rural places, rural persons experience advantages related to strong social support built among a small number of community stakeholders (Davis & Magilvy, 2000; Williams & Kulig, 2012; Mueller & MacKinney, 2001). This strength may enable local engagement in the process of policy implementation (Swanson, 2001). Provincial health policies rarely have the same effect on both urban and rural communities (Berkowitz et al., 1998). The impact place of residence can have on one’s health and wellbeing has significant implications for healthpolicy implementation. Drawing attention to the challenges and benefits associated with rural living makes it easier to appreciate the complex nature of rural communities. Therefore, a place-based policy analysis framework may be an effective strategy for the development, implementation, and evaluation of rural publichealthpolicy (Castle & Weber, 2006; Hartley, 2004; Mueller & MacKinney, 2011), responding to specific community challenges while drawing from the ideas and resources of community residents (Adams & Hess, 2001; Bradford, 2005). Rural women’s health researchers, Leipert and Reutter (2005), recommend that rural healthpolicy should be a collaborative process that allows rural community members to contribute to policy development and implementation. Leipert and Reutter (2005) also note that although policy documents acknowledge the impact of rural environment on health, few policies actually address this issue.
The rural–urban divide is also exemplified by the rela- tionship between women’s education and infant malnutri- tion and mortality rates. Although economic deprivation is associated with a lower level of education and literacy among women (67%) as compared to men (41%) all over the country, women’ s education level varies more signifi- cantly by place of residence. Almost 50% of urban women are literate, against 7.7% in the countryside. Education level predictably limits women’ s access to health informa- tion. The infant mortality rate and child malnutrition are closely related to the mother’ s education level: 128 per 1000 for children whose mothers’ instruction level is equal to or higher than secondary school and 191 per 1000 for children whose mothers attended only primary school . The proportion of underweight children is 35% for those whose mothers have no education, against 15% for those whose mothers have secondary education. Consider- ing that women’s education level is higher in urban than in rural areas, it can be inferred that high malnutrition and mortality rates affect rural children more than urban ones. Even though malnutrition is a widespread phenomenon in Chad, rural children (41%) are more affected than urban ones (31%). About 30% of children are underweight, in- cluding 13% who are severely underweight. Again, rural children are more affected (33%) than urban ones (22%). About 16% of children are severely or moderately emaci- ated. A malnourished child has high chances of contracting diseases, and a sick child is also more likely to become malnourished . Part of the reason malnutrition is recurrent is because, even when harvests are plentiful, poor families are forced to sell much of their harvest to re- pay debts incurred during the dry season, selling often at low prices due to high market supply. With reduced stocks to run through the lean period, they are again forced into debt.
of under- immunised children were more likely to be low earners, not have a consistent health care provider, to have four or more children, and to see vaccines as relatively unsafe. 251 This suggests that interventions may need to target particular socio-demographic groups. However, the only discernable socio-demographic difference in attitudes toward immunisation noted in the current study was that focus group participants who were also parents tended to have stronger views on immunisation. Whether this was an opinion for or against immunisation depended more upon the intensity of recent vaccine scares and trust in the reassurances of family doctors and State publichealth authorities. The other main pattern apparent in the focus groups was the correlation between support for State compulsion and the over-riding of parental choice amongst those countries where certain immunisations are already compulsory. This could suggest a degree of normalisation where laws on compulsory immunisation gradually become part of a cultural norm.
The National PublicHealth Partnership (NPHP) and the AHMC adopted the influenza pandemic plan in October 2003, and with the advent of the newly-identified disease SARS, as well as outbreaks of meningococcal disease, management and prevention of communicable diseases was prominent. Following on from the significant fund- ing boost for bioterrorism preparedness in 2002/03, pub- lic health preparedness became a more generic theme. The arrival of SARS occupied the national popular and political imagination as well as tested the infrastructure capacity of publichealth. Australia fared well during the outbreak. Apart from escaping with only six Australian cases, it provided an opportunity to establish a coordi- nated approach between the Commonwealth and the states/territories and also contributed to the global epide- miological investigation and prevention effort. SARS also prompted amendments to the Quarantine Act . While the recall following the Pan Pharmaceutical crisis put the Therapeutic Goods Administration (TGA) under the spotlight, it also managed to conclude negotiations that had been in train for several years on a Trans-Tasman regulatory regime and authority. Also on the regulatory front, the Australian New Zealand Food Regulation Min- isterial Council endorsed a nutrition, health and related claims policy guidelines and established a review of genet- ically modified (GM) labeling of foods . All these developments pointed to the global nature of publichealth, and the intersection between publichealth activi- ties and the economy.
