Investing in Health

Health Equity: Our Global Responsibility

2009-08-07T11:08:00.001-03:00

http://www.ccih09.pbworks.com

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>July 29th Update<

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Workplace Stress

2009-08-06T16:06:00.001-03:00

Workplace Stress and Heart Disease

By Paual Rasich
Reviewed by Elizabeth Klodas, MD, FACC

For years medical research has steadily found tiny clues that chronic stress may takes a toll on your health and shorten your life. Now the first large-scale study illuminates the definitive links between long-term mental stress and heart disease./.../

Social Stress

2009-08-06T13:43:00.001-03:00

Science News

Social Stress Linked To Harmful Fat Deposits, Heart Disease

ScienceDaily (Aug. 5, 2009) — A new study done by researchers at Wake Forest University School of Medicine shows that social stress could be an important precursor to heart disease by causing the body to deposit more fat in the abdominal cavity, speeding the harmful buildup of plaque in blood vessels, a stepping stone to the number one cause of death in the world./.../

Poverty

2009-08-06T12:39:00.001-03:00

http://www.bristol.ac.uk/poverty/health%20inequalities.html
The extent of health inequalities
Both cross-sectionally and along the lifecourse with effective policies which can reduce these inequalities.

The allocation of health resources
On the basis of need as a pre-requisite to reducing health inequalities and tackling the ‘inverse care law’.

The measurement of health
Using a ‘social model’ approach.

The main differences between our approach and a traditional ‘medical model’ of health are summarised below by comparing the Chief Medical Officer’s Top Ten Tips for Health and our alternative version:

Desigualdade social: menor desde 2002

2009-08-04T21:10:00.003-03:00

terça-feira, 4 de agosto de 2009, 18:24 | Estadão Online

Desigualdade social: menor desde 2002, aponta Ipea

Em junho, índice de Gini atingiu 0,493 pontos, o menor nível desde 2002, quando começou a ser apurado

Anne Warth, da Agência Estado

SÃO PAULO - Embora os efeitos da crise financeira internacional tenham gerado retração da economia no quarto trimestre de 2008 e no primeiro trimestre de 2009, a desigualdade social no Brasil diminuiu ao longo do primeiro semestre deste ano e registrou a maior redução contínua desde março 2002, início do levantamento realizado pelo Instituto de Pesquisa Econômica Aplicada (Ipea).

Em junho, o índice de Gini atingiu 0,493 pontos em junho, o menor nível desde 2002, quando começou a ser apurado pelo Ipea. O índice de Gini é um coeficiente criado pelo italiano Corrado Gini em 1912 para medir a desigualdade social, e varia de 0 a 1. Nesse cálculo, quanto mais próximo de 1, maior a desigualdade, e quanto mais próxima de zero, melhor a distribuição de renda. Entre janeiro e junho deste ano, a desigualdade caiu 4,1%, a maior queda ininterrupta da série histórica da pesquisa.

O índice de Gini é uma medida de desigualdade desenvolvida pelo estatístico italiano Corrado Gini e publicada em 1912. É comumente utilizada para calcular a desigualdade de distribuição de renda, mas pode ser usada para qualquer distribuição. Ele consiste em um número entre 0 e 1, onde 0 corresponde à completa igualdade de renda (onde todos têm a mesma renda) e 1 corresponde à completa desigualdade (onde uma pessoa tem toda a renda, e as demais nada têm).

O Ipea usou como base as informações sobre o rendimento da Pesquisa Mensal de Emprego (PME) do Instituto Brasileiro de Geografia e Estatística (IBGE), feita em seis das principais regiões metropolitanas do País - Recife (PE), Salvador (BA), Belo Horizonte (BH), Rio de Janeiro (RJ), São Paulo (SP) e Porto Alegre (RS).

Segundo o Ipea, desde março de 2002 a desigualdade social no País caiu 7,6% - na época, o índice de Gini era de 0,534. Desde dezembro de 2002, quando o coeficiente atingiu 0,545, o pior resultado da série, a redução da desigualdade foi de 9,5%. Em outros dois períodos de destaque na redução contínua da desigualdade social, o resultado foi inferior ao registrado de janeiro a junho deste ano. De abril a novembro de 2003, a desigualdade caiu 3,6%; e de março a outubro de 2007, 3,4%.

De acordo com o instituto, a redução do índice de Gini "pode estar relacionada tanto à perda de valor real das maiores rendas do trabalho como à proteção do conjunto dos rendimentos na base da pirâmide ocupacional nas regiões metropolitanas", diz o texto.

"De um lado, a crise se manifestou de forma mais concentrada no setor industrial, que geralmente paga os melhores salários. De outro lado, temos a proteção da renda na base da pirâmide social brasileira, com aumento do salário mínimo e políticas de transferência de renda previdenciárias e assistenciais", afirmou o presidente do Ipea, Marcio Pochmann.

Embora a redução da desigualdade tenha sido intensa no período, Pochmann ponderou que ela ainda não é suficiente. "Um índice de Gini acima de 0,4 ainda representaria péssima distribuição de renda. Há uma tendência de queda, mas ainda estamos longe de chegar a algo comparável a países mais avançados", admitiu.

Pobreza

Ainda segundo a pesquisa, a taxa de pobreza chegou a 31,1% da população em junho deste ano nas seis regiões metropolitanas, atingindo 14,5 milhões de pessoas. Em março de 2002, a taxa de pobreza era de 42,5% da população e atingia 18,5 milhões de habitantes. Nesse período de sete anos, quatro milhões de brasileiros deixaram a pobreza, uma redução de 26,8%. De janeiro de 2007 a junho de 2009, a pobreza caiu 6,1%, de forma ininterrupta, a uma média mensal de 0,35%.

A pobreza desde 2002 diminuiu mais fortemente em Belo Horizonte, onde a queda foi de 35,5%, Porto Alegre (-33,6%) e Rio de Janeiro (-31,2%), e de forma mais lenta, abaixo da média nacional de 26,8%, em São Paulo (-25,2%), Salvador (-23,9%) e Recife (-14,1%). Em junho, a maior taxa de pobreza foi registrada em Recife (51,1%), e a menor em Porto Alegre (25,7%). Em São Paulo, ela chegou a 27%; no Rio, 29,6%; em Belo Horizonte, 30%; e em Salvador, 44,3%.

No Rio, 1,4 milhão de pessoas deixaram a pobreza; em São Paulo, 1,3 milhão; em Belo Horizonte, 600 mil; em Porto Alegre, 400 mil; em Salvador, 200 mil; no Recife, 100 mil pessoas.

No comunicado, o Ipea destaca que os indicadores sociais apresentaram um comportamento diferente nessa crise em comparação ao que normalmente ocorria em períodos de retração da economia.

"A situação atual apresenta algo de novo em relação a outros momentos de grave manifestação de crise econômica no Brasil. Ao contrário dos períodos de 1982/83, 1989/90 e de 1998/99, quando a inflexão econômica implicava aumento da pobreza nas regiões metropolitanas, não se observa crescimento na taxa de pobreza desde o último trimestre de 2008", diz o texto.

A instituição ressalta que ainda é preciso analisar o que motivou essa mudança, mas afirma que "a interferência da política anticíclica deve também estar resultando em efeitos compensatórios suficientes para evitar o agravamento social nas regiões metropolitanas".

Making sense of health statistics

2009-08-04T09:49:00.002-03:00

(http://www.who.int/bulletin/volumes/87/8/09-069872.pdf)

Gerd Gigerenzera

a Hardnig Center for Risk Literacy, Max Planck Institute for Human Development, Lentzeallee 94, 14195 Berlin, Germany.

Correspondence to Gerd Gigerenzer (e-mail: gigerenzer@mpib-berlin.mpg.de).

Many physicians, patients, health journalists and politicians do not understand

health statistics. Yet we make little effort to educate our children in statistical thinking or our medical students in understanding health statistics.

This collective statistical illiteracy has resulted in serious consequences for health./.../

Social Determinants of Health/Disease

2009-08-02T13:22:00.003-03:00

Estão aqui referências das postagens feitas no Blog Principal, compatíveis com as palavras chave "Social Determinants".

O propósito é de facilitar o acesso aos interessados.

MONDAY, JULY 20, 2009

What We Mean by Social Determinants of Health

From: Ruggiero, Mrs. Ana Lucia (WDC) to EQUIDAD

Vicente Navarro, Department of Health Policy and Management

Johns Hopkins University Bloomberg School of Public Health

keynote address was given at the Eighth IUHPE European Conference on September 9, 2008,

in Turin, Italy, and was originally published in IUHPE – Global Health Promotion, Vol. 16, No. 1, 2009, SAGE Publications

International Journal of Health Services, Volume 39, Number 3, Pages 423–441, 2009 doi: 10.2190/HS.39.3.a

Available online as PDF file [19p.] at: http://baywood.com/hs/ijhs393A.pdf

Focus on overall health

Appointed by Dr. Maria Ines Reinert Azambuja
Published: August 01, 2009 12:00 PM
Ask yourself, “What is more important to my health: being able to find a doctor, or having a good paying job?” If you answered “the job,” then you’re already thinking about a concept researchers call the social determinants of health.

TUESDAY, MAY 19, 2009

Learning Device on Social Determinants

THURSDAY, FEBRUARY 05, 2009

Reducing health inequities through action on the social determinants of health

From: Ruggiero, Mrs. Ana Lucia (WDC)

WHO 124th Session EB124.R6 - Agenda item 4.6 - 23 January 2009

WHO Executive Board, Having considered the Secretariat’s report on the final report of the Commission on Social Determinants of Health,1

SUNDAY, FEBRUARY 15, 2009

Medical Humanities Blog

On Bioethics (& the Social Determinants of Health)

SATURDAY, NOVEMBER 03, 2007

The social determinants of health:Developing an evidence base for political action

FRIDAY, MAY 30, 2008

Social determinants of health: a call for papers

Appointed by Dr. Maria Ines Reinert Azambuja

The Lancet: Social determinants of health: a call for papers
From the Lancet website:
SATURDAY, MAY 31, 2008

2385 - AMICOR11 - 31/05/2008

Saturday, May 31, 2008

The inflammation paradigm: Towards a consensus to explain coronary disease mortality in the 20th century.
CVD Prevention and Control (2008) 3, 69–76
Maria Ines Azambuja a,*, Aloyzio Achutti b, Richard Levins c.

