Objective. Estimate cataract surgical rates (CSR) for Brazil and each federal unit in 2006 and 2007 based on the number of surgeries performed by the Unified Health System to help plan a comprehensive ophthalmology network in order to eliminate cataract blindness in compliance with the target set by the World Health Organization (WHO) of 3 000 cataract surgeries per million inhabitants per year. Methods. This descriptive study calculates CSR by using the number of cataract surgeries carried out by the Brazilian Unified Health System for each federal unit and estimates the need for cataract surgery in Brazil for 2006-2007, with official population data provided by the Brazilian Institute of Geography and Statistics. The number of cataract surgeries was compared with the WHO target. Results. To reach the WHO goal for eliminating age-related cataract blindness in Brazil, 560 312 cataract surgeries in 2006 and 568 006 surgeries in 2007 needed to be done. In 2006, 179 121 cataract surgeries were done by the Unified Health System, corresponding to a CSR of 959 per million population; in 2007, 223 317 were performed, with a CSR of 1 179. With the Brazilian Council of Ophthalmology estimation of 165 000 surgeries each year by the non-public services...
In this article we describe the development of an information system for environmental childhood cancer surveillance. The Wisconsin Cancer Registry annually receives more than 25,000 incident case reports. Approximately 269 cases per year involve children. Over time, there has been considerable community interest in understanding the role the environment plays as a cause of these cancer cases. Wisconsin’s Public Health Information Network (WI-PHIN) is a robust web portal integrating both Health Alert Network and National Electronic Disease Surveillance System components. WI-PHIN is the information technology platform for all public health surveillance programs. Functions include the secure, automated exchange of cancer case data between public health–based and hospital-based cancer registrars; web-based supplemental data entry for environmental exposure confirmation and hypothesis testing; automated data analysis, visualization, and exposure–outcome record linkage; directories of public health and clinical personnel for role-based access control of sensitive surveillance information; public health information dissemination and alerting; and information technology security and critical infrastructure protection. For hypothesis generation...
The primary health care approach was introduced to the World Health Organization (WHO) Executive Board in January 1975. In this article, I describe the changes that occurred within WHO leading up to the executive board meeting that made it possible for such a radical approach to health services to emerge when it did. I also describe the lesser-known developments that were taking place in the Christian Medical Commission at the same time, developments that greatly enhanced the case for primary health care within WHO and its subsequent support by nongovernmental organizations concerned with community health.
The term “global health” is rapidly replacing the older terminology of “international health.” We describe the role of the World Health Organization (WHO) in both international and global health and in the transition from one to the other. We suggest that the term “global health” emerged as part of larger political and historical processes, in which WHO found its dominant role challenged and began to reposition itself within a shifting set of power alliances.
The prevailing views on the role of public health professionals refer to professionals in the academic world, without taking into account the fact that many public health professionals are government employees. For example, the American Public Health Association states that public health professionals play an active role in communicating public health information to nonscientific audiences, such as the general population or the mass media.
Using the international maternal health field as a case study, we draw on ethnographic research to investigate how public health researchers and policy experts are responding to tensions between vertical and horizontal approaches to health improvement. Despite nominal support for an integrative health system approach, we found that competition for funds and international recognition pushes professionals toward vertical initiatives. We also highlight how research practices contribute to the dominance of vertical strategies and limit the success of evidence-based policymaking for strengthening health systems. Rather than support disease-and subfield-specific advocacy, the public health community urgently needs to engage in open dialogue regarding the international, academic, and donor-driven forces that drive professionals toward an exclusive interest in vertical programs.
Core competencies have been used to redefine curricula across the major health professions in recent decades. In 2006, the Association of Schools of Public Health identified core competencies for the master of public health degree in graduate schools and programs of public health. We provide an overview of the model development process and a listing of 12 core domains and 119 competencies that can serve as a resource for faculty and students for enhancing the quality and accountability of graduate public health education and training. The primary vision for the initiative is the graduation of professionals who are more fully prepared for the many challenges and opportunities in public health in the forthcoming decade.
