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‣ Health surveys and use of maternal and child health care services in three municipalities within the São Paulo metropolitan area

de Carvalho, Wladithe Organ; Galvao Cesar, Chester Luiz; Carandina, Luana; de Azevedo Barros, Marilisa Berti; Goi Porto Alves, Maria Cecilia; Goldbaum, Moises
Fonte: Pan Amer Health Organization Publicador: Pan Amer Health Organization
Tipo: Artigo de Revista Científica Formato: 314-323
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Objectives. To describe the changes in the use of maternal and child health care services by residents of three municipalities-Embu, Itapecerica da Serra, and Taboao da Serra-in the São Paulo metropolitan area, 12 years after the implementation of the Unified Health System (SUS) in Brazil, and to analyze the potential of population-based health care surveys as sources of data to evaluate these changes.Methods. Two population-based, cross-sectional surveys were carried out in 1990 and 2002 in municipalities located within the São Paulo metropolitan area. For children under 1 year of age, the two periods were compared in terms of outpatient services utilization and hospital admission; for the mothers, the periods were compared in terms of prenatal care and deliveries. In both surveys, stratified and multiple-stage conglomerate sampling was employed, with standardization of interview questions.Results. The most important changes observed were regarding the location of services used for prenatal care, deliveries, and hospitalization of children less than 1 year of age. There was a significant increase in the use of services in the surrounding region or hometown, and decrease in the utilization of services in the city of São Paulo (in 1990...

‣ Health surveys and use of maternal and child health care services in three municipalities within the Sao Paulo metropolitan area

CARVALHO, Wladithe Organ de; CESAR, Chester Luiz Galvao; CARANDINA, Luana; BARROS, Marilisa Berti de Azevedo; ALVES, Maria Cecilia Goi Porto; GOLDBAUM, Moises
Fonte: PAN AMER HEALTH ORGANIZATION Publicador: PAN AMER HEALTH ORGANIZATION
Tipo: Artigo de Revista Científica
Português
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Objectives. To describe the changes in the use of maternal and child health care services by residents of three municipalities-Embu, Itapecerica da Serra, and Taboao da Serra-in the Sao Paulo metropolitan area, 12 years after the implementation of the Unified Health System (SUS) in Brazil, and to analyze the potential of population-based health care surveys as sources of data to evaluate these changes. Methods. Two population-based, cross-sectional surveys were carried out in 1990 and 2002 in municipalities located within the Sao Paulo metropolitan area. For children under 1 year of age, the two periods were compared in terms of outpatient services utilization and hospital admission; for the mothers, the periods were compared in terms of prenatal care and deliveries. In both surveys, stratified and multiple-stage conglomerate sampling was employed, with standardization of interview questions. Results. The most important changes observed were regarding the location of services used for prenatal care, deliveries, and hospitalization of children less than 1 year of age. There was a significant increase in the use of services in the surrounding region or hometown, and decrease in the utilization of services in the city of Sao Paulo (in 1990...

‣ Teacher training in the field of health promotion : a proposal for International collaboration and preparation of a symposium for the 20th IUHPE World Conference

Jourdan, Didier; Simovska, V.; Valiama, R.; Pakkarár, L.; Simar, C.; Mannix-McNamara, P.; Samdal, O.; Viig, N.G.; Carvalho, Graça Simões de; Diagne, F.; Guével, M-R.; Buijs, G.; Young, I.
Fonte: IUHPE - International Union for Health Promotion and Education Publicador: IUHPE - International Union for Health Promotion and Education
Tipo: Conferência ou Objeto de Conferência
Publicado em 09/09/2008 Português
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Schools are considered to be settings for both health education and health promotion. But the core business of schools is actually focussed on educational outcomes, not reducing health problems. In most countries, schools give low priority to health promotion and school staffs, mainly teachers, are not aware of their role in health promotion. Studies show that teachers who have received health promotion training tend to be involved more frequently in health promotion projects and have a more comprehensive approach to health education. Pre-service and In-service staff training is then a main challenge. That’s the reason why we have launched an initiative to join international forces to strengthen and advocate for teacher training in health promotion. The main goals are: develop research, affirm and reinforce the work done in teacher training in health promotion, support the institutes/colleges/universities in the provision of initial and in-service teacher training and stimulate international partnership work.; LIBEC/CIFPEC - unidade de investigação 16/644 da FCT.