Fumacê..., por Aloyzio Achutti*
Artigos - Fumacê..., por Aloyzio Achutti*

Tuesday, May 27, 2008

Can metabolic syndrome usefully predict cardiovascular disease and diabetes?
Prof Naveed Sattar FRCPathBackground

SUNDAY, AUGUST 31, 2008

Closing the gap in a generation: Health equity through action on the social determinants of health

http://www.who.int/entity/social_determinants/final_report/csdh_finalreport_2008.pdf
Executive summaryEnglish [pdf 5.34Mb]
http://www.who.int/entity/social_determinants/final_report/csdh_finalreport_2008_execsumm.pdf

FRIDAY, MAY 30, 2008

Our cities, our health, our future

From: ruglucia@PAHO.ORG
Our cities, our health, our future
Report to the WHO Commission on Social Determinants of Health from the Knowledge Network on Urban Settings (KNUS) 2008
Chair and Lead Writer: Tord Kjellstrom
Available online as PDF file [199p.] at:http://www.who.int/social_determinants/resources/knus_final_report_052008.pdf

MONDAY, NOVEMBER 12, 2007

2370 - AMICOR10 - 12/11/2007

enMonday, November 12, 2007
Health in the Americas: Brazil
Capítulo sobre Condições de Saúde no BR 2007. Há um capítulo para cada país da América e outro temático para o conjunto
Labels: Brazil;
posted by Aloyzio Achutti at 12:33 AM 0 comments

Wednesday, November 07, 2007
Our Greatest Challenge? Global Inequalities in CV Care
Low and middle income countries suffer more than 80% of the global burden of cardiovascular disease, but more than 80% of global expenditure on cardiovascular health care occurs in high income countries, according to Stephen MacMahon from The George Institute for International Health in Sydney, Australia.
Sessions Science OnDemand®.

Why has healthcare reform failed?
To make it work, lawmakers need to understand the barriers that have blocked reform.By Henry Aaron November 6, 2007Every 15 years or so, proposals to reform the entire U.S. healthcare system seize national attention. It suggests that even if it succeeds, healthcare reform will not come from a single bill that transforms a $2.5-trillion industry but from repeated legislation of modest scope enacted over many years.

Shaping the world to illustrate inequalities in health
Shaping the world to illustrate inequalities in healthDanny Dorling a, Anna Barford aVisualizing inequalities in health at the world scale is not easily achieved from tables of mortality rates. Maps that show rates using a colour scale often are less informative than many map-readers realize. Labels: inequality
posted by Aloyzio Achutti at 12:09 PM 0 comments
AHA President: Disparities in health care

Conner Lecturer: Social inequality
Conner Lecturer: Social inequalityboosts heart diseasePoverty is widely recognized as a risk factor for poor health and lower life expectancy, but lack of income is not the main determinant of health.

Saturday, November 03, 2007
The social determinants of health:Developing an evidence base for political action

SATURDAY, SEPTEMBER 29, 2007

Achieving health equity: from root causes to fair outcomes

Achieving health equity: from root causes to fair outcomes
Professor Sir Michael Marmot, International Institute for Society and Health, University College London, UKThis paper is an abridged version of the Interim Statement of the Commission on Social Determinants of Health The Lancet, Volume 370, Number 9593, 29 September 2007
Website:http://www.thelancet.com/journals/lancet/article/PIIS0140673607613853/abstract
WHO website:http://www.who.int/social_determinants/en/

TUESDAY, JANUARY 27, 2009

A conceptual framework for public health: NICE's emerging approach

Ruggiero, Mrs. Ana Lucia (WDC) to EQUIDAD
M.P. Kelly, E. Stewart, A. Morgan, A. Killoran, A. Fischer, A. Threlfall and J. Bonnefoy

TUESDAY, NOVEMBER 06, 2007

Conner Lecturer: Social inequality

FRIDAY, JANUARY 18, 2008

Investment for Health: Integrating Health in All Policies

Investment for Health: Integrating Health in All PoliciesVenice, 9th-14th, March 2008
General Information

WEDNESDAY, SEPTEMBER 03, 2008

WHO’s Commission on Social Determinants of Health: Inequities are Killing People on a Grand Scale at The Social Medicine Portal

WHO’s Commission on Social Determinants of Health: Inequities are Killing People on a Grand Scale at The Social Medicine Portal:
"On Thursday, August 28th the WHO’s Commission on the Social Determinants of Health issued its final report: Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health.

MONDAY, OCTOBER 29, 2007

Social Determinants of the Premature Cardiovascular Mortality

De: Ruggiero, Mrs. Ana Lucia (WDC) [mailto:ruglucia@paho.org]

Enviada em: segunda-feira, 29 de outubro de 2007 18:38

Assunto: Presentacion: Factores Sociales Determinantes de la Muerte Prematura debida a Enfermedades cardiovascularesPorto Alegre – Brazil
Prof. Sergio Luiz Bassanesi
Departamento de Medicina Social
Facultad de Medicina Universidad Federal de Rio Grande do Sul - Brazil
https://sas.elluminate.com/p.jnlp?psid=2007-10-29.1009.M.1BC839C524B0BA4B8BF53A3EC0770F.vcr
Link to: PPT presentation:
http://portal.paho.org/sites/IKM/WorkSpaces/ikmbrownbag/Documents/Cardiovascular%20Diseases%20OPAS.ppt

WEDNESDAY, JUNE 01, 2005

[ProCOR] Conference report: 6th ICPC "Protecting the heart of global development"

WEDNESDAY, DECEMBER 26, 2007

2375 – AMICOR10 – 26/12/2007

"You are responsible, forever, for what you have tamed."

(Antoine Marie Roger de Saint-Exupery
June 29, 1900 - July 31st, 1944.)

Monday, December 24, 2007

HEALTH PROMOTION

RELATED SITES

- Health promotion
- Chronic diseases and health promotion
- Health promotion (African Region)
- Move for health
- Health promotion (Western Pacific Region)
- School health and youth health promotion
- Health promotion (European Region)

Thursday, December 20, 2007
Walk, don't run, to prevent or reverse metabolic syndrome

Johnson JL, Slentz CA, Houmard JA, et al. Exercise training amount and intensity on metabolic syndrome (from Studies of a Targeted Risk Reduction Intervention through Defined Exercise). Am J Cardiol 2007; 100:1759-1766.
Related links
Fitness linked to reduced mortality, even in obese subjects[HeartWire > Prevention; Dec 04, 2007]
"Fat and fit": Less abdominal obesity than unfit counterparts, better metabolic profiles [HeartWire > News; Aug 02, 2007]
Amount of exercise at least as important as intensity, new study shows [HeartWire > News; Oct 10, 2005]

ESC Congress 2008: 30 August 2008 - 03 September 2008

Tuesday, December 18, 2007

Socioeconomic Gradients in Immune Response to Latent Infection

Heart Disease and Stroke Statistics 2008 Update. A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee -- Rosamond et al., 10.1161/CIRCULATIONAHA.107.187998 -- Circulation

Thursday, November 01, 2007

Excess Body Fat Associated with Increased Risk for Six Cancers

By Peggy Peck, Executive Editor, MedPage Today Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco October 31, 2007
Add Your Knowledge™
Additional Other Cancers Coverage

Walter C. Willett, M.D.Harvard Medical School
WASHINGTON, Oct. 31 -- Obesity is on course to overtake tobacco as the leading risk factor for cancer in America, according to a report issued today.

Poverty Collection

PLoS Journals : Poverty Collection: "Poverty Collection The Council of Science Editors has organized a Global Theme Issue on Poverty and Human Development on October 22, 2007. More than 200 science and health journals, including three PLoS journals, are participating by publishing new articles. We have also collected together related articles with a poverty theme from the archive of all the PLoS journals. Global Theme Issue Related PLoS Articles "

Tuesday, October 30, 2007

Cesar Victora

(Na série especial de ZH "Mentes Iluminadas" está um AMICOR:)

Monday, October 29, 2007

Genome-wide association with select biomarker traits in the Framingham Heart Study

Emelia J Benjamin1,

Bush Aide Blocked Report

2007-07-29T09:36:00.000-03:00

"..few of the issues it focuses on, such as AIDS treatment and research, have been public health priorities for the Bush administration. But others -- including ratifying the international tobacco treaty and making global health an element of U.S. foreign policy -- are more politically sensitive"
the Global Health Draft In 2006
http://www.washingtonpost.com/wp-srv/nation/documents/CTAGlobalHealthdraft.pdf

Bush Aide Blocked ReportGlobal Health Draft In 2006 Rejected for Not Being Political
By Christopher Lee and Marc KaufmanWashington Post Staff WritersSunday, July 29, 2007; A01
A surgeon general's report in 2006 that called on Americans to help tackle global health problems has been kept from the public by a Bush political appointee without any background or expertise in medicine or public health, chiefly because the report did not promote the administration's policy accomplishments, according to current and former public health officials.
The report described the link between poverty and poor health, urged the U.S. government to help combat widespread diseases as a key aim of its foreign policy, and called on corporations to help improve health conditions in the countries where they operate. A copy of the report was obtained by The Washington Post.
Three people directly involved in its preparation said its publication was blocked by William R. Steiger, a specialist in education and a scholar of Latin American history whose family has long ties to President Bush and Vice President Cheney. Since 2001, Steiger has run the Office of Global Health Affairs in the Department of Health and Human Services.

Prescription Drug Cost Sharing Associations With Medication and Medical Utilization and Spending and Health

2007-07-03T18:21:00.000-03:00

Prescription Drug Cost Sharing Associations With Medication and Medical Utilization and Spending and Health
Dana P. Goldman, PhD; Geoffrey F. Joyce, PhD; Yuhui Zheng, MPhil

JAMA. 2007;298:61-69.
Context Prescription drugs are instrumental to managing and preventing chronic disease. Recent changes in US prescription drug cost sharing could affect access to them.

Objective To synthesize published evidence on the associations among cost-sharing features of prescription drug benefits and use of prescription drugs, use of nonpharmaceutical services, and health outcomes.

Data Sources We searched PubMed for studies published in English between 1985 and 2006.

Study Selection and Data Extraction Among 923 articles found in the search, we identified 132 articles examining the associations between prescription drug plan cost-containment measures, including co-payments, tiering, or coinsurance (n = 65), pharmacy benefit caps or monthly prescription limits (n = 11), formulary restrictions (n = 41), and reference pricing (n = 16), and salient outcomes, including pharmacy utilization and spending, medical care utilization and spending, and health outcomes.