Research on racism as a harmful determinant of population health is in its infancy. Explicitly naming a long-standing problem long recognized by those affected, this work has the potential to galvanize inquiry and action, much as the 1962 publication of the Kempe et al. scientific article on the “battered child syndrome” dramatically increased attention to—and prompted new research on—the myriad consequences of child abuse, a known yet neglected social phenomenon. To further work on connections between racism and health, the author addresses 3 interrelated issues: (1) links between racism, biology, and health; (2) methodological controversies over how to study the impact of racism on health; and (3) debates over whether racism or class underlies racial/ethnic disparities in health.
This article provides an overview of the magnitude of and trends in racial/ethnic disparities in health for women in the United States. It emphasizes the importance of attending to diversity in the health profiles and populations of minority women. Socioeconomic status is a central determinant of racial/ethnic disparities in health, but several other factors, including medical care, geographic location, migration and acculturation, racism, and exposure to stress and resources also play a role. There is a need for renewed attention to monitoring, understanding, and actively seeking to eliminate racial/ethnic disparities in health.
This paper examines two innovative educational initiatives for the Ecuadorian public health workforce: a Canadian-funded Masters programme in ecosystem approaches to health that focuses on building capacity to manage environmental health risks sustainably; and the training of Ecuadorians at the Latin American School of Medicine in Cuba (known as Escuela Latinoamericana de Medicina in Spanish). We apply a typology for analysing how training programmes address the needs of marginalized populations and build capacity for addressing health determinants. We highlight some ways we can learn from such training programmes with particular regard to lessons, barriers and opportunities for their sustainability at the local, national and international levels and for pursuing similar initiatives in other countries and contexts. We conclude that educational efforts focused on the challenges of marginalization and the determinants of health require explicit attention not only to the knowledge, attitudes and skills of graduates but also on effectively engaging the health settings and systems that will reinforce the establishment and retention of capacity in low- and middle-income settings where this is most needed.
A growing literature on the social determinants of health strongly suggests the value of examining social policy interventions for their potential links to health equity. I investigate how sectoral job training, an intervention favored by the Obama administration, might be conceptualized as an intervention to improve health equity. Sectoral job training programs ideally train workers, who are typically low income, for upwardly mobile job opportunities within specific industries. I first explore the relationships between resource redistribution and health equity. Next, I discuss how sectoral job training theoretically redistributes resources and the ways in which these resources might translate into improved health. Finally, I make recommendations for strengthening the link between sectoral job training and improved health equity.
Local public health laboratories (PHLs) serve many of the same roles as state PHLs and often perform many or portions of the 11 Core Functions and Capabilities of State Public Health Laboratories; however, they differ in several important ways. First, many local laboratories provide testing at the site of patient care (e.g., sexually transmitted infection clinics) or address local environmental issues (e.g., water quality). Second, local PHLs support the missions of local public health departments, which may differ from those at the state level. Third, local PHLs often serve as conduits, collecting specimens for various state-level screening and disease-control programs; and while they may not perform the testing, local PHLs are responsible for tracking specimens, ordering tests, and reporting results. Fourth, local PHLs often serve as surge capacity for state PHLs, particularly for testing to support emergency response. Last, local PHLs work with and are typically co-located in the local public health agency with other public health programs. Local PHL professionals work as a team with investigators, inspectors, and community and public health medical professionals and, thus, are poised to provide rapid and relevant responses to community needs.
Proposals to improve the US health system are commonly supported by models that have only a few variables and overlook certain processes that may delay, dilute, or defeat intervention effects. We use an evidence-based dynamic simulation model with a broad national scope to analyze 5 policy proposals. Our results suggest that expanding insurance coverage and improving health care quality would likely improve health status but would also raise costs and worsen health inequity, whereas a strategy that also strengthens primary care capacity and emphasizes health protection would improve health status, reduce inequities, and lower costs. A software interface allows diverse stakeholders to interact with the model through a policy simulation game called HealthBound.
Without the modern tools of surveillance, or the ability to develop a national vaccination campaign, local health departments were often on their own in preparing and combating the spread of the disease during the influenza epidemic of 1918. This article reviews the state of public health before the epidemic, seeking to place the reaction to the disease in the context of the evolution of public health. The epidemic struck at a critical time in the history of the nation and of public health, and we must explore not only the tools and technologies that were available to practitioners at the time, but also the authority provided by local and state public health practitioners to apply these tools. Much of public health was rooted in the experiences and practices developed over the previous century in responding to often dramatic outbreaks of cholera, yellow fever, typhoid, and a host of other infectious diseases.