‣ “Health for Three-Thirds of the Nation”: Public Health Advocacy of Universal Access to Medical Care in the United States

Derickson, Alan
Fonte: © American Journal of Public Health 2002 Publicador: © American Journal of Public Health 2002
Tipo: Artigo de Revista Científica
Publicado em /02/2002 Português
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The public health community has made important, original contributions to the debate over universal access to health services in the United States. Well before the decision of the American Public Health Association in 1944 to endorse a health plan encompassing virtually the entire populace, prominent public health practitioners and scholars embraced universality as an essential principle of health policy. Influenced by Arthur Newsholme, C.-E. A. Winslow began to promote this principle in the 1920s. Many others came to justify universal medical care as a corollary of the traditional ideal of all-inclusive public health services. By the 1940s, most leaders in the field saw national health insurance as the best way to attain universal access. For the past 30 years, advocates of universalism have asserted a social right to health services.

‣ Public Health, the APHA, and Urban Renewal

Lopez, Russ P.
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
Publicado em /09/2009 Português
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Joint efforts by fields of public health in the last decade have advocated use of the built environment to protect health. Past involvement by public health advocates in urban policy, however, has had mixed results. Although public health has significantly contributed to health improvements, its participation in urban renewal activities was problematic. Health advocates and the American Public Health Association produced guidelines that were widely used to declare inner-city areas blighted and provided a scientific justification for demolishing neighborhoods and displacing mostly poor and minority people. Furthermore, health departments failed to uphold their legal responsibility to ensure that relocated families received safe, affordable housing alternatives. These failures have important implications for future health-related work on the built environment and other core public health activities.

‣ The Public Health Foundation of Health Services for American Indians & Alaska Natives

Rhoades, Everett R.; Rhoades, Dorothy A.
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
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The integration of public health practices with federal health care for American Indians and Alaska Natives (AI/ANs) largely derives from three major factors: the sovereign nature of AI/AN tribes, the sociocultural characteristics exhibited by the tribes, and that AI/ANs are distinct populations residing in defined geographic areas. The earliest services consisted of smallpox vaccination to a few AI/AN groups, a purely public health endeavor. Later, emphasis on public health was codified in the Snyder Act of 1921, which provided for, among other things, conservation of the health of AI/AN persons. Attention to the community was greatly expanded with the 1955 transfer of the Indian Health Service from the US Department of the Interior to the Public Health Service and has continued with the assumption of program operations by many tribes themselves. We trace developments in integration of community and public health practices in the provision of federal health care services for AI/AN persons and discuss recent trends.

‣ Use of health services in Hill villages in Central Nepal

Niraula, Bhanu B
Fonte: Health Transition Centre, National Centre for Epidemiology and Population Health, The Australian National University Publicador: Health Transition Centre, National Centre for Epidemiology and Population Health, The Australian National University
Tipo: Artigo de Revista Científica Formato: 53218 bytes; application/pdf
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This paper reports the use and non-use of health care facilities in the Hill villages in central Nepal. The health behaviour model (HBM) is applied to test the significance of socio-economic variables on the use of the modern health care system. The study finds that all three characteristics of the HBM model, predisposing, enabling and need, are significantly related to use and non-use of the modern health care system. The analysis shows that number of living children, respondent’s education, nearness to the road and service centre, value of land, knowledge about health workers and experience of child loss are some of the variables that are positively and significantly related to the use of modern health care. Age of the respondents and household size were found to be negatively associated with health-care use. Contrary to expectation, caste is unimportant. Making use of the qualitative data, this paper argues that the health care system is unnecessarily bureaucratic and patriarchal, which favours the socio-economically well-off.; yes