Results Increased cost sharing is associated with lower rates of drug treatment, worse adherence among existing users, and more frequent discontinuation of therapy. For each 10% increase in cost sharing, prescription drug spending decreases by 2% to 6%, depending on class of drug and condition of the patient. The reduction in use associated with a benefit cap, which limits either the coverage amount or the number of covered prescriptions, is consistent with other cost-sharing features. For some chronic conditions, higher cost sharing is associated with increased use of medical services, at least for patients with congestive heart failure, lipid disorders, diabetes, and schizophrenia. While low-income groups may be more sensitive to increased cost sharing, there is little evidence to support this contention.

Conclusions Pharmacy benefit design represents an important public health tool for improving patient treatment and adherence. While increased cost sharing is highly correlated with reductions in pharmacy use, the long-term consequences of benefit changes on health are still uncertain.

What’s Missing From the Health-Care Debate

2007-05-28T10:32:00.000-03:00

http://powerandpowerlessness.typepad.com/
From the Susan Rosenthal's Blog
The latest report by the Commonwealth Fund confirms what we already know; Americans pay more for health care and have poorer health compared with people living in nations that spend less on health care yet enjoy better health.

It is generally assumed that lack of access to medical care is to blame for America’s abysmal health statistics and that improved access will remedy the situation. This is mistaken. Lack of access is just one indicator of the social inequality that is driving America’s health crisis.

The myth that good health is a product of the health-care system was fueled by the expansion of the welfare state after World War II. The establishment of the British National Health Service (NHS) in 1948 was accompanied by better health and a reduction in the difference in death rates between the social classes.

Politicians claimed that the NHS had produced these benefits, but later studies revealed that population health improves with a rise in the general standard of living and a reduction in class inequality, as occurred in Britain after the war.

To investigate the link between health and inequality, researchers examined workers in the highly stratified British civil service. Despite all the subjects enjoying decent pay and equal access to medical care, the risk of illness and premature death increased as one moved down the social hierarchy. These health differences were significant and could not be accounted for by differences in smoking, diet or exercise.

Inequality is not only an independent factor in determining health, it is the most important factor. As inequality increases, health deteriorates. This holds true for everyone living in an unequal society, not just those on the short end of the stick.

A study published in 1998 compared income inequality with death rates in 282 American cities. Greater inequality was associated with higher death rates at all income levels. Areas with the greatest inequality suffered 140 additional deaths for every 100,000 people per year compared to areas with the lowest inequality. The difference in death rates was comparable to the loss of life from lung cancer, diabetes, motor vehicle crashes, HIV infection, suicide and homicide combined.

Inequality in the U.S. has grown steadily since the 1970s, when Corporate America pushed to raise productivity by driving down workers’ living standards. As corporate profits increased, health deteriorated, and poverty epidemics like HIV/AIDS and tuberculosis emerged in the world’s richest nation.

The U.S. has the worst health statistics in the industrialized world because it is the most unequal society in the industrialized world.

The accumulation of profit at the top of society creates an accumulation of sickness at the bottom. No form of health-care system can reverse the health-damaging effects of class inequality.

Next week, I will explain how the fight for equal rights is key to winning a universal health-care system.

For more on this subject, read POWER and Powerlessness. Available at www.powerandpowerlessness.com

Healthy Workplace, Healthy Workers

2007-05-11T07:29:00.000-03:00

http://www.medpagetoday.com/Cardiology/Hypertension/tb/5622
WASHINGTON, May 10 -- An employee health program incorporating a fitness center, health education, and incentives improved workers' cardiovascular health and workplace safety, investigators reported here.

Explain to interested patients that a healthy workplace -- one that rewards and
fosters wellness -- may contribute to workers' health and on-the-job safety.
This study was published as an abstract and presented orally at a
conference. The data and conclusions should be considered to be preliminary
until they are published in a peer-reviewed publication.
Employees who availed themselves of those services improved blood pressure control by 9% and diabetes control by 15%, found Sharon A. Clark, D.H.Sc., of JEA, the municipal utility company in Jacksonville, Fla., and colleagues.
On-the-job accidents also dropped by nearly 70%, they reported at the American Heart Association's Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.
The rising cost of medical care and an aging, predominately male, employee population (median age 47) spurred the utility company to do more to foster employee health, Dr. Clark said.
Their efforts began in 1989, when a dozen JEA workers approached the company to create a fitness center so they wouldn't have to walk the city's bridges to get their exercise. The company agreed to provide space while the employees provided the equipment and day-to-day administration. /.../

Global Health Strategy

2007-04-09T15:04:00.000-03:00

De: Equity, Health & Human Development [mailto:EQUIDAD@LISTSERV.PAHO.ORG]
Em nome de Ruggiero, Mrs. Ana Lucia (WDC)
Enviada em: segunda-feira, 9 de abril de 2007 10:45Para: EQUIDAD@LISTSERV.PAHO.ORG
Assunto: [EQ] Health is global
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_072697
“…This report provides the rationale for a UK global health strategy. A coherent strategic framework is essential if the UK is to maximise its impact on global health. The report outlines the need for an international approach if we are to protect the health of the UK population, reduce global poverty and harness the opportunities of globalisation….”
“….Globalisation has intensified human interaction, bringing countries closer together and making national borders more porous. The barriers of time and geography that traditionally separated people and nations have been reduced, leading to an intensifi cation of international trade, travel and communications. These trends are not new but their increase could affect the health of everyone, everywhere. Poverty and ill health in one country threatens the prosperity and wellbeing of populations in all countries. People everywhere have a right to the highest attainable standard of health. Protecting and promoting health is a duty of our global citizenship.

Chronic diseases such as obesity, diabetes, mental ill health, and alcohol- and tobacco-related illness – once deemed the preserve of industrialised nations – are
now worldwide problems. The dramatic increase in the incidence of HIV/AIDS and tuberculosis in some countries, and the emergence of avian influenza in Asia, could pose major threats to the health of the UK population. It may be a cliché, but it is true that infectious diseases do not respect borders. Just as diseases cross borders, so can narcotics, unhealthy lifestyles and chemical and biological pollutants.

Global health issues are complex, interdependent and, more often than not, influenced by actions or circumstances in countries other than those directly affected. The determinants of global health include poverty, conflict, violence, climate change and environmental degradation, illegal drug trafficking and the effects of international trade. These are cross-border problems. Solutions require cooperative action.
However, globalisation also provides immense opportunities for improving global health. Opportunities for developing and sharing knowledge and research are unprecedented. There is now a large number of public–private partnerships dedicated to global health issues – with more resources available than ever before….”PDF file 64p.

CONTENTS
1. INTRODUCTION looks at the objectives of a global health strategy
2. GLOBAL HEALTH TODAY provides a brief overview of the current state of the world’s health. It looks at the burden of communicable and non-communicable disease. It also describes key determinants of health, focusing in particular on climate change, health inequalities and inequity both within and between countries. Chapter 2 also highlights the importance of health systems and research.

3. GLOBALISATION AND HEALTH
examines the implications of globalisation on human health. The chapter concludes that trade and investment, travel, migration and communication all have positive and negative effects on human health.

4. WHY TAKE ACTION ON GLOBAL HEALTH? explains why we need to take action on global health. The report gives five reasons why it is important for the UK to engage with the global health agenda:
- It is necessary for making our world more secure, protecting the health of the UK population and contributing to safeguarding our domestic investment in health and
the economy.
- It is central to our efforts on sustainable development.
- Health is a valuable commodity to trade in.
- Health is a global public good.
- Health is a human right.
A key challenge for the strategy will be to navigate an economically and ethically acceptable path through these diverse and sometimes conflicting areas
5. IDENTIFYING AREAS FOR ACTION
provides a framework for taking the strategy forward. The range and extent of global health problems is such that we need to prioritise areas for action and ensure the most effective use of our available resources. As a starting point, Chapter 5 identifies four broad areas:
- health and foreign policy
- health and development
- health and the UK economy
- global threats to UK health

6. WORKING TOGETHER describes how government needs to work with domestic and international partners. It is essential that the government provides an environment that enables those with the right skills to work on global issues.
ANNEXES
Annex A: Millennium Development Goals and Targets, with examples of potential DH/NHS contributions
Annex B: The Code of Practice governing NHS recruitment of international health professionals
Annex C: Selected examples of commitments made in Eliminating World Poverty: Making Governance Work for the Poor that have the potential to improve global health
References

YouTube - Arundhati Roy

2007-03-06T11:10:00.000-03:00

YouTube - Arundhati Roy
http://youtube.com/watch?v=jFOuSoy5H-k

"There is a system of economic disparity that is being entrenched in the world today....And the disparities are not between rich countries and poor countries; they are between rich people and poor people....Liquid capital can move through poor countries at an enourmous scale...Dictating economic agendas in those countries....And that capital requires the course of powers of the nation state to contain the revolt in the servants' quarters...The only way to confront it...is the joining of hands of people who do not believe in empire...we have to bring [globalization] to its knees"

Arundhati Roy (born November 24, 1961) is an Indian novelist, activist and a world citizen. She won the Booker Prize in 1997 for her first novel The God of Small Things.

Roy spent her childhood in Aymanam, in the state of Kerala, India. She left Kerala for Delhi at age 16, and embarked on a homeless lifestyle, staying in a small hut with a tin roof; making a living selling empty bottles. She then proceeded to study architecture at the Delhi School of Architecture.
Roy is a figure-head of the anti-globalization/alter-globalization movement and a vehement critic of neo-imperialism. Roy was awarded the Sydney Peace Prize in May 2004 for her work in social campaigns and advocacy of non-violence. In January 2006 she was awarded the Sahitya Akademi award for her collection of essays, 'The Algebra of Infinite Justice', but declined to accept it.

Russia funds health crisis plan

2007-02-23T09:04:00.000-02:00

Russia has set aside almost $3bn (£1.53bn) for an emergency programme to tackle its epidemic of ill-health and a falling life expectancy.

The programme aims to reduce mortality rates by targeting diabetes, TB, HIV/Aids and cancer.

The health ministry says average life expectancy for Russian men is less than 60 years - about 15 years lower than in most other industrialised countries.

Life expectancy for Russian women is about 72.

Politically sensitive

The BBC's Steven Eke in Moscow says this represents a new Five Year Plan - not aimed at boosting the production of tractors but at tackling the causes behind one of the world's worst health crises.

Many diseases have spread rapidly since the Soviet Union's collapse.

Prime Minister Mikhail Fradkov said: "We aim to tackle the problem seriously - and that includes providing adequate funding for the fight against TB, diabetes, cancers, HIV and viral hepatitis."

Our correspondent says Russian and international medical authorities have previously accused the government of chronic inaction - even of being in denial about the extent of the country's health crisis.

