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Public Health Policy (public + health_policy)
Selected AbstractsWhy ,Health' is not a Central Category for Public Health PolicyJOURNAL OF APPLIED PHILOSOPHY, Issue 2 2009STEPHEN JOHN abstract We normally think that public health policy is an important political activity. In turn, we normally understand the value of public health policy in terms of the promotion of health or some health-related good (such as opportunity for health), on the basis of the assumption that health is an important constituent or determinant of wellbeing. In this paper, I argue that the assumption that the value of public health policy should be understood in terms of health leads us to overlook important benefits generated by such policy. To capture these benefits we need to understand the ends of public health policy in terms of the promotion of ,physical safety'. I then go on to argue that the idea that ,health' is an important category for evaluating or estimating individuals' wellbeing in the normative context of social policy is confused. I then clarify the relationship between my arguments and QALY-based accounts of health assessment. In the final section of the paper, I defend this surprising conclusion against various attacks. [source] New Directions for Health Insurance Design: Implications for Public Health Policy and PracticeTHE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 2003Sara Rosenbaum ABSTRACT National attention on issues of public health preparedness necessarily brings into sharp focus the question of how to assure adequate, community-wide health care financing for preventive, acute care, and long-term medical care responses to public health threats. In the U.S., public and private health insurance represents the principal means by which medical care is financed. Beyond the threshold challenge of the many persons without any, or a stable form of, coverage lie challenges related to the structure and characteristics of health insurance itself, particularly the commercial industry and its newly emerging market of consumer-driven health plans. States vary significantly in how they approach the regulation of insurance and in their willingness to support various types of insurance markets. This variation is attributable to the size and robustness of the insurance market, the political environment, and regulatory tradition and custom. Reconciling health insurance markets with public health-related health care financing needs arising from public health threats should be viewed as a major dimension of national health reform. [source] Maternal capital and the metabolic ghetto: An evolutionary perspective on the transgenerational basis of health inequalitiesAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 1 2010Jonathan C.K. Wells There is particular interest in understanding socioeconomic and ethnic variability in health status. The developmental origins of disease hypothesis emphasize the importance of growth patterns across the life-course in relation to noncommunicable disease risk. The physiological components of cardiovascular risk, collectively termed the metabolic syndrome, derive in part from a disparity between the homeostatic "metabolic capacity" of vital organs and the "metabolic load" induced by large tissue masses, a rich diet and sedentary behavior. From an evolutionary perspective, the risk of such disparity is decreased by maternal physiology regulating offspring growth trajectory during gestation and lactation. Maternal capital, defined as phenotypic resources enabling investment in the offspring, allows effective buffering of the offspring from nutritional perturbations and represents the environmental niche initially occupied by the offspring. Offspring growth patterns are sensitive to the magnitude of maternal capital during early windows of plasticity. Offspring life-history strategy can then respond adaptively to further factors across the life-course, but only within the context of this initial maternal influence on growth. Maternal somatic capital is primarily gained or lost across generations, through variable rates of fetal and infant growth. I argue that the poor nutritional experience of populations subjected to colonialism resulted in a systematic loss of maternal capital, reflected in downward secular trends in stature. Accelerating the recovery of somatic capital within generations overloads metabolic capacity and exacerbates cardiovascular risk, reflected in increased disease rates in urbanizing and emigrant populations. Public health policies need to benefit metabolic capacity without exacerbating metabolic load. Am. J. Hum. Biol., 2010. © 2009 Wiley-Liss, Inc. [source] Programme and policy issues related to promoting positive early nutritional influences to prevent obesity, diabetes and cardiovascular disease in later life: a developing countries view,MATERNAL & CHILD NUTRITION, Issue 3 2005Noel W. Solomons MD Abstract Public health policy differs from programme insofar as the former is the expression of goals at a higher decision-making level (international, regional, national or provincial) and the latter involves the execution of intervention measures at the community or individual level. It has recently become fashionable to speak of ,evidence-based' policy. There is now ample evidence to suggest that early nutritional influences on