‣ Health professionals' knowledge, practice and opinions about fetal alcohol syndrome and alcohol consumption in pregnancy

Payne, J.; Elliott, E.; D'Antoine, H.; O'Leary, C.; Mahony, A.; Haan, E.; Bower, C.
Fonte: Public Health Assoc Australia Inc Publicador: Public Health Assoc Australia Inc
Tipo: Artigo de Revista Científica
Publicado em //2005 Português
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OBJECTIVE: To measure the knowledge, attitudes and practices of health professionals regarding fetal alcohol syndrome (FAS) and alcohol use during pregnancy. METHOD: A postal survey of a representative random sample of health professionals was conducted in Western Australia (WA) in 2002/03. 1,143 (79%) of 1,443 eligible health professionals completed the survey (87 Aboriginal Health Workers, 286 allied health professionals, 537 community nurses, 170 general practitioners and 63 obstetricians). RESULTS: Of 1,143 health professionals, 12% identified all four essential diagnostic features of FAS. Most (95%) had never diagnosed FAS. Although 82% believed that making a diagnosis of FAS might improve treatment plans and 85% agreed FAS was preventable, 53% said the diagnosis might be stigmatising. Only 2% felt very prepared to deal with FAS and most wanted information for themselves and their clients. Of the 659 health professionals caring for pregnant women, only 45% routinely ask about alcohol use in pregnancy, only 25% routinely provide information on the consequences of alcohol use in pregnancy and only 13% provide advice consistent with NHMRC guidelines on alcohol consumption in pregnancy. CONCLUSION: Health professionals have identified the need for educational materials for themselves and their clients. IMPLICATIONS: FAS is likely to be under-ascertained in Australia due to a lack of knowledge of FAS by health professionals. Until this lack of knowledge is addressed...

‣ Health transition research in the control of morbidity and mortality from acute respiratory infection.

Douglas, Robert M; D'ouza, Rennie
Fonte: Health Transition Centre, National Centre for Epidemiology and Population Health, The Australian National University Publicador: Health Transition Centre, National Centre for Epidemiology and Population Health, The Australian National University
Tipo: Artigo de Revista Científica Formato: 32218 bytes; application/pdf
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The essence of health transition research is its multidisciplinary character and openness to broad theory. Theories of health transition provide the context in which classic epidemiological studies can, most effectively, contribute to population health improvement. Acute respiratory infections are a leading cause of morbidity in all countries, and a major cause of premature death in countries where mortality is high. The international ARI control program in childhood sponsored by the World Health Organization is built on conventional biomedical foundations. Health systems in Australia and Pakistan continue to be driven by this conventional model which has contributed to changes in mortality but probably not exclusively. A health transition approach forces us to step back, and place the gains of the biomedical model in a social and historical perspective. Using that perspective to move public health policy forward in the modern nation state requires adventurous lateral thinking. We review here the problem of acute respiratory infections in Australian and Pakistani children. In Australia, we focus on the large differences in respiratory infection severity and outcomes between Aboriginal children and Caucasians. We also draw attention to our current ignorance on what differentiates children who are prone to respiratory infections from those who are not. In Pakistan...

‣ NAVIGATING the Future Through the Past The Enduring Historical Legacy of Federal Children's Health Programs in the United States

Brosco, Jeffrey Paul
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
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The United States excels at treating the most complex medical conditions, but our low-ranking health statistics (relative to other countries) do not match our high-end health care spending. One way to understand this paradox is to examine the history of federal children's health programs. In the 1800s, children's health advocates confronted social determinants of health to reduce infant mortality. Over the past 100 years, however, physicians have increasingly focused on individual doctor–patient encounters; public health professionals, meanwhile, have maintained a population health perspective but struggled with the politics of addressing root causes of disease. Political history and historical demography help explain some salient differences with European nations that date to the founding of federal children's health programs in the early 20th century. More recently, federal programs for children with intellectual disability illustrate technical advances in medicine, shifting children's health epidemiology, and the politics of public health policy.