He says some have already pointed out that the extra spending announced for healthcare today is one 60th of the amount earmarked for the same period for an overhaul of the Russian armed forces.

The demographic crisis is an extremely sensitive matter politically.

The population fell by more than 560,000 last year to 142.2m, a new low for the post-Soviet era.

Experts point out that much of Russia's health crisis is the result of unhealthy lifestyles, especially very high rates of smoking and alcohol abuse.

There are also environmental issues - last year, a survey by a US research centre said that half of the world's most polluted places were in the former Soviet Union.

Health Promotion Practice

2007-01-10T23:15:00.000-02:00

McGraw-Hill Education Europe: "

Description

"A very welcome addition to the practical side of health promotion! Laverack's brief and simply-worded text weaves together just the right balance of theory, evidence, tips and case studies to satisfy the new learner looking to gain a grasp of health promotion's empowering whole, while still offering new insights to the more seasoned practitioner."
Ronald Labonté, Institute of Population Health, University of Ottawa

* How can health promotion practitioners help communities to become more empowered?
* How do you encourage different communities to work together towards a shared goal?
* How can you focus your resources to be most effective in building empowered communities?
* How do you evaluate your success (and failures) in building empowered communities?

Power and empowerment are two complex concepts that are central to health promotion practice. People experience empowerment in many different ways and this book explains an approach that has been used by health promoters to intentionally build and evaluate empowerment. The book provides a special focus on communities and is illustrated throughout with useful field experiences in the United Kingdom, Asia, North America, the Pacific region and Africa.

The book aims to provide the reader with:

* An understanding of the key concepts of power and empowerment and the link to improved health outcomes in the context of health promotion programmes
* An understanding of practical approaches that can be used in health promotion programming to build and evaluate empowered communities
* Case study examples of how communities can be empowered in practice

This unique book offers sound theoretical principles to underpin the practical approaches used to build empowered communities and brings together new and innovative approaches in health promotion practice.

Health Promotion Practice is essential reading for health promotion students and practitioners who want to learn more about innovative approaches to build empowered communities in their everyday work. It will inspire them to work in more empowering ways in health promotion practice and to carefully contemplate how they can influence the way others gain power. "

Understanding and reducing disparities in health

2006-12-22T15:03:00.000-02:00

October 23-25, 2006: "The conference focuses on three broad areas of action influencing health disparities: policy, prevention, and healthcare. It emphasize both basic research on the behavioral, social, and biomedical pathways giving rise to disparities in health and applied research on the development, testing, and delivery of interventions to reduce disparities in these three action areas. The conference employs a multi-level analytic framework (i.e., ranging from individuals to societies). It includes research relevant to a wide range of population groups (e.g., variation by SES, race, ethnicity, gender) residing in the United States, while not attempting to provide detailed analyses of each and every group. Consideration is given to multiple public health issues and their interactions (e.g., multiple morbidities rather than single illnesses) and to risk factors or causal processes common to various health conditions (e.g., smoking, diet, exercise, access to health care).

For the purposes of this conference, we are defining these action areas as:

POLICY: The means employed by governments and other institutions to influence the function and well-being of individuals, groups, communities, and society as a whole.

PREVENTION: Interventions at the individual, group or community level to provide targeted audiences the knowledge and skills to avert or minimize health risks.

HEALTH CARE: The "

Health, ethics and law

2006-12-03T08:34:00.000-02:00

From: Equity, Health & Human Development [EQUIDAD@LISTSERV.PAHO.ORG]; em nome de; Ruggiero, Mrs. Ana Lucia (WDC) [ruglucia@PAHO.ORG])
Available online PDF [87p] at: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=931703

“……This article offers an alternative theoretical framework for health ethics, policy and law, integrating both substantive criteria and procedural mechanisms - a joint scientific and deliberative approach - to guide health-system reform and allocation of scarce health resources. It appeals to a particular vision of the good life: human flourishing, which values health intrinsically and more highly than non-intrinsic or solely instrumental social goods, such as income. This view gives special moral importance to what I have called health capability. Health capability constitutes a person's ability to be healthy; it includes health functioning and health agency.

This paradigm sketches a joint scientific and deliberative approach, employing a public scientific process that combines the evidence base of medicine and public health with the expert opinions of physicians and public health experts with input from individuals. This view contrasts with paradigms in which consumers alone, physicians or public health experts alone, strict algorithms or cost-benefit calculations, shared decision making within an informed consent model, fair procedures, or third parties, such as insurers, make health care decisions.

The main focus of the article is on what I call shared health governance, a paradigm in which individuals, providers, and institutions work together to empower individuals and create an enabling environment for all to be healthy. Shared health governance extends beyond the individual patient-doctor relationship to the institutions that oversee the health sector. Shared health governance incorporates individuals' decisions for themselves and for their society at large.

This shared health governance model can potentially improve individuals' health and health agency and decrease costs. Evaluation must consider costs because we live in a world of scarce resources and every resource has an alternative use, so its expenditure corresponds with an opportunity cost. Therefore, some limits are necessary and individuals and society, through shared health governance, must use these resources parsimoniously by evaluating both equity and efficiency….” (au)

Social Inequalities in Health: New Evidence and Policy Implications -- Kristensen 333 (7579): 1177 -- BMJ

2006-12-02T09:39:00.000-02:00

Social Inequalities in Health: New Evidence and Policy Implications -- Kristensen 333 (7579): 1177 -- BMJ: "Do we really welcome one more book on social inequalities in health now? Or have we had sufficient explanations, suggestions, and "beyond-the-Black-Report" analyses? There will be some that think so. None the less, I strongly commend this book. It is the result of a five year European Science Foundation Programme on "Social Variation in Health Expectancy in Europe," and includes contributors who are among the most distinguished scientists in the field. In nine chapters, they present state of the art reviews combined with selected results from recent interdisciplinary research. The difference of opinions in explaining social inequalities in health are not reflected or discussed in depth in this book. I would rather characterise it as a product built on a basic consensus.
Social Inequalities in Health concentrates on three issues: life course influences, psychosocial adversity, and the role of macro-social determinants of health. The overarching aim is to move beyond . . . [Full text of this article]"

Centre for International Public Health Policy

2006-11-26T20:48:00.000-02:00

University of Edinburgh: School of Health, CIPHP, Home page: "The Centre for International Public Health Policy (CIPHP) has recently been established at the University of Edinburgh to carry out research of the highest standard in health policy, disseminate its research, and provide exceptional postgraduate teaching. Focusing on the principles of equity, access, and universality, Prof Allyson Pollock and her colleagues have gained an international reputation for the quality and social relevance of their research."

The effects of social status on biological aging as measured by white-blood-cell telomere length (Abstract)

2006-11-26T09:38:00.000-02:00

Blackwell Synergy: Aging Cell, Vol 5, Issue 5, pp. 361-365: The effects of social status on biological aging as measured by white-blood-cell telomere length (Abstract): "Low socio-economic status (SES) is associated with a shortened life expectancy, but its effect on aging is unknown. The rate of white-blood-cell (WBC) telomere attrition may be a biological indicator of human aging. We tested the hypothesis that SES is associated with telomere attrition independent of known risk factors influencing the aging process. We studied 1552 female twins. A venous blood sample was taken from each twin and isolated WBCs used for extraction of DNA. Terminal restriction fragment length (TRFL) was measured. Questionnaire data were collected on occupation, education, income, smoking, exercise, height and weight. Standard multiple linear regression and multivariate analyses of variance tested for associations between SES and TRFL, adjusting for covariates. A discordant twin analysis was conducted on a subset to verify findings. WBC telomere length was highly variable but significantly shorter in lower SES groups. The mean difference in TRFL between nonmanual and manual SES groups was 163.2 base pairs (bp) of which 22.9 bp (14%) was accounted for by body mass index, smoking and exercise. Comparison of TRFL in the 17 most discordant SES twin pairs confirmed this difference. Low SES, in addition to the harmful effects of smoking, obesity and lack of exercise, appears to have an impact on telomere length."

WHO | CSDH reports and other publications

2006-11-17T07:57:00.000-02:00

WHO CSDH reports and other publications: "Who we areAbout the Commission: its goals, specific themes, country examples, civil society participation, knowledge networks, and the Commissioners.CSDH brochure [pdf 747kb] /.../ "

Tackling Health Inequities Through Public Health Practice: A Handbook for Action

2006-11-16T11:58:00.000-02:00

Tackling Health Inequities Through Public Health Practice: A Handbook for Action
THE NATIONAL ASSOCIATION OF COUNTY & CITY HEALTH OFFICIALS, Washington, DC
THE INGHAM COUNTY HEALTH DEPARTMENT Lansing, Michigan Edited by Richard Hofrichter
Publication supported by a grant from the W.K. Kellogg Foundation 2006
Available online as PDF file [252p] at: http://tinyurl.com/wq4vb
".........Health practitioners in local health departments
(LHDs) face many dilemmas and struggles in seeking to protect and improve the public's health. As the front line of the public health response in local communities, they often must cope with immediate crises and chronic issues with limited resources, restrictive statutory mandates, categorical funding, and political pressures from state and local officials. Addressing the root causes of inequities in the distribution of disease and illness might seem like a luxury. But it is not....

From World War to Class War: The Rebound of the Rich

2006-08-31T20:50:00.000-03:00

Longwoods Publishing :: Healthcare Policy / Politiques de Santé :: Vol. 2 No. 1 2006 ::
From World War to Class War: The Rebound of the Rich: "Incomes in Canada, as in many other countries, are becoming increasingly unequal. In North America this process has several notable features. First, after 40 years of stability, income has since 1980 been increasingly concentrated in the hands of the top 0.01% of earners. Second, this concentration correlates with an explosion in the relative earnings of corporate CEOs, a sort of 'corporate kleptocracy.' Third, the top earners have appropriated most of the productivity gains over this period. The resources and political influence of the super-rich underlie the growing prominence of the 'elite' agenda: lower taxes, smaller government and privatization or shrinkage of social programs. The marketing of this agenda may explain much of the nonsense that contaminates health policy debates. "

The Value of Medical Spending in the United States, 1960-2000:

2006-08-30T18:39:00.000-03:00

NEJM -- The Value of Medical Spending in the United States, 1960-2000: "

Background The increased use of medical therapies has led toincreased medical costs. To provide insight into the value ofthis increased spending, we compared gains in life expectancywith the increased costs of care from 1960 through 2000.

Methods We estimated life expectancy in 1960, 1970, 1980, 1990,and 2000 for four age groups. To control for the influence ofnonmedical factors on survival, we assumed in our base-caseanalysis that 50 percent of the gains were due to medical care.We compared the adjusted increases in life expectancy with thelifetime cost of medical care in the same years.