chronic disease risk in later life are contributing to the acceleration of the overall worldwide epidemic of obesity and non-transmissible diseases. In developing countries, in which 80% of the world's population resides, the opportunities for preventive policy must be balanced against needs, cost and effectiveness considerations and the intrinsic limitations of policy execution. Not everyone in the population is at risk of suffering from any given negative condition of interest, nor will everyone at risk benefit from any given intervention. Hence, decisions must be made between universal or targeted policies, seeking maximal cost-efficiency, but without sowing the seeds of either discrimination or stigmatization with a non-universal application of benefits. Moreover, although large segments of the covered population may benefit from a public health measure, it may produce adverse and harmful effects on another segment. It is ethically incumbent on policy makers to minimize unintended consequences of public health measures. With respect to the particular case of mothers, fetuses and infants and long-term health, only a limited number of processes are amenable to intervention measures that could be codified in policy and executed as programmes. [source] Social Determinants and Their Unequal Distribution: Clarifying Policy UnderstandingsTHE MILBANK QUARTERLY, Issue 1 2004HILARY GRAHAM Public health policy in older industrialized societies is being reconfigured to improve population health and to address inequalities in the social distribution of health. The concept of social determinants is central to these policies, with tackling the social influences on health seen as a way to reduce health inequalities. But the social factors promoting and undermining the health of individuals and populations should not be confused with the social processes underlying their unequal distribution. This distinction is important because, despite better health and improvement in health determinants, social disparities persist. The article argues that more emphasis on social inequalities is required for a determinants-oriented approach to be able to inform policies to address health inequalities. [source] Are there Characteristics of Infectious Diseases that Raise Special Ethical Issues?1DEVELOPING WORLD BIOETHICS, Issue 1 2004Charles B. Smith ABSTRACT This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases' powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack on humans by foreign micro-organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases. The individual fear and community panic associated with infectious diseases often leads to rapid, emotionally driven decision making about public health policies needed to protect the community that may be in conflict with current bioethical principles regarding the care of individual patients. The discussion includes recent examples where dialogue between public health practitioners and medical-ethicists has helped resolve ethical issues that require us to consider the infected patient as both a victim with individual needs and rights and as a potential vector of disease that is of concern to the community. [source] Mephentermine dependence without psychosis: a Brazilian case reportADDICTION, Issue 6 2010Henrique Faria De Sousa ABSTRACT Background Substance abuse is a serious health concern. This report presents the case of a 22-year-old Brazilian man with a history of mephentermine use who fulfils all the criteria for chemical dependence listed by ICD-10. Mephentermine is a sympathomimetic agent derived from methamphetamine which, in Brazil, is restricted to veterinary use. Case description The subject used the substance at a high dose (120 mg) to improve his physical performance while working out at a gym. His symptoms included anorexia and insomnia. After days of intense activity, he felt fatigue and soreness. A physical examination revealed scars on both forearms from the injections and a psychological examination revealed moderate speech and motor agitation. Conclusions Cases such as this may be common among the general public. They should have some bearing upon medical practice and public health policies involving drugs. [source] Does problem drinking affect employment?HEALTH ECONOMICS, Issue 2 2004Evidence from England Abstract In this paper, we use data from the Health Survey of England to show that problem drinking is negatively and significantly associated with the probability of being in work, once the endogenous relationship between these outcomes is accounted for. Being a problem drinker leads to a substantial reduction in the probability of working by between 7 and 31%, the former figure being roughly equivalent to the positive effect of having a degree relative to no qualifications in our data. This finding is robust to a variety of identifying restrictions and definitions of problem drinking. Moreover, we find that problem drinking defined by the observed psychological and physical symptoms of alcohol is an important predictor of employment, and allows for the fact that individuals differ in their tolerance or susceptibility to alcohol. Our results suggest that there may be important labour market benefits from public health policies aimed at the prevention and treatment of problem drinking. Copyright © 2003 John Wiley & Sons, Ltd. [source] SARS , a perspective from