Social, political, and economic disruptions caused by natural and human-caused public health emergencies have catalyzed public health efforts to expand the scope of biosurveillance and increase the timeliness, quality, and comprehensiveness of disease detection, alerting, response, and prediction. Unfortunately, efforts to acquire, render, and visualize the diversity of health intelligence information are hindered by its wide distribution across disparate fields, multiple levels of government, and the complex interagency environment. Achieving this new level of situation awareness within public health will require a fundamental cultural shift in methods of acquiring, analyzing, and disseminating information. The notion of information “fusion” may provide opportunities to expand data access, analysis, and information exchange to better inform public health action.
The National Health Survey undertaken in 1935 and 1936 was the largest morbidity survey until that time. It was also the first national survey to focus on chronic disease and disability. The decision to conduct a survey of this magnitude was part of the larger strategy to reform health care in the United States. The focus on morbidity allowed reformers to argue that the health status of Americans was poor, despite falling mortality rates that suggested the opposite. The focus on chronic disease morbidity proved to be an especially effective way of demonstrating the poor health of the population and the strong links between poverty and illness. The survey, undertaken by a small group of reform-minded epidemiologists led by Edgar Sydenstricker, was made possible by the close interaction during the Depression of agencies and actors in the public health and social welfare sectors, a collaboration which produced new ways of thinking about disease burdens.
Climate change presents the biggest threat to human health in the 21st century. However, many public health leaders feel ill equipped to face the challenges of climate change and have been unable to make climate change a priority in service development. I explore how to achieve a regionally responsive whole-of-systems approach to climate change in the key operational areas of a health service: service governance and culture, service delivery, workforce development, asset management, and financing. The relative neglect of implementation science means that policymakers need to be proactive about sourcing and developing models and processes to make health services ready for climate change. Health research funding agencies should urgently prioritize applied, regionally responsive health services research for a future of climate change.
Vitamin A supplementation is a public health intervention that clinical trials have suggested can significantly improve child survival in the developing world. Yet, prominent scientists in India have questioned its scientific validity, opposed its implementation, and accused its advocates of corruption and greed. It is ironic that these opponents were among the pioneers of populationwide vitamin A supplementation for ocular health. Historically, complex interests have shaped vitamin A supplementation resistance in India. Local social and nutritional revolutions and shifting international paradigms of global health have played a role. Other resistance movements in Indian history, such as those in response to campaigns for bacillus Calmette-Guérin and novel vaccines, have been structured around similar themes. Public health resistance is shaped by the cultural and political context in which it develops. Armed with knowledge of the history of a region and patterns of past resistance, public health practitioners can better understand how to negotiate global health conflicts.
When the American Museum of Health (AMH) opened in 1939 at the World’s Fair, its popularity convinced its organizers that the AMH was merely the first in a nationwide network of health museums. The AMH’s organizers had imported an approach to health education developed in Germany, which promoted health as a positive attribute through interactive, visually impressive displays that relied on clarity and simplicity—as epitomized by the “Transparent Man”—to encourage a feeling of wonder among exhibit goers. However, other museum professionals rejected this approach, and the AMH failed to catalyze a broad health museum movement. Nevertheless, the notion that presenting the body as an object of wonder will improve the public’s health has reappeared in the more recent past, as popular anatomical shows claim that exposing the interior of the human body will convince viewers to live healthier lives.
The pattern of association between socioeconomic factors and health outcomes has primarily depicted better health for those who are higher in the social hierarchy. Although this is a ubiquitous finding in the health literature, little is known about the interplay between these factors among indigenous populations. We begin to bridge this knowledge gap by assessing evidence on social gradients in indigenous health in Australia. We reveal a less universal and less consistent socioeconomic status patterning in health among Indigenous Australians, and discuss the plausibility of unique historical circumstances and social and cultural characteristics in explaining these patterns. A more robust evidence base in this field is fundamental to processes that aim to reduce the pervasive disparities between indigenous and nonindigenous population health.