Results From 1960 through 2000, the life expectancy for newbornsincreased by 6.97 years, lifetime medical spending adjustedfor inflation increased by approximately $69,000, and the costper year of life gained was $19,900. The cost increased from$7,400 per year of life gained in the 1970s to $36,300 in the1990s. The average cost per year of life gained in 1960–2000was approximately $31,600 at 15 years of age, $53,700 at 45years of age, and $84,700 at 65 years of age. At 65 years ofage, costs rose more rapidly than did life expectancy: the costper year of life gained was $121,000 between 1980 and 1990 and$145,000 between 1990 and 2000.

Conclusions On average, the increases in medical spending since1960 have provided reasonable value. However, the spending increasesin medical care for the elderly since 1980 are associated witha high cost per year of life gained. The national focus on therise in medical spending should be balanced by attention tothe health benefits of this increased spending.

Socioeconomic inequalities in cardiovascular disease in Australia

2006-08-30T08:51:00.000-03:00

Media release (AIHW): "

A report released today by the Australian Institute of Health and Welfare (AIHW) says thousands of hospitalisations and deaths from cardiovascular disease, particularly coronary heart disease and stroke, could be avoided if rates among the least advantaged were the same as those from the more socioeconomically advantages areas of Australia.

The report, Socioeconomic inequalities in cardiovascular disease in Australia: Current patterns and trends since 1992, shows that in 2002, adults from the most disadvantaged areas of Australia (areas characterised by low income, low educational attainment and unemployment) had significantly higher death rates from cardiovascular disease (CVD), coronary heart disease (CHD) and stroke than adults from the least disadvantaged areas-between 1.6 and 1.9 times as high.

Ms Lynelle Moon, of the Institute's Cardiovascular Disease and Diabetes Unit said, 'If everyone experienced the same death rates as those in the more socioeconomically advantaged areas, around 28% of deaths from cardiovascular disease, 32% of deaths from coronary heart disease and 24% of deaths from stroke might have been avoided in 2002. This translates to over 3,400 deaths which may be regarded as being due to socioeconomic inequality.'

Despite falls in CVD death rates between 1992 and 2002 for all socioeconomic groups, the proportion of those deaths due to socioeconomic inequality has increased over the same period.

Compared with those in more socioeconomically advantaged areas, in 2003-04, adults living in the most disadvantaged areas of Australia also had significantly higher hospitalisation rates for all types of cardiovascular disease, including coronary emergencies and stroke.

'Again, if everyone experienced the same hospitalisation rates as those in the most advantaged areas, around 16% of all CVD hospitalisations, and 38% of emergency coronary heart disease and 24% of stroke hospitalisations, might have been avoided in 2003-04. This translates to almost 45,400 CVD hospitalisations,' Ms Moon said.

Despite falls in hospitalisation rates for all socioeconomic groups between 1996-97 and 2003-04 the proportion of hospitalisations due to socioeconomic inequality increased substantially for acute coronary syndrome, from 19% to 32% for males and from 28% to 41% for females.

Further information: Ms Lynelle Moon AIHW, tel. 02 6244 1235.

For media copies of the report: Publications Officer, AIHW, tel. 61 2 6244 1032.

Availability: Check the AIHW Publications Catalogue for availability of Socioeconomic inequalities in cardiovascular disease in Australia: Current patterns and trends since 1992.

Personal Responsibility and Physician Responsibility

2006-08-23T19:44:00.000-03:00

NEJM -- Personal Responsibility and Physician Responsibility -- West Virginia's Medicaid Plan: "It is unclear what steps will be taken if physicians do not comply with reporting requirements. The four indicators require data collection from physicians' offices. This requirement for additional documentation is an unfunded administrative mandate that could actually decrease physician participation in the Medicaid program.
In the face of both increasing health care costs and numbers of uninsured persons, states will continue to seek ways to control Medicaid costs. Clinicians often abstain from policy discussions until it is too late for them to have an impact. But who is better able to provide evidence of the misguided nature of such plans? What physician would recommend that a person with diabetes who misses appointments lose the ability to attend diabetes education classes? What physician wants to be faced with a child with asthma whose benefits have been reduced to four prescriptions per month when she gets pneumonia and an antibiotic makes five? In an era of 'personal responsibility,' physicians must assume the responsibility of speaking out about how such policies affect their practices and their patients' health. "

Imposing Personal Responsibility for Health

2006-08-23T19:37:00.000-03:00

NEJM -- Imposing Personal Responsibility for Health: "The concept of personal responsibility in health care is that if we follow healthy lifestyles (exercising, maintaining a healthy weight, and not smoking) and are good patients (keeping our appointments, heeding our physicians' advice, and using a hospital emergency department only for emergencies), we will be rewarded by feeling better and spending less money. The details of programs that emphasize personal responsibility, however, are often sketchy, and many difficult questions related to individual freedom and patients' autonomy remain unanswered. For instance, which well-meaning measures to promote responsible behavior actually make a difference, and which are primarily coercive and potentially counterproductive? Which measures may actually improve health or save money, and which may merely shift costs from government, private insurers, or employers to patients?
There are many examples of initiatives that are meant to promote personal responsibility. The World Health Organization will no longer hire persons who smoke, suck, chew, or snuff any tobacco product, although it will still recruit people 'who do not have a healthy lifestyle.' In the United States, some employers target smokers, some even going so far as to fire workers who smoke when they are not at work. At some companies, health insurance may cost less for nonsmokers or for people who complete weight-loss programs, and employees may receive financial incentives to participate in health screenings, fitness programs, or tobacco-cessation programs. Wal-Mart has considered discouraging unhealthy people from applying for work by including some physical activity in all jobs. A national survey conducted in July 2006 estimated that 53 percent of Americans think it is 'fair' to ask people with unheal" /.../

Policy Challenges in Modern Health Care

2006-08-22T22:13:00.000-03:00

RWJF - Newsroom - Features - Download Chapters from "Policy Challenges in Modern Health Care": "'Policy Challenges in Modern Health Care'
Chapter titles lead to article summaries and full text of the chapters.
Table of contents, preface and acknowledgements
Introduction
David Mechanic, Lynn B. Rogut, David C. Colby and James R. Knickman
Part I: The Context of Health and Health Care Policy
Morality, Politics, and Health Policy
James A. Morone
Cross Pressures: The Contemporary Politics of Health Reform
Theda Skocpol and Patricia Seliger Keenan
The Employer-Based Health Insurance System: Mistake or Cornerstone?
Sherry A. Glied
Entrepreneurial Challenges to Integrated Care
James C. Robinson"/.../

More Wealth = Better Health In U.S., Report: Even Upper-Middle-Class At Big Disadvantage Compared To Richer People

2006-08-20T16:43:00.000-03:00

More Wealth = Better Health In U.S., Report: Even Upper-Middle-Class At Big Disadvantage Compared To Richer People - CBS News:
(Referred by Maria Ines Reinert Azambuja and Henry Greenberg)
"(WebMD) In the U.S., your health depends on your wealth — even if you're not poor. That finding comes from a study showing that after age 55, even people with upper-middle-class incomes suffer more disability than those with even higher earnings. Meredith Minkler, DrPH, and colleagues at the University of California, Berkeley, analyzed data from the 2000 U.S. Census. People below the poverty line for that year — $17,761 for a family of four — were six times more likely to suffer from a disability than those making seven times that much or more. That's really no surprise. Poor people in the U.S. have limited access to health care. And they live and work in less healthy environments than wealthier Americans. But Minkler and colleagues also found that people whose income was 600 percent of the poverty level were more likely to be disabled than those at 700 percent or higher. The researchers defined disability as a condition lasting at least six months that made it difficult to dress, bathe, or get around the home. "What was unusual was that we found that people in the middle class were still at a disadvantage compared with those at just a slightly higher income," Minkler said in a news release. "The fact that there's a significant difference between people at 600 percent and 700 percent above the poverty level was a striking finding of this study." A four-person household at 600 percent of the year 2000 poverty level would have an income of $106,566 a year. The same household at 700 percent of the poverty level would earn $124,327 per year. Men age 65-74 who earned between six and seven times the poverty level were 44 percent more likely to be disabled than those who earned seven or more times the poverty level. "With almost 85 percent of Americans who are 55 years of age or older living at an income level under 700 percent of the poverty line, this is not simply an issue of very poor people having a disadvantage in health outcomes," Minkler and colleagues conclude. "Rather, higher risk is demonstrated across a very large proportion of the older population, as compared with the most advantaged." The study appears in the Aug. 17 issue of The New England Journal of Medicine. SOURCES: Minkler, M. The New England Journal of Medicine, Aug. 17, 2006; vol 355: pp 695-703. News release, University of California, Berkeley.By Daniel J. DeNoonReviewed by Louise Chang, M.D.© 2006, WebMD Inc. All rights reserved."

"Estimativa do Impacto Econômico das Doenças Cardoivasculares no Brasil"

2006-08-02T10:55:00.000-03:00

Caros companheiros do GT Investindo em Saúde,

É com grande satisfação que desejamos convidá-los para uma apresentação sobre "Estimativa do Impacto Econômico das Doenças Cardoivasculares no Brasil" a se realizar durante a reunião ordinária do Serviço de Cardiologia, no Anfiteatro do Centro de Imagem (HMV), no próximo dia 10 de agosto, na quinta feira da próxima semana, das 7:30 às 8:30 da manhã.
Tratam-se de resultados de uma pesquisa realizada em 4 países (Brasil, Africa do Sul, India e China) na qual a Dra. Maria Inês Reinert Azambuja, o apresentador Dr. Murilo Foppa e eu estamos envolvidos, parcialmente apoiados pela Instituição "IC-Health", e sediado - o componente de nosso país - no Instituto de Educação e Pesquisa.
Como já foi informado anteriormente este trabalho pretende ser um passo inicial de fundamentação para um novo projeto de prevenção de Doenças Cardiovasculares e promoção da saúde.
Discussão e sugestões serão benvidos. Seguindo-se imediatamente à reunião poderemos dispor de alguns poucos minutos para trocar idéias sobre nossos próximos passos.
Um abraço a todos e até lá. AA

NIH Conference on Understanding and Reducing Disparities in Health

2006-07-28T17:19:00.000-03:00

NIH Conference on Understanding and Reducing Disparities in Health:
Behavioral and Social Science - Research Contributions

October 23-24, 2006 - Bethesda, Maryland

Website: http://obssr.od.nih.gov/HealthDisparities/index.html

The conference focuses on three broad areas of action influencing health disparities: policy, prevention, and healthcare. It emphasize both basic research on the behavioral, social, and biomedical pathways giving rise to disparities in health and applied research on the development, testing, and delivery of interventions to reduce disparities in these three action areas.

