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Agricultural policy and sustainable livestock development.

Future agricultural and rural development is, to a large extent, influenced by the projected food needs of 2.5 billion people expected to swell the world population by 2020. This increase will require more food in general and, in view of recent experience in East Asia, more animal products. To achieve this increase will require judicious use of resources, and trade, especially in those countries where natural resources are insufficient to support food production. Achieving food sufficiency in a sustainable manner is a major challenge for farmers, agro-industries, researchers and governments. The latter play an important role as many of the farmers' choices are, to a large extent, directed by government or supra-government, often through macro- and micro-economic policy. In many countries the economic, environmental, trade and agricultural policies have not been conducive to an agricultural development that is risk-free with respect to the environment, animal welfare or public health. The recent decline of government support in agriculture forced farmers in Western countries to think about more risk adverse agricultural practices and more efficient production systems. On the other hand, many countries in Eastern Europe and the former Soviet Union, as well as other developing countries, are still going through a painful process of adjustment to new market conditions. International banks and development agencies have a mandate to help developing countries, but are somewhat restricted both by needing to work directly with governments and by their perceived dogmatic approach to development. Changing policies do, now and in the future, also affect the development of animal disease control programmes, including the control of parasitic diseases. On the one hand there is an increasing interest in risk-free control practices, and on the other hand a demand for greater regulatory control over the production process. As parasitic diseases of animals are closely linked to the environment (i.e. grazing and waste management) and public health (i.e. parasitic zoonoses), the new interest in sustainable agriculture provides a challenge for those concerned with the control and prevention of animal parasitism.

Agriculture↗

Finding the common ground: where health and educational agendas meet--the School Health Incentive Program (SHIP) grants scheme.

ISSUE ADDRESSED: This paper investigates a school health promotion grants scheme as a strategy for increasing opportunities and support for schools to undertake a whole-school approach to health issues of their choice. METHOD: The School Health Incentive Program (SHIP) is an ongoing initiative offering annual grants and tailored support from health and education professionals. SHIP commenced in 2000 in the former South Eastern Sydney Area Health Service (SESAHS), New South Wales. It is a partnership between the Health Promotion Service (HPS), the three education sectors, parent groups, other health services and The Cancer Council NSW. RESULTS: Over the period 2000-04 SHIP awarded 103 grants to 71 schools from SESAHS, representing about 32,000 students. Average grant funding per student reached was $2.50. Schools used the Health Promoting Schools framework to plan and implement their health activities. Results included positive outcomes in the areas of curriculum planning, policy and procedure development, changes to physical and social environments and the development of partnerships between the school and the health sector, other organisations, parents and other schools. CONCLUSIONS: SHIP developed partnerships between health, education sectors and schools, encouraged schools to adopt a whole-school approach to health issues, and supported the development of subsequent health-focused initiatives.

Health Policy↗

The future of nursing education.

Market-driven economic policy, dramatic technology developments, changing demographics, and the knowledge explosion are rapidly changing health care and educational institutions as well as creating a climate of continuous rapid change. Nursings' contract with society requires the profession to be responsive to these changes. Four views of changes in nursing practice and therefore nursing education are presented. Changes in the role of faculty and in the nature of the curriculum are described. Twelve strategies for facilitating change are listed.

Clinical Competence↗

Policy shifts and organizational adaptation: a review of current developments.

Changes in the operations and structure of local mental health centers are occurring in response to policy and funding shifts at the state and federal levels. Clinical and administrative staffing changes reflect both cutbacks in funding for traditional outpatient and inpatient services, as well as increases in partial care, community, residential and case management services. Centers are diversifying their funding sources, especially through increased revenues from Medicare-Medicaid sources. Governing boards remain active in center policy making, with few changes in their composition. Current adaptation strategies focus mainly on enhancing efficiency, reviewing service costs, expanding services to more viable markets, and improving business practices. These actions and strategies are compared to findings from previous studies, and their implications are discussed.

Ambulatory Care↗

Levelling the playing fields of England: promoting health in deprived communities.

Health promotion is about focusing on systems in which those 'waiting to be ill' are living their lives now. Unlike the old, the new public health agenda is about developing and implementing healthy public policies. This stance involves everyone working together to develop change in the conditions of living. This article presents a brief overview of the role of the health promotion specialist in a Primary Care Trust working with six Sure Start Programmes in a town that has high levels of poverty and deprivation. To demonstrate the principles of 'health for all', the article concludes with an overview of the development of a partnership to promote initiation and continued exclusive breastfeeding using collaborative working, community participation and equity.

