generation for women's empowerment.

Asia↗
PubMed1997

Paying for services in Laos.

The effectiveness of ensuring quality of care in reproductive health/family planning (RH/FP) services and making services accessible to people in rural areas is being demonstrated in Laos, where community people are willingly paying nominal fees for services provided under JOICFP's project. The birth spacing project is being implemented by the Institute of Mother and Child Health (IMCH) under the UNFPA-supported regional "Capacity Building for Sustainable Community-based RH/FP Project Emphasizing Quality of Care (RAS/96/P09)." How to reinvest funds collected for services was one of the main topics of a project review and planning workshop held in Vientiane on July 18 and 19. The event was attended by 15 staff members directly involved in project implementation who focused on ways to effectively manage the funds. Specifically, the participants discussed establishing a revolving fund system. The participants noted that the project, which reaches out to remote villages with mobile teams of health care personnel, has been successful in creating awareness of RH/FP issues and motivating community people. In many areas, community people have voiced their desire to sustain services with their own support if outside funding is withdrawn. Neighboring villages to project communities have also expressed their interest in launching the project with their own funds. Interviews conducted as part of a small-scale survey of project areas in Laos clearly indicated a high level of awareness of FP. In response to this, the project personnel are now focusing on ways to build on this awareness and meet unmet needs with high-quality services and counseling.

Asia↗
PubMedDate not supplied

An interventional strategy to strengthen integration of NLEP into primary health care.

The Government of Orissa implemented the Revised Operational Strategy in September 1999 to integrate the NLEP functions into primary health care activities. An interventional strategy, in the form of consensus on job responsibilities and capacity-building through training of PHC staff, was developed and adopted in a rural block under the Department of Community Medicine to strengthen the integration process. The impact was studied six months after the intervention by comparing it with the leprosy situation in the pre-intervention period. Data were collected by verification of registers at the block PHC and sub-centre levels. Analysis was done using different leprosy indices, such as new case-detection rate (NCDR), child rate, deformity rate, profile of leprosy cases and patient compliance, etc. This integrated approach was found to be more community-oriented and effective in early case-detection in children and women. It also helped in providing continuous MDT services because of the involvement of primary health care functionaries in the post-intervention period.

Adult↗
PubMed2003

A call for action to support best practices in evaluation of comprehensive tobacco control evaluation strategies.

The National Tobacco Control Best Practices Working Group convened a two-day workshop to support best practices in evaluation of comprehensive tobacco control strategies. A Better Practices Model, aimed at developing a self-correcting system for best practices, guided the workshop content and process. Organizers intended to identify a common surveillance and monitoring framework for tobacco control strategies in Canada by first building strong working relationships between 44 decision-makers, practitioners and researchers from 12 Canadian jurisdictions. Participants identified needs and recommendations related to increased understanding and use of uniform evaluation strategies, building capacity, and recognition of the complexity of the task of evaluating comprehensive tobacco control strategies. The workshop highlighted the need for increased communication to facilitate understanding across the different sectors of participants. It also identified the potential benefits of harmonization in evaluation of tobacco control strategies across jurisdictions. Priority actions include forming a national team to agree on a model for evaluation, conducting an environmental scan for indicators, planning evaluation / monitoring and research agendas and determining roles for various stakeholders.

Canada↗
PubMed2003

Including health in transport policy agendas: the role of health impact assessment analyses and procedures in the European experience.

From the mid-1990s, research began to highlight the importance of a wide range of health impacts of transport policy decisions. The Third Ministerial Conference on Environment and Health adopted a Charter on Transport, Environment and Health based on four main components: bringing awareness of the nature, magnitude and costs of the health impacts of transport into intergovernmental processes; strengthening the arguments for integration of health into transport policies by developing in-depth analysis of the evidence; developing national case studies; and engaging ministries of environment, health and transport as well as intergovernmental and nongovernmental organizations. Negotiation of the Charter was based on two converging processes: the political process involved the interaction of stakeholders in transport, health and environment in Europe, which helped to frame the issues and the approaches to respond to them; the scientific process involved an international group of experts who produced state-of- the-art reviews of the health impacts resulting from transportation activities, identifying gaps in existing knowledge and methodological tools, specifying the policy implications of their findings, and suggesting possible targets for health improvements. Health arguments were used to strengthen environmental ones, clarify costs and benefits, and raise issues of health equity. The European experience shows that HIA can fulfil the need for simple procedures to be systematically applied to decisions regarding transport strategies at national, regional and local levels. Gaps were identified concerning models for quantifying health impacts and capacity building on how to use such tools.