a school of nursing in Hong KongJOURNAL OF CLINICAL NURSING, Issue 2 2004David R. Thompson PhD Background., Severe acute respiratory syndrome (SARS) is a new infectious disease with significant morbidity and mortality that has had a major impact on health and health care services worldwide. Hong Kong has had a significant number of cases and deaths. Nurses, at the vanguard of the clinical health care team, have been particularly affected by it. The outbreak prompted the health authorities to implement a series of public health measures and hospital policies, including a guideline for the diagnosis and management of patients with SARS. Aims and objectives., This paper aims at providing an overview of what is known about SARS and the impact it has had in Hong Kong and to highlight from the perspective of a school of nursing the major clinical, educational and public health implications. Conclusions., The lack of understanding and uncertainty about the disease led to significant variation in the provision of information, contributing to the confusion and anxiety in the community. Therefore, there is a need to revise the nursing curriculum, to provide continuing education to all health care professionals, particularly with regard to infection control measures, and to revisit the range of public health policies to ensure the health of the community is protected by these policies. There also has been a reaffirmation of the importance of health promotion that highlights the importance of the partnership between nurses, health policy makers and public health personnel. It is evident that the organization and delivery of clinical practice, teaching and health promotion have to be flexible and responsive to a changing health scenario. Relevance to clinical practice., Nurses must play a crucial role in the prevention, detection and containment of SARS. They will need to implement and ensure strict adherence to infection control measures and, in some circumstances, isolation and quarantine may be warranted. Attention to the psychological state of patients and family members should not be overlooked. Paramount is education of patients, families and members of the public at large. [source] Community-specific, preventive oral health policies: preventive measures on dental cariesJOURNAL OF INVESTIGATIVE AND CLINICAL DENTISTRY, Issue 1 2010Shahrokh Esfandiari Abstract In all health fields, limited infrastructure and resources hinder the provision of basic services to low-income populations. Subsequently, oral health is often neglected, as over 90% of caries remains untreated in developing communities. In order to deliver the most cost-effective prevention methods, public health officials must assess each available strategy on an individual community basis. In this paper, examples from oral health will demonstrate the importance of community-specific determinants in the formation of preventive public health policies. These determinants include economical, cultural, social, and political elements that can assist policy makers in generating effective functional public health policies. [source] A critical analysis of UK public health policies in relation to diet and nutrition in low-income householdsMATERNAL & CHILD NUTRITION, Issue 2 2006Pamela Attree phd Abstract Diet and nutrition, particularly among low-income groups, is a key public health concern in the UK. Low levels of fruit and vegetable consumption, and obesity, especially among children, have potentially severe consequences for the future health of the nation. From a public health perspective, the UK government's role is to help poorer families make informed choices within healthy frameworks for living. However, the question is , to what extent are such policies in accordance with lay experiences of managing diet and nutrition on a low-income? This paper critically examines contemporary public health policies aimed at improving diet and nutrition, identifying the underlying theories about the influences on healthy eating in poor families, and exploring the extent to which these assumptions are based on experiential accounts. It draws on two qualitative systematic reviews , one prioritizing low-income mothers' accounts of ,managing' in poverty; and the other focusing on children's perspectives. The paper finds some common ground between policies and lay experiences, but also key divergencies. Arguably, the emphasis of public health policy on individual behaviour, coupled with an ethos of empowered consumerism, underplays material limitations on ,healthy eating' for low-income mothers and children. Health policies fail to take into account the full impact of structural influences on food choices, or recognize the social and emotional factors that influence diet and nutrition. In conclusion, it is argued that while health promotion campaigns to improve low-income families' diets do have advantages, these are insufficient to outweigh the negative effects of poverty on nutrition. [source] Modern India and the vitamin D dilemma: Evidence for the need of a national food fortification programMOLECULAR NUTRITION & FOOD RESEARCH (FORMERLY NAHRUNG/FOOD), Issue 8 2010Uma S. Babu Abstract India is located between 8.4 and 37.6°N latitude with the majority of its population living in regions experiencing ample sunlight throughout the year. Historically, Indians obtained most of their vitamin D