Breast Feeding↗

[Selected results of an evaluation study on a Viennese model project: discharge management in hospitals by home care nurses--the view of patients and their families].

In recent years, demographic developments, changes in the financing of hospitals as well as demands for integrated care approaches by health and social policy makers have brought the issue of an improved hospital discharge management to the forefront. The article discusses results of an evaluation study of a Viennese model project on indirect discharge management at the Kaiser-Franz-Josef-Hospital in Vienna. The service coordinated at hospital level is provided by ambulant nurses for specific wards of the hospital. The data of the study show that the target group consists primarily of old patients with multiple illnesses requiring home care services as well as patients being transferred to nursing homes. The evaluation proves that patients and their families are highly satisfied with the service. Dedicated contact persons really provide crucial support to patients and relatives in this emotionally distressed transitional period, seeing their clients through difficult decisions. Discharge managers and clients jointly find out actual needs of the patient and discuss possible solutions considering available resources of the respective lay system and ways to strengthen it. The outcome is a tailor-made care package, coordinated across professional services, matching the patients' needs and resources. Moreover the study illustrates that concepts of transitional nursing care require extraordinary skills and competences on the part of the discharge manager, currently not covered by the Austrian curriculum for nurses.

Adolescent↗

The change of family size and structure in China.

With the socioeconomic development and change of people's values, there is some significant change in family size and structure in China. According to the 10% sample data from the 4th Census, 1 family has 3.97 persons on an average, less than the 3rd Census by 0.44 persons; among all types of families, 1-generation families account for 13.5%, 3 generation families for 18.5%, and 2-generation families account for 68%. Instead of large families consisting of several generations and many members, small families has now become a principal family type in China. According to the analysis of the sample data from the 4th Census, the family size is mainly decided by the fertility level in particular regions, and it also depends on the economic development. So family size is usually smaller in more developed regions, such as in Beijing, Tianjin, Zhejiang, Liaoning as well as in Shanghai of which family size is only 3.08 persons; and family size is generally larger in less developed regions such as in Qinghai, Guangxi, Gansu, Xinjiang, and in Tibet of which family size is as large as 5.13 persons. Specialists regard the increase of the number of families as 1 of the major consequences of the economic development, change of living style, and improvement of living standard, Young people now are more inclined to live separately from their parents. However, the increase of the number of families will undoubtedly place more pressure on housing and require more furniture and other durable consumer goods from the market. Therefore, the government and other social sectors related should make corresponding plans and policies to cope with the increase of families and minifying of family size so as to promote family planning and socioeconomic development, and to create better social circumstances for small families.

Asia↗

The world economic crisis. Part 1: Repercussions on health.

The widespread economic crisis has resulted in a fall in living standards in the western hemisphere of over 9% (1981-83) and in Sub-Saharan Africa they have fallen to the level of 1970. Food production in the African countries most seriously affected by drought dropped by 15% between 1981 and 1983. Living standards also fell in some countries in Europe and in some of the poorest countries of Asia. The high cost of fuel, the heavy burden of interest payments and unfavourable terms of trade in Africa and Latin America led to serious unemployment, devaluation of national currencies and formidable austerity policies. While some countries have succeeded in protecting their health services from cuts in public expenditure, in many others cuts in health budgets have been substantial. The effects of the crisis in some countries have amounted to the virtual disintegration of rural health services. There are limited data available to show what has been happening to levels of expenditure on health, but those presented here demonstrate that levels of health expenditure per head have fallen in many countries. The cumulative effects on health of increased poverty, unemployment, underemployment and famine, and the reduced capacity of health services to respond to health problems can be documented with facts for a number of countries in Latin America and Africa. Malnutrition has increased and improvements in infant mortality have been checked or reversed. The economic crisis has placed at risk the health of the most vulnerable.

Africa↗

Are the economics of pharmaceutical research and development changing?: productivity, patents and political pressures.

Pharmaceutical research and development (R&D) competition in the 1980s and 1990 s was characterised by rising R&D expenditures, favourable returns to innovators and the introduction of many new classes of drugs with high social benefits. However, in the past 3 years, the number of new drug introductions has been well below the historical trend, while the cost per new drug continues to increase. In addition to lagging R&D productivity, the industry has been characterised by other economic and policy uncertainties. These include a wave of early patent challenges and growing political pressure to contain pharmaceutical expenditures. This paper examines the consequences of these developments.

Drug Approval↗