‣ Progress Towards Universal Health Coverage in BRICS; Translating Economic Growth into Better Health

Rao, Krishna D.; Petrosyan, Varduhi; Correia Araujo, Edson; McIntyre, Diane
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Journal Article; Publications & Research :: Journal Article; Publications & Research
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Brazil, the Russian Federation, India, China and South Africa – the countries known as BRICS – represent some of the world’s fastest growing large economies and nearly 40% of the world’s population. Over the last two decades, BRICS have undertaken health-system reforms to make progress towards universal health coverage. This paper discusses three key aspects of these reforms: the role of government in financing health; the underlying motivation behind the reforms; and the value of the lessons learnt for non-BRICS countries. Although national governments have played a prominent role in the reforms, private financing constitutes a major share of health spending in BRICS. There is a reliance on direct expenditures in China and India and a substantial presence of private insurance in Brazil and South Africa. The Brazilian health reforms resulted from a political movement that made health a constitutional right, whereas those in China, India, the Russian Federation and South Africa were an attempt to improve the performance of the public system and reduce inequities in access. The move towards universal health coverage has been slow. In China and India, the reforms have not adequately addressed the issue of out-of-pocket payments. Negotiations between national and subnational entities have often been challenging but Brazil has been able to achieve good coordination between federal and state entities via a constitutional delineation of responsibility. In the Russian Federation...

‣ Public Health, Private Body

Broom, Dorothy
Fonte: Public Health Association of Australia Publicador: Public Health Association of Australia
Tipo: Artigo de Revista Científica
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A number of comparatively recent epistemological shifts draw attention to the body, among them developments in social (including feminist) theory and gender studies. In many social science and humanities disciplines, there is now considerable research and debate about notions of embodiment. Yet despite the fact that our subject matter is, ultimately, the life and death of human bodies, public health has remained largely silent on the question of what bodies are and how our public health work, whether academic or applied, is shaped by ideas about embodiment. Consequently, public health notions of the body remain implicit, ambiguous, often contradictory and incoherent. In this discussion, I strive to make explicit what some of our implicit ideas might be, to speculate on why bodies are excluded from most public health discourse, how that exclusion is achieved, and the consequences for public health research and practice. In an active consideration of the fundamental subject matter of public health, I invite attention to where and how greater self-consciousness about embodiment and its consequences might instigate shifts in public health thinking and action.

‣ Health promotion needs of Hammanskraal families with adolescents orphaned by HIV/AIDS

Peu,MD; van Wyk,NC; Botha,ADH
Fonte: Health SA Gesondheid (Online) Publicador: Health SA Gesondheid (Online)
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2008 Português
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Health promotion is regarded as the cornerstone of good health. It is the action expected from individuals and families in order to better their own health situation. Health promotion is an art and science (Edelman & Mandle, 2002:16) that is integrated into the primary health care to reduce existing health problems. The purpose of the research on which this article is reporting, was to explore and describe the health promotion needs of families with adolescents orphaned by human immunodeficiency virus or acquired immune deficiency syndrome (HIV/AIDS). The research was located within a qualitative paradigm that is both exploratory and descriptive. Eight families who were purposely selected participated in the research process. Qualitative methods, such as group interviews and field notes were utilised to collect data. The health promotion needs of the families with adolescents orphaned by HIV/AIDS were explored and described. Tesch's analysis process, which entails a series of steps, was followed (Creswell, 2003:192). Themes, categories and subcategories that form the central focus of health promotion needs emerged during the data analysis. These themes,categories and subcategories are used to develop guidelines for health promotion.