The conference employs a multi-level analytic framework (i.e., ranging from individuals to societies). It includes research relevant to a wide range of population groups (e.g., variation by SES, race, ethnicity, gender) residing in the United States, while not attempting to provide detailed analyses of each and every group. Consideration is given to multiple public health issues and their interactions (e.g., multiple morbidities rather than single illnesses) and to risk factors or causal processes common to various health conditions (e.g., smoking, diet, exercise, access to health care).

Contact information : Suzanne Heurtin-Roberts, Ph.D. National Cancer Institute
co-chair of the organizing committee - sheurtin@mail.nih.gov

Health Disparities

2006-07-28T09:55:00.000-03:00

Chronic Disease - Health Disparities: A Selected Bibliography: "Eliminating health disparities is an overarching goal of the Healthy People 2010 national public health agenda, and it is a top priority for the Centers for Disease Control and Prevention (CDC). As part of the CDC Futures Initiative, we aim to eliminate health disparities by helping people who are at the greatest risk for poor health.
To accomplish these goals, we need effective interventions, such as those highlighted at the 19th National Conference on Chronic Disease Prevention and Control, March 1–3, 2005. The conference brings together leading experts on health disparities and is a collaboration between the CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), the Prevention Research Centers, and the Association of State and Territorial Chronic Disease Program Directors.
This bibliography, prepared specifically for conference attendees, contains publication citations written by CDC staff and partners during the past four years. Included are peer-reviewed journal articles, book chapters, and monographs focusing on the United States.
Whether you are just getting involved in efforts to eliminate health disparities or are a long-time supporter, we hope this bibliography provides the information you need to help close the gaps and reach populations bearing the greatest burden of poor health./.../"

Cardiovascular Health in the Developing World

2006-07-27T10:11:00.000-03:00

De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org]
Em nome de "Maria Inês Reinert Azambuja"
Enviada em: quarta-feira, 26 de julho de 2006 18:07
Para: Cardiovascular Health in the Developing World
Assunto: [ProCOR] Re: ProCOR seeks your input (6)

Dear Catherine,
It is indisputable that, today, the main determinants of ill health and early mortality in Brazil and other countries of the Region are poverty and social exclusion.

Our population is ageing, and as well discussed by Leeder and colleagues in "A Race Against Time," chronic diseases shall become a huge problem here during the next decades, accompanying this demographic trend. Poverty-related deaths will tend to follow the demographic track. With less children, the main burden of poverty-related diseases and deaths will fall upon the adult population. As recognized in 1946 by two eminent cardiologists from our Medical School (FAMED-UFRGS) in Brazil,"Rich cardiac patients have a relatively long and tranquil life. The poor fall fast and recurrently in heart failure and stand still; their lives are short and painful" (Prof. Álvaro Barcelos Ferreira, 1943[1])

"Rest and adequate exercises, appropriate hours of work and leisure, hygienic housing and so on, are conditions which are out of the reach of the poor. It is even painful to prescribe them care, good life and treatment which they can not follow or afford. Soon after compensating a heart failure, they are obliged to go back to work - almost invariably inadequate to their condition, to the fight for life which throw them again in the failure of their central circulatory organ." (Prof. Thomaz Mariante[2], 1943)

Probably the great challenge that we need to address is how to plan feasible interventions to prevent and control the impact of chronic diseases in Brazil in the next years in a way that they become a component of the macroeconomic agenda towards Brazil development, and could contribute to lessen the social and health inequalities which have prevented us to grow.
And additionally, how to convince central economies of the advantages of this approach...

Overall population health results much more from production of services, insumes, medications and equipements (meaning economic strength) than from their consume. If our countries are not able to overcome the levels of urban poverty that exist today, political instability will increase and with it, ill health and deaths (overall).

The challenge that I would pose to the PROCOR team would be: how to use Chronic Diseases Prevention policies to reduce destitution and stimulate the economic growth of third world countries?
Best regards,
Maria Inês Azambuja, MD
School of Medicine
Universidade Federal do Rio Grande do Sul Porto Alegre, RS Brazil miazambuja@terra.com.br
----------------------------------------------------------------------------
[1] Ferreira AB. The social problem of the cardiac patient. In: Panteão Médico Rio-Grandense. Cultural and historical synthesis: progress and evolution of Medicine in the State of Rio Grande do Sul, Brazil, 1943.
[Portuguese]

[2] Mariante T. The problem of angiocardiopathies in Rio Grande do Sul. In:
Panteão Médico Rio-Grandense. Cultural and historical synthesis: progress and evolution of Medicine in the State of Rio Grande do Sul, Brazil, 1943.
[Portuguese]
_____________________________________________________________________

My Life as a Quant: Reflections on Physics and Finance

2006-07-24T21:33:00.000-03:00

Dr. Emanuel Derman will discuss his book My Life as a Quant: Reflections on Physics and Finance (John Wiley & Sons). Wall Street is no longer the old-fashioned business it once was. In recent years, investment banks and hedge funds have increasingly turned to quantitative trading strategies and derivative securities for their profits, and have raided academia for PhDs to model these volatile products and manage their risk.

Nowadays, the fortunes of firms and the stability of markets often rest on mathematical models. "Quants"–the scientifically trained practitioners of quantitative finance who build these models–have become key players on the Wall Street stage.

And no Wall Street quant is better known than Emanuel Derman. One of the first high-energy particle physicists to migrate to Wall Street, he spent seventeen years in the business, eventually becoming managing director and head of the renowned Quantitative Strategies group at Goldman, Sachs & Co. There he coauthored some of today's most widely used and influential financial models, including the widely used Black-Derman-Toy model of interest rates.

Physics and quantitative finance look deceptively similar. But, writes Derman, "When you do physics you're playing against God; in finance, you're playing against God's creatures." How can one justify using the precise methods of physics in the frenzied world of financial markets? Is it reasonable to treat the economy and its markets as a complex machine? Or is quantitative finance merely flawed thinking masquerading as science, a brave whistling in the dark?

Do biomarkers of stress mediate the relation between socioeconomic status and health?

2006-06-23T09:50:00.000-03:00

Do biomarkers of stress mediate the relation between socioeconomic status and health?
Jennifer B Dowd and Noreen Goldman
Objectives: To test the relation between socioeconomic status (SES) and biomarkers of chronic stress, including basal cortisol, and to test whether these biomarkers account for the relation between SES and health outcomes.
Design: Cross sectional study using data from the 2000 social and environmental biomarkers of aging study (SEBAS).
Setting: Taiwan.
Participants: Nationally representative sample of 972 men and women aged 54 and older.
Main outcome measures: Highest risk quartiles for 13 biomarkers representing functioning of the neuroendocrine system, immune/inflammatory systems, and the cardiovascular system: cortisol, adrenaline (epinephrine), noradrenaline (norepinephrine), serum dihydroepiandrosterone sulphate (DHEA-S), insulin-like growth factor 1 (IGF1), interleukin 6 (IL6), albumin, systolic blood pressure, diastolic blood pressure, waist-hip ratio, total cholesterol-HDL ratio, HDL cholesterol, and glycosylated haemoglobin; self reported health status (1–5) and self reported mobility difficulties (0–6).
Results: Lower SES men have greater odds of falling into the highest risk quartile for only 2 of 13 biomarkers, and show a lower risk for 3 of the 13 biomarkers, with no association between SES and cortisol. Lower SES women have a higher risk for many of the cardiovascular risk factors, but a lower risk for increased basal readings of adrenaline, noradrenaline, and cortisol. Inclusion of all 13 biological markers does not explain the relation between SES and health outcomes in the sample.
Conclusions: These data do not support the hypothesis that chronic stress, via sustained activation of stress related autonomic and neuroendocrine responses, is an important mediator in the relation between SES and health outcomes. Most notably, lower SES is not associated with higher basal levels of cortisol in either men or women. These results place an increased burden of proof on researchers who assert that psychosocial stress is an important pathway linking SES and health.
Abbreviations: SES, socioeconomic status; DHEA-S, dihydroepiandrosterone sulphate; IGF1, insulin-like growth factor 1; IL6, interleukin 6; AL, allostatic load; SNS, sympathetic nervous system; HPA, hypothalamic pituitary-adrenal; SEBAS, social and environmental biomarkers of aging study/.../

Action for Equity

2006-06-12T11:29:00.000-03:00

The Institute of Public Health in Ireland is holding a flagship event "Action for Equity" on 17 & 18 October 2006 in The Four Seasons Hotel, Carlingford, Co Louth.

Alma-Ata

2006-05-30T11:32:00.000-03:00

http://www.who.int/social_determinants/links/events/wha2006/en/index.html
World Health Organization – May 2006

Website: http://www.who.int/social_determinants/links/events/wha2006/en/index.html

"Managing the Politics of Equity and Social Determinants of Health" - the title of the informal briefing the Commission held at the 59th World Health Assembly. The briefing drew sharper focus on the necessity of major health stakeholders to step up action on the social causes of ill-health. High-level policy makers, civil society members and WHO staff attended the briefing, proclaimed as a "historical moment" by a floor delegate. Among the attendees was Dr Halfdan Mahler considered to be the father of the Alma Ata Declaration and former WHO Director-General from 1973 to 1988.

"He gave us the dream. He launched new ideas and made us realize that it was possible to achieve health for everybody," Commissioner, Dr Giovanni Berlinguer noted. Dr Berlinguer outlined the evolution of global health politics over the past three decades and lamented the impact of changes in the political economy which saw public health recoil under the shadow of major financial institutions. He told delegates that the setting up of the Commission on Social Determinants of Health was an opportunity to add momentum to a global movement that wanted to see health inequalities addressed.

Bolivia's Health Minister Dr Nila Heredia pointed out her country's challenges to address inequalities in health, stating the low health budget and historical factors as some of the major obstacles (see her presentation below). She mentioned poverty, poor housing and low levels of education, particularly among women, as some of the key social determinants of health in Bolivia. The government was exploring several programs to address health inequalities which included a "zero malnutrition" program and the promotion of a social security system that would allow segments of society to gain free access to health.

Civil society representative, Dr Hani Serag challenged WHO and the Commission to address the "profound determinants such as violence, wars, and neo-liberal policies" and to allow the different components of the Commission to work independently. Dr Serag further challenged WHO to return to the principles of the Alma-Ata Declaration (see below).