These recommendations are consistent with the Wilson and Jungner criteria (Table 2) and more recent analyses of their application to genome screening at its current state of development for clinical testing [22, 122]. Some conditions for which newborn screening is widely performed cannot be identified effectively by any method of genetic or genomic testing because many cases do not have a genetic cause. For example, congenital hypo- thyroidism may be caused by maternal dietary iodine defi- ciency or transfer of maternal anti-thyroid antibodies across the placenta. In other circumstances, even though genetic factors usually cause the condition, genetic hetero- geneity and complexity make it unlikely that genetic test- ing will be as sensitive or as specific as current screening methods. Newborn screening for congenital hearing loss by testing otoacoustic emissions provides a clear example. Substituting genomic methods for the methods that are currently used to screen for such conditions would jeopardize the health or development of some children who are identified by current newborn screening programs.
The Institute was a member of a partnership that developed a fuel poverty action research programme in Donegal and Cork. This research assessed changes in health, energy efficiency and household economy in low income households which have energy efficiency measures installed. The partnership also included Combat Poverty Agency, Sustainable Energy Ireland, the Department of Social and Family Affairs, the Department of the Environment, Housing and Local Government, the Department of Health and Children and the East Coast Area Health Board.
Whether ISDS is redeemable, even after twenty years of NAFTA and a distinct evolution in the standards and procedures of the international investment regime, is still very far from clear. It still amounts to a bet, and therefore a risk in itself. It is also unsure which reforms will be politically viable and implementable given internal divisions in the EU and the external pressure from the US. As such, an approach that views TTIP as an opportunity for reform without any clear idea of what that should be or how it would work, is fundamentally flawed. Quick, Baetens and others, including the EU Commission, effectively ask us to trust that their particular mix of reform proposals will solve all of the manifold problems of ISDS. Or, alternatively, that we need to at least try them out and see. They are asking us to let them experiment with this new legal system on a massive scale, not with an individual BIT, but with a regional agreement covering a substantial portion of the world’s capital. This is hugely irresponsible, especially given the very patchy track record of reform proposals to date and the depth of the problems with ISDS. The question is whether we should be taking such an experimental approach to the State’s right to regulate in the public interest? Australia’s answer in the context of its own Free Trade Agreement with the US was a clear no, and it excluded ISDS from that agreement. Given that the investment arbitration regime has really only fully crystallised in the last 20 years, it is clear that changes occur in the regime relatively rapidly. Therefore, it should be considered that a compromise struck now, relative to the set of reform proposals currently in fashion, is likely to look insufficient or inadequate in the not too distant future. The clear trajectory of the regime is towards accelerated reform. Subsequent reforms will almost certainly overtake those incorporated into TTIP, as even the marginal evolution of EU agreements from rudimentary EU BITs to CETA, and now to the more complex proposals for TTIP, amply demonstrate.
The development and dissemination of clinical guidelines alone is insufficient to change current practice and deliver improved patient outcomes . Further investment in strategies to increase adoption of guideline recommendations is required . However, decisions about implementation intervention investment should be guided by consideration of effectiveness as well as economic efficiency, equity and affordability [12,13]. Economic evaluation combines evidence about the cost and benefits of alternative interventions in order to identify investment opportunities that demonstrate value for money [14-16]. Given escalating healthcare costs and constrained budgets in publichealth systems, economic evaluations contribute significantly to the evidence base informing decision makers and healthcare funders. Effective, cost-effective and affordable implementation strategies are needed to ensure the intended benefit of clinical guidelines are realized . Similarly, assessment of the budget impact of implementation strategies is warranted to assess the affordability and financial consequences of healthcare practice changes. At present there is limited evidence regarding the economic cost of adverse fetal and maternal outcomes associated with alcohol consumption during pregnancy [18-21], and no evidence concerning the cost- effectiveness of practice change interventions aiming to improve recommended antenatal care for maternal alcohol consumption . This paper presents a protocol for the economic evaluation of an antenatal practice change intervention to improve care addressing alcohol consumption in pregnancy. The paper aims to answer the following research question: From the Australian health care system perspective, what is the cost and cost-effectiveness of the practice change intervention to increase routine provision of antenatal care for maternal alcohol consumption compared to usual practice, and is it an affordable model for local health services?