‣ Health inequalities and the health of the poor: What do we know? What can we do?

Gwatkin,D.R
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2000 Português
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The contents of this theme section of the Bulletin of the World Health Organization on "Inequalities in health" have two objectives: to present the initial findings from a new generation of research that has been undertaken in response to renewed concern for health inequalities; and to stimulate movement for action in order to correct the problems identified by this research. The research findings are presented in the five articles which follow. This Critical Reflection proposes two initial steps for the action needed to alleviate the problem; other suggestions are given by the participants in a Round Table discussion which is published after these articles. The theme section concludes with extracts from the classic writings of the nineteenth-century public health pioneer, William Farr, who is widely credited as one of the founders of the scientific study of health inequalities, together with a commentary. This Critical Reflection contributes to the discussion of the action needed by proposing two initial steps for action. • That professionals who give very high priority to the distinct but related objectives of poverty alleviation, inequality reduction, and equity enhancement recognize that their shared concern for the distributional aspects of health policy is far more important than any differences that may divide them. • That health policy goals...

‣ Through Mintzberg’s glasses: a fresh look at the organization of ministries of health

Unger,Jean-Pierre; Macq,Jean; Bredo,François; Boelaert,Marleen
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2000 Português
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In 1987, district health care policies were officially adopted by a majority of developing countries. Many operational problems constraining implementation of such policies have subsequently been identified, most of which are attributable to well-known characteristics of less developed countries. However, the policy of operational and administrative decentralization has often been critically obstructed by inappropriate organizational structures in ministries of health. By applying Mintzberg’s analytical framework to several ministries of health, we identify structural deficiencies that make systems unfit to match their policy environment and yield the expected outcomes of functional and decentralized services. We propose a typology likely to elicit strategies for decentralizing health care administration. Our analysis is based on the following steps: - a description of Mintzberg’s concepts of organizational structure, generic components (strategic apex, technostructure, supporting structure, middle line, operational core) and functions (horizontal and vertical integration, liaison devices, vertical and horizontal decentralization) applied to health systems; - a discussion of divisionalized adhocracy as a suitable configuration for health organizations with a need for a high degree of regional autonomy...

‣ Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso

Su,Tin Tin; Kouyaté,Bocar; Flessa,Steffen
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2006 Português
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OBJECTIVE: To quantify the extent of catastrophic household health care expenditure and determine the factors responsible for it in Nouna District, Burkina Faso. METHODS: We used the Nouna Health District Household Survey to collect data on 800 households during 2000-01 for our analysis. The determinants of household catastrophic expenditure were identified by multivariate logistic regression method. FINDINGS: Even at very low levels of health care utilization and modest amount of health expenditure, 6-15% of total households in Nouna District incurred catastrophic health expenditure. The key determinants of catastrophic health expenditure were economic status, household health care utilization especially for modern medical care, illness episodes in an adult household member and presence of a member with chronic illness. CONCLUSION: We conclude that the poorest members of the community incurred catastrophic health expenses. Setting only one threshold/cut-off value to determine catastrophic health expenses may result in inaccurate estimation leading to misinterpretation of important factors. Our findings have important policy implications and can be used to ensure better access to health services and a higher degree of financial protection for low-income groups against the economic impact of illness.

‣ A sociodental approach to assessing children's oral health needs: integrating an oral health-related quality of life (OHRQoL) measure into oral health service planning