through adequate sun exposure; however, darker skin pigmentation and the changes which have accompanied India's modernization, including increased hours spent working indoors and pollution, limit sun exposure for many. Inadequate sun exposure results in reduced vitamin D synthesis and ultimately poor vitamin D status if not compensated by dietary intake. Dietary vitamin D intake is very low in India because of low consumption of vitamin D rich foods, absence of fortification and low use of supplements. All these factors contribute to poor vitamin D status as measured by low circulating levels of 25-hydroxy vitamin D. Our review searches the published literature specific to India for evidence that would confirm the need to fortify food staples with vitamin D or stimulate public health policies for vitamin D supplementation and dietary guidelines tailored to the Indian diet. This review documents findings of widespread vitamin D deficiency in Indian populations in higher and lower socioeconomic strata, in all age groups, in both genders and people in various professions. Moreover, poor vitamin D status in India is accompanied by increased bone disorders including osteoporosis, osteomalacia in adults and rickets and other bone deformities in children. Without a concerted national effort to screen for vitamin D status, to implement policies or guidelines for vitamin D fortification and/or supplementation and to re-assess recommended dietary intake guidelines, dramatic increase in the number of bone disorders and other diseases may lie ahead. [source] Intellectual Property Rights in Bilateral Investment Treaties and Access to Medicines: The Case of Latin AmericaTHE JOURNAL OF WORLD INTELLECTUAL PROPERTY, Issue 5 2006Rosa Castro Bernieri The link between intellectual property protection and access to medicines has been studied from different perspectives. After signing the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement, most developing and least developed countries agreed to protect pharmaceutical products under the patent system. Beyond the criticisms of this system as an incentive mechanism to encourage private investment in research and development, it is widely acknowledged that a balance must exist between its benefits and costs. The patent system interaction with public health policies is twofold: providing incentives to develop new medicines, on the one hand, and increasing the prices of medicines, on the other. The TRIPS Agreement, the Doha Declaration and the subsequent Decision on Implementation of Paragraph 6 of the Doha Declaration all recognized this important trade-off. Different effects prevail in each interest group or country and negotiations of international intellectual property right (IPR) standards reflect this conflict. Nevertheless, the post-TRIPS scenario is full of new bilateral and regional agreements. The old bilateral investment treaties (BITS) are evolving towards new forms of all-encompassing arrangements that include intellectual property and liberalization of trade and services, apart from the classical rules for investment protection. This trend imposes a new landscape in IPR protection: one in which the above-described balance might be inclining towards one side. This article analyzes some legal, political and economic features of this new generation of BITS in Latin America. [source] From "Veshyas" to "Entertainment Workers": Evolving Discourses of Bodies, Rights, and Prostitution in IndiaASIAN POLITICS AND POLICY, Issue 2 2009Subir K. Kole The discursive terrain of prostitution has undergone several changes with modernity/postmodernity. Various groups of feminists hold contentious, often conflicting, ideologies on this issue. Two broad groups emerge from these debates: One takes a clear abolitionist perspective, while the other takes a sex work position. Both these groups actively lobby and join forces with individuals and institutions to influence global and national policy-making. There is a great degree of variation and overlap within and across each camp. Among those taking a sex work position, some argue that selling sex is equal to using any other part of the body for making a living. This article examines the discursive terrain of prostitution in India, focusing on what it means to treat sex as any other use of the body in commerce. It concludes that prohibition is a prejudice that India must overcome to develop sound public health policies. [source] Original article: The prevalence of Barrett's esophagus in the US: estimates from a simulation model confirmed by SEER dataDISEASES OF THE ESOPHAGUS, Issue 6 2010T. J. Hayeck SUMMARY Barrett's esophagus (BE) is the precursor and the biggest risk factor for esophageal adenocarcinoma (EAC), the solid cancer with the fastest rising incidence in the US and western world. Current strategies to decrease morbidity and mortality from EAC have focused on identifying and surveying patients with BE using upper endoscopy. An accurate estimate of the number of patients with BE in the population is important to inform public health policy and to prioritize resources for potential screening and management programs. However, the true prevalence of BE is difficult to ascertain because the condition frequently is symptomatically silent, and the numerous clinical studies that have analyzed BE prevalence have produced a wide range of estimates. The