Few implementation studies have focussed explicitly on developing a qualitative understanding of the experi- ences of those who are actually involved at the front lines. In this paper, we focus on presenting the perspec- tives of those responsible for implementation on the ground. Specifically, we explore the collective experi- ences of HA managers and front line staff with the early implementation of the CF Framework within the STIP and HL exemplar programs in BC. An analysis of the differences between HAs and specific subgroups of par- ticipants is beyond the scope of this paper and will be presented in subsequent publications. First, we present a thematic analysis, and then discuss findings in rela- tion to key influences on implementation drawing on Greenhalgh et al. ’s framework on the diffusion of in- novations in health service organizations . Know- ledge about the implementation experience and the challenges encountered by practitioners and managers may help inform improvements in both the policy intervention and the implementation process.
Background: Healthcare professionals or physicians are important assets for health institutions in ensuring optimum delivery of healthcare to the people. Job satisfaction in various aspects including daily tasks, responsibilities and other duties will indirectly provide high productivity to an organization as well as ensuring a conducive working environment and reducing the resignation rates. Resignation rate trends among physicians in Malaysia ranged from 6.4% in 2000 to 3.5% in 2016. The introduction of Full Paying Patient services in Ministry of Health hospitals in 2007 somewhat contributed to the reduction in resignation rate of physicians. The purpose of this research is to assess this retention strategy implemented in Ministry of Health in achieving one of its objectives (to retain physicians). The assessment will help gain a better understanding of the complexities involved to assist policymakers in establishing good policies and guidelines to reduce the rate of resignation among physicians in the government hospitals and ultimately ensure a sustainable national health system.
The ongoing Zika outbreak is a significant publichealth concern, and any ethical concerns with potential interventions against it need fairly urgent resolutions. However, philosophical analysis has not clearly resolved whether non-identity is morally relevant in the decades since it was first described. In cases like this, where there is reasonable disagreement among experts on an issue, policy should arguably take the views of the public into account. As such, it may help publichealthpolicy- makers come to a provisional stance on the non-identity problem if they understand the moral intuitions of the general public. This would also enable us to compare philosophers ’ ethical analyses and the general public ’ s moral intuitions, and scrutinise them if they conflict. Rawls supported this approach with his argument for a ‘ reflective equilibrium. ’ He suggested that our normative conclusions should be based on the interaction between analysis and intuition . Moreover, understanding the public ’ s views could help gauge whether contraception would be widely used if it were made more available, or the extent to which people might reject it on the basis of the non-identity problem or other ethical concerns.
Adaptation of the generalised framework of the model (i.e. incorporating details of pur- chasing and behaviours from survey data sets with epidemiological models of risk) to model broader problems than just alcohol is also conceivable. The consumption and purchase of food in relation to policies and tax on foodstuffs and related risks of unhealthy diets, obesity etc. could plausibly be modelled, as could purchase of tobacco and the harms due to smok- ing, or potentially even the incentivising of physical activity. We believe that our model framework can provide a useful reference point for such single behaviour publichealthpolicy models. An important extension to the work would be modelling the interaction of multiple behaviours rather than a single one. For example, there are known correlations be- tween drinking alcohol and smoking (Pierani and Tiezzi 2009), and the inter-relationship is complex when policy impacts are to be modelled because different policies might have dif- ferent consequences e.g. increasing alcohol prices might cause people to substitute instead to more tobacco, the pub smoking ban could cause people to drink less because they visit the pub less, or more because they decide to smoke instead at home and drink more of the cheaper alcohol. An even wider multiple behaviour model could be conceived incorporating alcohol, smoking, diet and physical exercise, and though we are currently engaged in such a research project modelling the joint behavioural impact of health messages to students starting University, it is unclear at this stage whether such a detailed level of granularity of behaviours as undertaken in our Sheffield Alcohol Policy model, would be the most feasible or efficient approach.
dependent partners, uniting the different disciplines and combining academic and tacit knowledge to support publichealth. In reality, however, it appears to be diffi- cult to sufficiently connect academic research, practice and publichealthpolicy. The three domains do not easily work together because they emanate from three more or less independent ‘ niches ’ . The term ‘ niche ’ is used here because policy, practice and research are characterized by specific ideologies as well as unique norms and values, internal orientations, communication and languages, internal codes of behavior, self-directed improvement processes, independence and a strong desire to protect themselves against the outside world [2-4]. Due to their niche character, the three domains do not easily converge, despite universal calls for colla- boration [4-12]. Collaboration is thought to foster qual- ity improvement of local and, ultimately, national publichealthpolicy in order to tackle complex publichealth problems. Quality improvement in the Dutch publichealth sector is urgently needed because, despite having boasted very good population health status in the past, the Netherlands, compared to the rest of the European Union, has seen a substantial decline in population health status in recent years. The assumption that colla- boration between practice, research and policy will result in more solid evidence and higher quality stan- dards in publichealth is widely supported [13-22]. Unfortunately, evidence does not naturally find its way into policy and practice .