Gherunpong,Sudaduang; Sheiham,Aubrey; Tsakos,Georgios
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2006 Português
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OBJECTIVE: We adopted a sociodental approach to assess the real dental needs of Thai primary school children, and integrated an oral health-related quality of life measure (OHRQoL) into oral health service planning. We then compared the results of this sociodental assessment with standard estimates of a child's oral health needs. METHODS: We developed a new model of sociodental needs assessment and used it to assess the level of impact that various oral health conditions have on the everyday lives of school children. We then carried out a cross-sectional study of all grade-6 children (11-12 years old) in Suphan-buri Province, Thailand. We examined the sample (n = 1034) to assess the children's oral health and then we interviewed each child individually to assess what impact any dental conditions he or she may have on their quality of life. This assessment was done using an OHRQoL indicator, the Child Oral Impacts on Daily Performances index (child-OIDP). We integrated the results obtained using this indicator with those estimates obtained using more traditional, standard clinical methods, in order to generate a clearer picture of exactly which non-progressive dental conditions really needed treatment. These results take into account the impact those conditions have on the overall well-being of children and their ability to function normally and unimpeded. We were then able to prioritize their dental needs according to the severity of disruption caused in their daily lives. FINDINGS: Using standard or "normative" estimates of dental health care needs...

‣ District health programmes and health-sector reform: case study in the Lao People's Democratic Republic

Perks,Carol; Toole,Michael J; Phouthonsy,Khamla
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2006 Português
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The Lao People's Democratic Republic (Lao PDR) is classified by the World Bank as a low-income country under stress. Development partners have sought to utilize effective aid instruments to help countries classified in this way achieve the Millennium Development Goals; these aid instruments include sector-wide approaches (SWAps) that support decentralized district health systems and seek to avoid fragmentation and duplication. In Asia and the Pacific, only Bangladesh, Papua New Guinea and the Solomon Islands have adopted SWAps. Since 1991, a comprehensive primary health care programme in the remote Sayaboury Province of Lao PDR has focused on strengthening district health management, improving access to health facilities and responding to the most common causes of mortality and morbidity among women and children. Between 1996 and 2003, health-facility utilization tripled, and the proportion of households that have access to a facility increased to 92% compared with only 61% nationally. By 2003, infant and child mortality rates were less than one-third of the national rates. The maternal mortality ratio decreased by 50% despite comprehensive emergency obstetric care not being available in most district hospitals. These trends were achieved with an investment of approximately US$ 4 million over 12 years (equivalent to US$ 1.00 per person per year). However...

‣ Reproductive health and health sector reform in developing countries: establishing a framework for dialogue

Lubben,Marianne; Mayhew,Susannah H.; Collins,Charles; Green,Andrew
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2002 Português
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It is not clear how policy-making in the field of reproductive health relates to changes associated with programmes for the reform of the health sector in developing countries. There has been little communication between these two areas, yet policy on reproductive health has to be implemented in the context of structural change. This paper examines factors that limit dialogue between the two areas and proposes the following framework for encouraging it: the identification of policy groups and the development of bases for collaborative links between them; the introduction of a common understanding around relevant policy contexts; reaching agreement on compatible aims relating to reproductive health and health sector change; developing causal links between policy content in reproductive health and health sector change as a basis for evidence-based policy-making; and strengthening policy-making structures, systems, skills, and values.

‣ Globalization and health: a framework for analysis and action

Woodward,David; Drager,Nick; Beaglehole,Robert; Lipson,Debra
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2001 Português
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Globalization is a key challenge to public health, especially in developing countries, but the linkages between globalization and health are complex. Although a growing amount of literature has appeared on the subject, it is piecemeal, and suffers from a lack of an agreed framework for assessing the direct and indirect health effects of different aspects of globalization. This paper presents a conceptual framework for the linkages between economic globalization and health, with the intention that it will serve as a basis for synthesizing existing relevant literature, identifying gaps in knowledge, and ultimately developing national and international policies more favourable to health. The framework encompasses both the indirect effects on health, operating through the national economy, household economies and health-related sectors such as water, sanitation and education, as well as more direct effects on population-level and individual risk factors for health and on the health care system. Proposed also is a set of broad objectives for a programme of action to optimize the health effects of economic globalization. The paper concludes by identifying priorities for research corresponding with the five linkages identified as critical to the effects of globalization on health.