Commissioner Dr Ndioro Ndiaye stressed the importance of including sectors outside the health domain to be part of the developing healthy societies: "If we do not look at the intersectoral angle, that health is not just a medical problem … we will not succeed." The Commission already engages different ministries and sectors outside health to work collaboratively on social determinants of health and equity.

The Declaration of Alma-Ata

Presentations

Equidad y determinantes sociales de la salud [pdf 119kb]
Presentation by Dr Nila Heredia, Minister of Health, Bolivia

Canada’s Participation and Response [pdf 146kb]
Presentation by Jim Ball, Public Health Agency of Canada

Addressing Unhealthy Policies [pdf 367kb]
Presentation by Drs Hani Serag, Alaa Shukrallah, People’s Health Movement

The Global Burden of Disease

2006-05-26T13:23:00.000-03:00

Our aim was to calculate the global burden of disease and risk factors for 2001, to examine regional trends from 1990 to 2001, and to provide a starting point for the analysis of the Disease Control Priorities Project (DCPP).

Methods
We calculated mortality, incidence, prevalence, and disability adjusted life years (DALYs) for 136 diseases and injuries, for seven income/geographic country groups. To assess trends, we re-estimated all-cause mortality for 1990 with the same methods as for 2001. We estimated mortality and disease burden attributable to 19 risk factors.

Findings
About 56 million people died in 2001. Of these, 10·6 million were children, 99% of whom lived in low-and-middle-income countries. More than half of child deaths in 2001 were attributable to acute respiratory infections, measles, diarrhoea, malaria, and HIV/AIDS. The ten leading diseases for global disease burden were perinatal conditions, lower respiratory infections, ischaemic heart disease, cerebrovascular disease, HIV/AIDS, diarrhoeal diseases, unipolar major depression, malaria, chronic obstructive pulmonary disease, and tuberculosis. There was a 20% reduction in global disease burden per head due to communicable, maternal, perinatal, and nutritional conditions between 1990 and 2001. Almost half the disease burden in low-and-middle-income countries is now from non-communicable diseases (disease burden per head in Sub-Saharan Africa and the low-and-middle-income countries of Europe and Central Asia increased between 1990 and 2001). Undernutrition remains the leading risk factor for health loss. An estimated 45% of global mortality and 36% of global disease burden are attributable to the joint hazardous effects of the 19 risk factors studied. Uncertainty in all-cause mortality estimates ranged from around 1% in high-income countries to 15–20% in Sub-Saharan Africa. Uncertainty was larger for mortality from specific diseases, and for incidence and prevalence of non-fatal outcomes.

Inequality, Politics and Power

2006-05-26T12:02:00.000-03:00

Third World Bank Conference on Inequality

Topic: Inequality, Politics and Power, June 5-6, 2006

Agenda: http://siteresources.worldbank.org/INTDECINEQ/Resources/conference_on_inequality_2006_agenda.pdf

“….The distributions of income, wealth and political power are jointly determined, with economic status both affecting and being affected by political influence. In addition, the impact of inequality on the nature of institutions and on policy choice is one of the key channels through which income and wealth distributions affect economic performance.

The Conference on Inequality will focus on the interaction between economic and political inequalities, and on their consequences for institutional and economic development. The program includes both theoretical and empirical papers prepared by academics and professionals that were selected drawing on a widely advertized call for submissions …”

Papers:

· Endogenous Constitutions, Davide Ticchi and Andrea Vindigni (University of Urbino and Princeton University)

· Trade, Inequality, and the Political Economy of Institutions, Quy-Toan Do and Andrei Levchenko (World Bank and International Monetary Fund)

· Populist Policies in the Transition to Democracy, Daniel Mejía and Carlos Esteban Posada (Brown University and Banco de la República)

· The Colonial Origins of Inequality: Exploring the Causes and Consequences of Land Distribution, E.H.P. Fankema (University of Groningen)

· The Profits of Power: Land Rights and Agricultural Investment in Ghana, Markus Goldstein and Christopher Udry (World Bank and Yale University)

· Revolution and Redistribution in Iran: Changes in poverty and distribution 25 years later, Djavad Salehi-Isfahani (Virginia Tech)

· Are Jurisdictions with the Median Voter and Median Inequality Favored?, Santanu Gupta (Institute of Technology and Management)

· Informatization, Turnout, and Income Inequality, Ryo Arawatari (Osaka University)

· Divide and Conquer: Noisey Communication in Networks, Power, and Wealth Distribution, Wilson Perez-Oviedo
(Cornell Univesity and Banco Central del Ecuador)

· Inflation, Inequality and Social Conflict, Christopher Crowe, (International Monetary Fund)

· Conflict and Wealth, Oskar Nupia (Universitat Pompeu Fabra)

· Kidnaps and Migration: Evidence from Colombia, Catherine Rodriguez and Edgar Villa (Boston University)

· Inequality and Education Decisions in Developing Countries, Catalina Gutierrez-Sourdis (New York University)

· To Segregate or to Integrate: Education Politics and Democracy, David de la Croix and Matthias Doepke (FNRS, IRES, Core and UCLA)

· Are Female Leaders Good for Education? Evidence from India, Irma Clots-Figueras (London School of Economics)

· Why doesn't Capitalism flow to Poor Countries?, Rafael Di Tella and Robert MacCulloch (Harvard Business School and Imperial College London)

· Economic Inequality and Corruption, Boris Begovic (Center for Liberal-Democratic Studies)

· How do Inequality and Households' Position in Income Ladder Affect the Response towards Privatisation? A Study of Indian States, V. Santhakumar and U.S. Mishra (Centre for Development Studies)

· Local Inequality and Project Choice in a Social Investment Fund, M. Caridad Araujo, Francisco H.G. Ferreira, Peter Lanjouw and Berk Ozler (World Bank)

· Social Funds, Clientelism and Redistribution: Chavez, Michael Penfold-Becerra (Instituto de Estudios Superiores de Administración)

· Inequality, Ethnicity and Social Disorder: The Ecuadorian Case, Jeannette Sánchez
·

Enfrentando o Desafio das Doenças Não Transmissíveis no Br.

2006-05-12T22:46:00.000-03:00

O mesmo relatório divulgado no dia 09 último, em inglês, me foi enviado agora pelo Dr. Carlos Alberto Machado em inglês. Se alguém desejar o arquivo neste última forma, mande-me uma mensagem que o remeterei.
Abraço
AA

De: Carlos Alberto Machado [mailto:carlos.a.machado@uol.com.br]
Enviada em: sexta-feira, 12 de maio de 2006 17:56
Para: Aloyzio Achutti
Assunto: Fw: Report Banco Mundial
Prioridade: Alta
Relatório No. 32576-BR
BRASIL
Enfrentando o Desafio
das Doenças Não Transmissíveis no Brasil
15 de novembro de 2005
Unidade de Gerenciamento do Brasil
Unidade de Gestão do Setor de Desenvolvimento Humano
Região da América Latina e do Caribe

1. SUMÁRIO EXECUTIVO
1.1 As doenças não transmissíveis (DNTs) são responsáveis por uma parcela
grande e crescente da carga de doenças no Brasil. Atualmente, cerca de 66% da carga de
doenças no País deve-se a doenças não transmissíveis, comparado a 24% de doenças
contagiosas e 10% de ferimentos. A mudança do perfil do Brasil, com maior carga de
doenças não transmissíveis, é uma conseqüência da urbanização, de melhorias nos
cuidados com a saúde, da mudança nos estilos de vida e da globalização. A maior parte
dessa carga de doenças não é um resultado inevitável de uma sociedade moderna – tratase
de um mal que pode ser prevenido, e geralmente a um custo baixo. Este relatório tem
por finalidade apresentar uma visão geral da carga de doenças não transmissíveis no
Brasil e suas raízes, examinar os custos e a efetividade de intervenções de políticas
alternativas para tratar dessa carga crescente, os custos e retornos em potencial da
expansão da prevenção das DNTs e das atividades de controle, além de considerar as
implicações políticas de expandir as atividades para tratar efetivamente dessa carga em
alteração.

Seminário: Desigualdade, Desenvolvimento e Pobreza

2006-05-10T00:42:00.000-03:00

Brasília, 17 de maio de 2006 - O Banco Mundial, o Instituto de Pesquisa Econômica Aplicada (Ipea) e o Departamento para Desenvolvimento Internacional do Governo do Reino Unido (DFID) realizam na quarta-feira, dia 17 de maio, em Brasília um seminário internacional sobre a desigualdade de renda na América Latina e no Brasil, e suas conseqüências para o desenvolvimento, a pobreza e o crescimento econômico no país e na região.

O Seminário será aberto pelo Presidente do Ipea, Glauco Arbix, pelo Diretor do Banco Mundial para o Brasil, John Briscoe e por Siegfried Hirsch, representando o DFID e serão apresentados os trabalhos Redução da pobreza e crescimento na América Latina: Círculos virtuosos e viciosos, do Banco Mundial, por William Maloney, e Transferências de Renda, Salário Mínimo e a Queda da Desigualdade no Brasil, por Sergei Soares, do Ipea.

Para participar é preciso inscrever-se nos telefones e e-mails (61) 3329-1009 – czardo@worldbank.org - Sra. Carla Zardo ou (61) 3329-8605 – darruda@wordbank.org - Sra. Daniella Arruda.

A evento será realizado na Auditório da sede o Ipea em Brasília - SBS - Quadra 1 - Bloco J - Ed. BNDES – Subsolo.

Haverá transmissão por videoconferência para o Ipea Rio, na Av. Presidente Antonio Carlos, 51, 10º andar, Centro

Veja a programação:

Brazil - Addressing the Non Communicable Diseases

2006-05-09T18:54:00.000-03:00

WB

Abstract: Non-communicable diseases account for a large and growing share of Brazil's burden of disease. Currently, about 66 percent of the disease burden in Brazil is due to non-communicable diseases, compared to 24 percent from communicable diseases and 10% from injuries. Brazil's shift towards non-communicable diseases is a consequence of urbanization, improvements in health care, changing lifestyles, and globalization. Most of this disease burden i s not an inevitable result of a modern, aging society, but preventable-often at low cost. The purpose of this report is to provide an overview of the changing non-communicable disease burden in Brazil and its root causes, to examine costs and effectiveness of alternative policy interventions to address this growing burden, and the costs disease and potential returns from expanding non-communicable disease prevention and control activities, and to consider policy implication of expanding activities to effectively address the shifting burden.