aim of this study was to use a computer simulation disease model of EAC to determine the estimates for BE prevalence that best align with US Surveillance Epidemiology and End Results (SEER) cancer registry data. A previously developed mathematical model of EAC was modified to perform this analysis. The model consists of six health states: normal, gastroesophageal reflux disease (GERD), BE, undetected cancer, detected cancer, and death. Published literature regarding the transition rates between these states were used to provide boundaries. During the one million computer simulations that were performed, these transition rates were systematically varied, producing differing prevalences for the numerous health states. Two filters were sequentially applied to select out superior simulations that were most consistent with clinical data. First, among these million simulations, the 1000 that best reproduced SEER cancer incidence data were selected. Next, of those 1000 best simulations, the 100 with an overall calculated BE to Detected Cancer rates closest to published estimates were selected. Finally, the prevalence of BE in the final set of best 100 simulations was analyzed. We present histogram data depicting BE prevalences for all one million simulations, the 1000 simulations that best approximate SEER data, and the final set of 100 simulations. Using the best 100 simulations, we estimate the prevalence of BE to be 5.6% (5.49,5.70%). Using our model, an estimated prevalence for BE in the general population of 5.6% (5.49,5.70%) accurately predicts incidence rates for EAC reported to the US SEER cancer registry. Future clinical studies are needed to confirm our estimate. [source] Genetic immunity and influenza pandemicsFEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY, Issue 1 2006Sergey N. Rumyantsev Abstract In addition to the great number of publications focused on the leading role of virus mutations and reassortment in the origin of pandemic influenza, general opinion emphasizes the victim side of the epidemic process. Based on the analysis and integration of relevant ecological, epidemiological, clinical, genetic and experimental data, the present article is focused on the evolution of ,virus , victim' ecological systems resulting in the formation of innate (i.e. genetic, constitutional) immunity in the involved species and populations. This kind of immunity functions today as the greatest natural barrier to the pandemic spread of influenza among humans and ecologically related kinds of animals. Global influenza pandemics can arise when the worldwide population contains at least a minimum number of people susceptible to a known or mutant influenza virus. Special attention is paid in this article to individual tests for the presence of this barrier, including the implications of specific findings for public health policy. Such tests could be based on in vitro observation of the action of relevant virus strains on primary cell cultures or on their cellular or molecular components extracted from individuals. The resources of the Human Genome Project should also be utilized. [source] Infant health production functions: what a difference the data makeHEALTH ECONOMICS, Issue 7 2009Nancy E. Reichman Abstract We examine the extent to which infant health production functions are sensitive to model specification and measurement error. We focus on the importance of typically unobserved but theoretically important variables (typically unobserved variables, TUVs), other non-standard covariates (NSCs), input reporting, and characterization of infant health. The TUVs represent wantedness, taste for risky behavior, and maternal health endowment. The NSCs include father characteristics. We estimate the effects of prenatal drug use, prenatal cigarette smoking, and first trimester prenatal care on birth weight, low birth weight, and a measure of abnormal infant health conditions. We compare estimates using self-reported inputs versus input measures that combine information from medical records and self-reports. We find that TUVs and NSCs are significantly associated with both inputs and outcomes, but that excluding them from infant health production functions does not appreciably affect the input estimates. However, using self-reported inputs leads to overestimated effects of inputs, particularly prenatal care, on outcomes, and using a direct measure of infant health does not always yield input estimates similar to those when using birth weight outcomes. The findings have implications for research, data collection, and public health policy. Copyright © 2008 John Wiley & Sons, Ltd. [source] The Epidemiology of Helicobacter pylori and Public Health ImplicationsHELICOBACTER, Issue 2009Nuno F. Azevedo Abstract This article presents a review of the literature on the epidemiology and public health implications of Helicobacter pylori infection published from April 2008 through to March 2009. The authors used MeSH terms "Helicobacter infections epidemiology,""Helicobacter infections prevention and control" to search multiple databases (PubMed, Embase, Cochrane, Cochrane Library, EBMR, BIOSIS), and independently searched PubMed using the term "Helicobacter" with "Epidemiology,""Transmission,""Prevalence" or "Environment." Articles without topical relevance were excluded. Two additional papers known to the authors were added. The identified