Despite a lack of consensus regarding the access, treatment and use of administrative data for research purposes, particularly when these datasets contain personally identifiable information, we nonetheless believe that the potential benefits provided by enhancing the knowledge surrounding health issues and the generation of evidence that supports regulatory decisions and shapes publichealthpolicy justifies the use of these data, provided that technical and administrative security measures, capable of preventing unauthorized access and disclosure. Even some authors, such as Lisa M. Lee, a bioethicist, have argue that the non-use of this data constitutes a lack of ethical behavior by preventing us from reaping these societal benefits (Lee, 2017).
Providing all children and families with clear information about health promo- tion and disease prevention is a na- tional priority. Each of the 10 leading health indicators (physical activity, overweight and obesity, tobacco use, substance use, responsible sexual be- havior, mental health, injury preven- tion, environmental quality, immuniza- tions, and access to care) outlined in Healthy People 2010 requires effective health promotion beginning in early childhood. Several national organiza- tions have developed guidelines for child health promotion, including the US Preventive Services Task Force 1 and
PI can be characterized as a policy problem with a high degree of political complexity because it involves a variety of sectors, actors and interests. Its programmatic com- plexity appears comparably low at first sight, at least with respect to its “technical content” . For example, the benefits of maintaining an active lifestyle (e.g. walking and biking during leisure time or for purposes of commuting to school or work) are easily understood by “the average citizen” . PI becomes a comparatively complex issue, however, when considered in relation to different “models of multiple causation” . These models are designed to address a large number of variables (e.g. individual, social and environmental) that may influence changes in sedentary behaviour. Various parties have been known to compete to win the adoption of their favoured models as “the most relevant” frameworks for use in the creation of physical activity policies and interventions. For instance, in her analysis of the Active Living policy in Canada, Bercovitz argued that the rhetoric of “active lifestyle” as a personal choice and individual responsibility was used to conceal structural health inequalities and the retreat of the welfare state from social responsibility for health in times of financial crisis .
Another dimension of the safeguarding children agenda of relevance to health visiting is the role played by public and media scrutiny when cases have tragic outcomes. Over the years in the UK child death inquiry reports have played an important role in shaping public perceptions and informing policy within the child welfare arena. However despite the high incidence of child deaths occurring to children under 5 years old and the stated universality of health visiting, the profession has largely avoided scrutiny or critique within this arena, with attention and blame being largely directed towards social care organisations and practice. This occurred following the death of 17 month old Baby Peter in 2007 although the subsequent review of child protection arrangements in England did draw attention towards the safeguarding role in health visiting (Laming 2009; Care Quality Commission 2009a).
4.1 Across NHS Shetland health professionals currently have some access to clinical supervision in a variety of formats and settings. Clinical supervision focuses on the personal and professional needs of the practitioner; safeguarding children case supervision by comparison focuses on the clinical care provided by the practitioner to individual children and their families, and the professional standards required for service delivery. This includes a management responsibility to ensure safe practice. The introduction of mandatory safeguarding children case supervision aims to enhance the establishment of support processes for health visitors and school nurses as recommended in the HMIe Report. 5.0 Definition of Case Supervision
The simple fact is that Americans con- sume too many calories as compared to their activity level. Some publichealth interventions to help decrease calorie con- sumption include reducing portion sizes in homes, workplaces and various eating establishments and more prominently la- beling the calorie and nutrient content of foods sold and consumed in stores, restau- rants, movie theatres and other venues to make the public more calorie- and food- content conscious. Other strategies include encouraging the establishment of healthy “fast-food” restaurant chains and includ- ing more healthful food choices at existing venues, fostering healthy eating messages and participation in physical activity in the media, financial incentives, encourag- ing the sale of nutritious snacks on school campuses and ensuring the nutritional content of school food programs. 28 Many