Decision Making↗
PubMed2003

The health care safety net: money matters but savvy leadership counts.

The nation's health care safety net--heavily reliant on external funding and support--is uniquely vulnerable to shifting and often adverse market and policy conditions. While adequate funding is essential to ensuring safety net providers can care for low-income people, the Center for Studying Health System Change (HSC) has identified a number of other factors key to building and maintaining viable community safety nets. Throughout the four rounds of HSC's Community Tracking Study (CTS) site visits, researchers have found that strong political and organizational leadership, community support, collaboration and business acumen have helped safety net providers build capacity and improve care coordination for low-income and uninsured people. These characteristics and business strategies have strengthened many community safety nets, better preparing them to weather current economic problems and providing a road map for the potentially tougher times ahead.

Capital Financing↗
PubMed2003

[Establishment and preliminary evaluation of the General Practitioners' Morbidity Sentinel Stations Program in Hungary. Prevalence of hypertension, diabetes mellitus and liver cirrhosis].

STUDY OBJECTIVE: To develop, introduce and test a methodology, which provides valid data about the prevalence and incidence of chronic, non-communicable diseases of great public health importance. DESIGN: The School of Public Health, University of Debrecen, Hungary and the National Public Health and Medical Officer Service the first time launched a morbidity sentinel stations network of general practitioners in four counties in Hungary in May 1998. Within the framework of this program the participating general practitioners reported the prevalence data of cardiovascular diseases, diabetes mellitus, liver cirrhosis, and major malignant diseases at the beginning, and from than on continuously report the incidence of these diseases. The authors built quality assurance into the program at different levels in order to ensure high quality data. PATIENTS: The study population consists of people belonging to the participating general practitioners' practices at any time, selected in a way to represent the eastern and western part of the country as well as the participating practices in the counties (Gyór-Moson-Sopron, Hajdú-Bihar, Szabolcs-Szatmár-Bereg, Zala) would give a geographically and according to settlement size representative sample of general practitioners in those counties. Eighty general practitioners were approached in the four counties by the county offices and overall 73 of them, 1.4% of the total practices in Hungary (5212), agreed to participate in the study, therefore information can be collected on 1.37% of the Hungarian population's (138,088 people) morbidity status. MAIN RESULTS: The population of practices participating in the program gives a representative sample of the counties population by age and sex. The prevalence of hypertension, diabetes mellitus and liver cirrhosis is high in all the counties involved. In most of the selected diseases the authors have found differences in the prevalence between the eastern and western part of Hungary with higher values in the western counties. The differences were most apparent in the older age groups in both sexes. CONCLUSIONS: The development and sustainability of primary care based, sentinel stations type, euroconform morbidity data collection system is undoubtedly justified in Hungary. The collected and thoroughly analysed data provide not only a valid and comprehensive basis to describe some aspects of the health status of the Hungarian population but also gives an opportunity to continuously monitor the changes in morbidity of the selected diseases. Thus, the program serves an important basis for health care capacity building, priority setting and the evaluation of the effectiveness of public health interventions.

Adolescent↗
PubMed2001

The Multilateral Initiative on Malaria (MIM): a perspective from the first co-ordinator.

If research against malaria is to have a major impact on health, then all available resources and expertise must be harnessed for maximal effect. Bringing together scientists, funding organisations and disease control experts, the Multilateral Initiative on Malaria (MIM) has made significant progress since its creation in 1997 in promoting and co-ordinating scientific research against malaria. Enhancing global collaboration, mobilizing resources, promoting capacity building in Africa and strengthening links between research and control are major emphases of MIM. The initiative primarily acts through drawing together diverse international research activities, setting well considered priorities, and promoting effective targeting of energies and funds. This article is a personal view on MIM contributed by the Wellcome Trust as the nominated co-ordinator during 1998 and part of 1999. It aims to set out the rationale for MIM, to explain the principles of its operation and to illustrate achievement during its first phase.

Humans↗
PubMed2003

Establishing a foundation for cardiovascular disease research in an African-American community--the Jackson Heart Study.

The JHS is the largest single-site prospective, epidemiological study of CVD among African Americans undertaken to date. It is focused on African-American health, yet comprehensive in its scientific scope. Its design will allow future refinements in scientific direction, the development of ancillary projects, and the formation of synergistic collaborations to develop and test novel hypotheses as our understanding of the CVD epidemic continues to evolve. This effort represents an important part of a broad-based, multi-pronged assault on ethnic disparities in the United States. Its novel capacity-building, minority training, and community participation components make it an exemplary model for American research. Meaningful community participation in the development of JHS owes much to the approaches described by Wyatt et al in this issue.

Black People↗