literature is summarized by subtopic: reviews; prevalence; incidence; transmission; risk factors; and public health policy. [source] Why ,Health' is not a Central Category for Public Health PolicyJOURNAL OF APPLIED PHILOSOPHY, Issue 2 2009STEPHEN JOHN abstract We normally think that public health policy is an important political activity. In turn, we normally understand the value of public health policy in terms of the promotion of health or some health-related good (such as opportunity for health), on the basis of the assumption that health is an important constituent or determinant of wellbeing. In this paper, I argue that the assumption that the value of public health policy should be understood in terms of health leads us to overlook important benefits generated by such policy. To capture these benefits we need to understand the ends of public health policy in terms of the promotion of ,physical safety'. I then go on to argue that the idea that ,health' is an important category for evaluating or estimating individuals' wellbeing in the normative context of social policy is confused. I then clarify the relationship between my arguments and QALY-based accounts of health assessment. In the final section of the paper, I defend this surprising conclusion against various attacks. [source] PREVALENCE AND ANTIMICROBIAL RESISTANCE OF LISTERIA SPECIES IN FOOD PRODUCTS IN BANGKOK, THAILANDJOURNAL OF FOOD SAFETY, Issue 1 2010SIRIPORN STONSAOVAPAK ABSTRACT A total of 380 meat and meat products, dairy and dairy products, fresh vegetables, fresh seafood, and ready-to-eat food samples from supermarkets in Bangkok, Thailand were collected and analyzed for the occurrence of Listeria spp. and of Listeria monocytogenes. The overall incidence of Listeria spp. was 16.8%, most of them were isolated from raw meat and vegetables. L. monocytogenes was isolated from 18 (4.7%) out of 380 studied samples. Other species isolated were L. innocua (6.6%), L. ivanovii (0.8%), L. seeligeri (0.5%), L. grayi (1.6%) and L. welshimeri (2.6%). The antimicrobial susceptibilities of the 64 isolate of Listeria spp. were also examined by the standard disk diffusion method. Listeria spp. were resistant to penicillin (6.3%), chloramphenicol (3.1%) and tetracycline (1.6%), but sensitive to amoxicillin, vancomycin, ampicillin, rifampicin and sulfamethoxazole. PRACTICAL APPLICATIONS Listeria monocytogenes prevalence in food products in Bangkok has been documented. More studies on the occurrence of L. monocytogenes are needed to establish microbiological criteria of foods in the country. The findings of our study, increases in antibiotic resistance among Listeria spp. will provide useful information for the development of public health policy in the use of antimicrobials in food animal production. [source] Evolving patterns of tobacco use in northern SwedenJOURNAL OF INTERNAL MEDICINE, Issue 6 2003B. Rodu Abstract., Rodu B, Stegmayr B, Nasic S, Cole P, Asplund K (University of Alabama at Birmingham, Birmingham, AL, USA; Umeå Hospital, Umeå, Sweden). Evolving patterns of tobacco use in northern Sweden. J Intern Med 2003; 253: 660,665. Background and objectives., Cross-sectional data from northern Sweden suggest that the increased use of Swedish moist snuff (snus) may have contributed to a decline in the prevalence of smoking, especially amongst men. This study describes the evolving patterns of tobacco use in this population over the period 1986,1999. Design., This is a prospective follow-up study of 1651 men and 1756 women, aged 25,64 years, who were enrolled in the northern Sweden MONICA project (entry in 1986, 1990, 1994) and who were followed-up in 1999. Information on tobacco use at entry and at follow-up was used to describe the stability of tobacco use over a period of 5,13 years ending in 1999. Results., Snus was the most stable form of tobacco use amongst men (75%); only 2% of users switched to cigarettes and 20% quit tobacco altogether. Smoking was less stable (54%); 27% of smokers were tobacco-free and 12% used snus at follow-up. Combined use (smoking and snus) was the least stable (39%), as 43% switched to snus and 6% switched to cigarettes. Former users of both products were much less stable than former users of either cigarettes or snus. The stability of smoking amongst women was 69%, which was higher than that amongst men (P < 0.05). Conclusions., The use of snus played a major role in the decline of smoking rates amongst men in northern Sweden. The evolution from smoking to snus use occurred in the absence of a specific public health policy encouraging such a transition and probably resulted from historical and societal influences. [source] A critical analysis of UK public health policies in relation to diet and nutrition in low-income householdsMATERNAL & CHILD NUTRITION, Issue 2 2006Pamela Attree phd Abstract Diet and nutrition, particularly among low-income groups, is a key public health concern in the UK. Low levels of fruit and vegetable consumption, and obesity, especially among children, have potentially severe consequences for the future health of the nation. From a public health perspective, the UK government's role is to help poorer families make informed choices within healthy frameworks for living. However, the question is , to what extent are such policies in accordance with lay experiences of managing diet and nutrition on a low-income? This paper critically examines contemporary public health policies aimed at improving diet and nutrition, identifying the underlying theories about the influences on healthy eating in poor families, and exploring the extent to which these assumptions are based on experiential accounts. It draws on two qualitative systematic reviews , one prioritizing low-income mothers' accounts of ,managing' in poverty; and the other focusing on children's perspectives. The paper finds some common ground between policies and lay experiences, but also key divergencies. Arguably, the emphasis of public health policy on individual behaviour, coupled with an ethos of empowered consumerism, underplays material limitations on ,healthy eating' for low-income mothers and children. Health policies fail to take into account the full impact of structural influences on food choices, or recognize the social and emotional factors that influence diet and nutrition. In conclusion, it is argued that while health promotion campaigns to improve low-income families' diets do have advantages, these are insufficient to outweigh the negative effects of poverty on nutrition. [source] Sunlight robbery: A critique of public health policy on vitamin D in the UKMOLECULAR NUTRITION & FOOD RESEARCH (FORMERLY NAHRUNG/FOOD), Issue 8 2010Oliver GillieArticle first published online: 28 JUN 2010 Abstract The British Isles have a very cloudy climate and as a result receive fewer hours of clear sunlight than most other industrial regions. The majority of people in these islands have low blood levels of vitamin D [25(OH)D] all year round. Few food products are fortified with vitamin D in the UK and the government does not recommend any vitamin D supplement for most adults in the UK. Diseases associated with vitamin D insufficiency such as cancer, heart disease, diabetes (types 1 and 2) and multiple sclerosis are more frequent in the UK, and particularly in Scotland, than in many other European countries and some, such as multiple sclerosis and diabetes (types 1 and 2), are increasing in incidence. Present knowledge suggests that the risk of some chronic diseases could be reduced if vitamin D intake or sun exposure of the population were increased. Yet policy and public health recommendations of the UK government and its agencies (e.g. the Health Protection Agency, the Food Standards Agency) and of Cancer Research UK have failed to take full account of established and putative benefits of vitamin D and/or sunshine. The epidemic of chronic disease in the UK, which is associated with and caused at least in part by vitamin D insufficiency, has not been adequately recognized by these agencies, and too often measures taken by them have been misguided, inappropriate or ineffective. [source] Lifestyle intervention for prevention of diabetes: determinants of success for future implementationNUTRITION REVIEWS, Issue 3 2009Cheryl Roumen Lifestyle interventions are reported to reduce the risk of type 2 diabetes in high-risk individuals after mid- and long-term follow-up. Information on determinants of intervention outcome and adherence and the mechanisms underlying diabetes progression are valuable for a more targeted implementation. Weight loss seems a major determinant of diabetes risk reduction, whereas physical activity and dietary composition may contribute independently. Body composition and genetic variation may also affect the response to intervention. Lifestyle interventions are cost-effective and should be optimized to increase adherence and compliance, especially for individuals in the high-risk group with a low socioeconomic status, so that public health policy can introduce targeted implementation programs nationwide. The aims of this review are to summarize the mid- and long-term effects of lifestyle interventions on impaired glucose tolerance and type 2 diabetes mellitus and to provide determinants of intervention outcome and adherence, which can be used for future implementation of lifestyle interventions. [source] Gestational age estimation on United States livebirth certificates: a historical overviewPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2007Megan L. Wier Summary Gestational age on the birth certificate is the most common source of population-based gestational age data that informs public health policy and practice in the US. Last menstrual period is one of the oldest methods of gestational age estimation and has been on the US Standard Certificate of Live Birth since 1968. The ,clinical estimate of gestation', added to the standard certificate in 1989 to address missing or erroneous last menstrual period data, was replaced by the ,obstetric estimate of gestation' on the 2003 revision, which specifically precludes neonatal assessments. We discuss the strengths and weaknesses of these measures, potential research implications and challenges accompanying the transition to the obstetric estimate. [source] Severe acute respiratory syndrome in childrenPEDIATRIC PULMONOLOGY, Issue 4 2003Gary W.K. Wong MD Abstract Severe acute respiratory syndrome (SARS) is a newly described and highly contagious respiratory infection. Many adult patients will develop progressive hypoxia, and a large proportion will develop respiratory distress syndrome (RDS), possibly related to massive and uncontrolled activation of the immune system. The mortality has been reported to be quite high, especially in the elderly with comorbid conditions. The causative agent has been identified as a novel coronavirus, and children appear to acquire the infection by close-contact household exposure to an infected adult. However, the severity is much milder and the clinical progression much less aggressive in young children. The exact pathophysiology of SARS is still unclear, and the medical treatment of SARS remains controversial. The main treatment regime used in Hong Kong is a combination of ribavirin and steroid. To date, there have been no reported case fatalities in children with this disease. The success of reducing the burden of this infection in children will depend on proper isolation of infected adults early in the course of illness. Strict public health policy and quarantine measures are the key in controlling the infection in the community. Pediatr Pulmonol. 2003; 36:261,266. © 2003 Wiley-Liss, Inc. [source] Case,control study of pleural mesothelioma in workers with social security in MexicoAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 3 2010Guadalupe Aguilar-Madrid MD Abstract Background Environmental and occupational exposure to asbestos in Mexico in the past has been a cause of deaths and health damages. Its magnitude is unknown to date. Our objective was to identify the proportion of cases of malignant pleural mesothelioma (MPM) that can be attributed to and occupational exposure to asbestos. Methods We carried out a case,control study of MPM in 472 workers insured by the Mexican Institute of Social Security, all Valley of Mexico residents, with 119 incident cases and 353 controls. Cases were histologically confirmed. Participants were questioned concerning their occupational history and sociodemographic data. Assignment to one of the four exposures was performed qualitatively by an expert hygienist. Odds ratios (ORs) and attributable risks (ARs) were calculated using a non-conditional logistic regression model. Results A total of 80.6% of cases and 31.5% of controls had occupational exposure to asbestos. ORs were adjusted for age and gender and by exposure category, and exhibited an increase with probability of exposure as follows: 3.7(95% CI 1.3,10.4) for the likely category and 14.3(95% CI 8,26) for the certain category; AR in the group occupationally exposed to asbestos was 83.2%, and the population AR was 44%. Conclusions Our results show that the relationship between industrial uses of all forms of asbestos is generating an increase in mesothelioma-related diseases and deaths among Mexican workers. As a public health policy, Mexico should prohibit the use of asbestos in all production processes with the aim of controlling the epidemic and preventing the occurrence of new cases of MPM. Am. J. Ind. Med. 53:241,251, 2010. © 2009 Wiley-Liss, Inc. [source] What should we do about the obesity epidemic?PRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 4 2002Dr Julian H. Barth MD The current increase in obesity is occurring despite increasing awareness by the population at large of the benefits of healthy eating and exercise. Although weight gain is the direct result of a mismatch in energy balance, it is important to realise that there is a complex interplay between the environment and individual biology and behaviour. Management of obesity whether in a primary or secondary care setting requires a multi-disciplinary team to produce an individualised approach to embrace food, exercise and behavioural change. The prevention of obesity requires a three-level approach. First, there needs to be a co-ordinated public health policy at national level to create an environment where it is easy to make healthy choices for physical activity and food. Second, there needs to be a policy that targets those individuals who are at risk of becoming obese and those who have lost weight to help prevent weight regain. Finally, there needs to be a systematic uptake of the established protocols for the management of individuals with obesity and its co-morbidities. The challenge in the UK is to build imaginative networks that integrate all available resources both within the NHS and without, such as sports centres, fitness clubs and slimming clubs. Copyright © 2002 John Wiley & Sons, Ltd. [source] Measuring Fatness, Governing Bodies: The Spatialities of the Body Mass Index (BMI) in Anti-Obesity PoliticsANTIPODE, Issue 5 2009Bethan Evans Abstract:, The Body Mass Index (BMI) is the dominant means of defining and diagnosing obesity in national and international public health policy. This paper draws on geographical engagements with Foucault's work on biopower and governmentality to question the power afforded the BMI in obesity policy. With reference to a UK public health intervention involving the measurement of children's bodies within schools, the paper questions the multiple materialities and spatialities of the BMI with reference to both its role in the construction of geographies of obesity and its (in)ability to capture the fleshy, material, and experiential bodies of those individuals involved in the process of measurement. The paper contributes to poststructuralist health geographies through writing fleshy, active bodies into a Foucauldian reading of health and illness, thus questioning the justifications and implications of an obesity politics focussed on the BMI. [source] | |||||||||||||||||||