Bridging the "Know-Do" Gap

2006-05-08T18:18:00.000-03:00

De: Equity, Health & Human Development [mailto:EQUIDAD@LISTSERV.PAHO.ORG] Em nome de Ruggiero, Mrs. Ana Lucia (WDC)
Enviada em: segunda-feira, 8 de maio de 2006 12:06
Para: EQUIDAD@LISTSERV.PAHO.ORG
Assunto: [EQ] Bridging the "Know-Do" Gap

Bridging the “Know–Do” Gap
Meeting on Knowledge Translation in Global Health

10–12 October 2005 - World Health Organization - Geneva, Switzerland
Organized by the Departments of: Knowledge Management and Sharing (KMS)
Research Policy and Cooperation (RPC) - World Health Organization
With support from: The Canadian Coalition for Global Health Research, Canadian International Development Agency, German Agency for Technical Cooperation (GTZ)
WHO Special Programme on Research & Training in Tropical Diseases - WHO/EIP/KMS/2006.2
World Health Organization 2006
Available online as PDF file at: http://www.who.int/kms/WHO_EIP_KMS_2006_2.pdf
“….Bridging the know–do gap is one of the most important challenges for public health in this century. It also poses the greatest opportunity for strengthenging health systems and ultimately achieving equity in global health….”
“…. the meeting on “Knowledge Translation for Global Health” was convened with the following objectives:
1) To learn from country experiences in bridging the knowpdo gap and to develop a typology of knowledge translation approaches in countries;
2) To clarify knowledge translation concepts and frameworks, and to identify effective and feasible practices and approaches; and
3) To identify priorities and mechanisms for knowledge translation research and action in global health.

Alberta Healthy Living Network - Alberta Healthy Living Network - University of Alberta

2006-05-07T08:27:00.000-03:00

Alberta Healthy Living Network - Alberta Healthy Living Network - University of Alberta: "Leadership for integrated, collaborative action to promote health and prevent chronic disease

The Alberta Healthy Living Network (AHLN) is a diverse group of over 100 multi-sector local, regional and provincial organizations and government departments.

This website has been developed with the generous support of the Canadian Diabetes Association."

Health Policy : Welfare state matters: A typological multilevel analysis of wealthy countries

2006-05-06T15:37:00.001-03:00

ScienceDirect - Health Policy : Welfare state matters: A typological multilevel analysis of wealthy countries: "Building on the social science literature, we hypothesized that population health indicators in wealthy industrialized countries are ‘clustered’ around welfare state regime types. We tested this hypothesis during a period of welfare state expansion from 1960 to 1994. We categorized data from 19 wealthy countries into 4 different types of welfare state regimes (Social Democratic, Christian Democratic, Liberal and Wage Earner Welfare States). Outcome variables were the infant mortality rate (IMR) and the low birth weight rate (LBW), obtained from the Organization of Economic Co-operation and Development (OECD) Health Data 2000 and from the United Nations Common Statistical Database (UNCSD). A two-level multilevel model was constructed, and fixed effects of welfare state were tested. Through the 39 years analyzed, Social Democratic countries exhibited a significantly better population health status, i.e., lower infant mortality rate and low birth weight rate, compared to other countries. Twenty percent of the difference in infant mortality rate among countries could be explained by the type of welfare state, and about 10% for low birth weight rate. The gap between Social Democracies and other countries widened over the 1990s. Our results confirm that countries exhibit distinctive levels of population health by welfare regime types even when adjusted by the level of economic development (GDP per capita) and intra-country correlations. It implies that countries, as groups, adopt similar policies or through any other ways, achieve similar level of health status. Proposed mechanisms of such process and suggestions for future research directions are presented in the discussion.

"

Health Policy : Welfare state matters: A typological multilevel analysis of wealthy countries

2006-05-06T15:37:00.000-03:00

Supercourse - Epidemiology, the Internet and Global Health

2006-04-29T16:55:00.000-03:00

Supercourse - Epidemiology, the Internet and Global Health: "Supercourse is a global repository of lectures on public health and prevention targeting educators across the world. Supercourse has a network of over 32000 scientists in 151 countries who are sharing for free a library of over 2500 lectures. The concept of the Supercourse and its lecture style has been described as the Global Health Network University and the Hypertext Comic Books. "

David Barker Theory

2006-04-29T16:46:00.000-03:00

David Barker: "Oregon Health & Science University 10/26/05
Birthweight, Growth Patterns Into Childhood Reveal Risk of Coronary Heart Disease Later in Life

United Press International - New York 10/27/05
Fast Fattening Kids May be Heart Risks

NewScientist.com - London 10/27/05
Fattening Up Skinny Toddlers Risks Heart Health

Boston Globe 10/31/05
Rapid Weight Gain in Young Linked to Later Heart Trouble

Detroit Free Press 11/01/05
Study Says Heart Disease Can Start in Childhood

The Oregonian 11/02/05
Weight Beyond Baby Fat a Worry

The Danone Institute - Paris 11/02/05
PROFESSOR DAVID JP BARKER, WINNER OF THE 2005 DANONE INTERNATIONAL PRIZE FOR NUTRITION

UK top-level scientist rewarded for his pioneering role within the area of diet, nutrition and chronic adult disease."

Trajectories of Growth among Children Who Have Coronary Events as Adults

2006-04-29T16:39:00.000-03:00

NEJM -- Trajectories of Growth among Children Who Have Coronary Events as Adults: "Background Low birth weight is a risk factor for coronary heart disease. It is uncertain how postnatal growth affects disease risk.

Methods We studied 8760 people born in Helsinki from 1934 through 1944. Childhood growth had been recorded. A total of 357 men and 87 women had been admitted to the hospital with coronary heart disease or had died from the disease. Coronary risk factors were measured in a subset of 2003 people.

Results The mean body size of children who had coronary events as adults was below average at birth. At two years of age the children were thin; subsequently, their body-mass index (BMI) increased relative to that of other children and had reached average values by 11 years of age. In simultaneous regressions, the hazard ratios associated with a 1 SD increase in BMI were 0.76 (95 percent confidence interval, 0.66 to 0.87; P<0.001) at 2 years and 1.14 (95 percent confidence interval, 1.00 to 1.31; P=0.05) at 11 years among the boys. The corresponding figures for the girls were 0.62 (95 percent confidence interval, 0.46 to 0.82; P=0.001) and 1.35 (95 percent confidence interval, 1.02 to 1.78; P=0.04). Low BMI at 2 years of age and increased BMI from 2 to 11 years of age were also associated with raised fasting insulin concentrations (P<0.001 for both).

Conclusions On average, adults who had a coronary event had been small at birth and thin at two years of age and thereafter put on weight rapidly. This pattern of growth during childhood was associated with insulin resistance in later life. The risk of coronary events was more strongly related to the tempo of childhood gain in BMI than to the BMI attained at any particular age.

Inquérito de Saúde: São Paulo

2006-04-29T10:56:00.000-03:00

CAPA
(Enviado por:Carlos Alberto Machado [carlos.a.machado@uol.com.br])

Este site refere-se a Inquéritos de Saúde realizados no Estado de São Paulo, por pesquisadores das Universidades Estaduais Paulistas e da Secretaria de Estado da Saúde. Os participantes, todos com experiências prévias em inquéritos domiciliares, formaram um grupo para aprofundar essa metodologia de investigação e elaboraram projetos com uma base referencial comum e técnicas padronizadas. O primeiro deles, Inquérito Multicêntrico de Saúde no Estado de São Paulo, ISA-SP, foi realizado em quatro áreas do Estado de São Paulo: duas na Região Metropolitana de São Paulo e duas no interior do Estado. Na Região Metropolitana foram estudados o Distrito de Saúde do Butantã e uma área formada pelos municípios de Taboão da Serra, Embu e Itapecerica da Serra, no interior foram estudados os municípios de Botucatu e de Campinas.
O segundo inquérito foi realizado no Município de São Paulo, ISA-Capital. A escolha das áreas baseou-se na sua importância epidemiológica e socioeconômica, na sua vinculação com as Universidades Estaduais, que mantêm, nos locais, unidades experimentais e de extensão de serviços, e na possibilidade de estudo de tendências onde ocorreram inquéritos prévios, representando também, por estas mesmas razões, áreas de estudo que são de interesse da Secretaria de Estado da Saúde.
Participaram da pesquisa pela Universidade de São Paulo – USP: a Faculdade de Saúde Pública e a Faculdade de Medicina; pela Universidade Estadual Paulista – UNESP e Universidade Estadual de Campinas – UNICAMP, as respectivas Faculdades de Medicina e, pela Secretaria de Estado da Saúde, o Instituto de Saúde.

O Inquérito Multicêntrico, ISA-SP, foi financiado pela Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP, através do programa de Pesquisa em Políticas Públicas, tendo como instituição parceira a Secretaria de Estado da Saúde de São Paulo, que participou também com recursos financeiros. O Inquérito no Município de São Paulo, ISA-Capital, foi financiado pela Secretaria Municipal de Saúde de São Paulo.

The WHO Child Growth Standards

2006-04-28T21:13:00.000-03:00

WHO | The WHO Child Growth Standards:
The WHO Child Growth Standards

This web site presents the WHO Child Growth Standards. These standards were developed using data collected in the WHO Multicentre Growth Reference Study. The site presents documentation on how the physical growth curves and motor milestone windows of achievement were developed as well as application tools to support implementation of the standards.

Related links

:: Media page

:: WHO Department of Nutrition for Health and Development

:: WHO Department of Child and Adolescent Health and Development

:: WHO Global Database on Child Growth and Malnutrition

:: Multimedia help

Addressing the Social Causes of Illness: International Development Research Centre

2006-04-28T18:45:00.000-03:00

Addressing the Social Causes of Illness: International Development Research Centre:
"By Stephen Dale

Why do some people live long lives, punctuated by only short periods of illness, while others die young after struggling with chronically poor health?

That question was posed to an audience at a recent panel discussion hosted by Canada’s International Development Research Centre (IDRC). International health experts are convinced that they’ve found the answer. In both rich and poor countries, longevity and susceptibility to disease often have less to do with germs and genetics than with the so-called “social determinants of health” — factors such as income, education, occupation, and access to services, good medical treatment, and decent housing. Several exhaustive studies show that scoring well on the checklist of social indicators means one will likely live a long and healthy life, while deprivation is just as sure a predictor of increased illness and fewer years. "/.../

Measuring Health Disparities: Home

2006-04-26T22:35:00.000-03:00

Measuring Health Disparities: Home: "measuringhealthdisparities.org was created to facilitate the use of the interactive CD-ROM Measuring Health Disparities developed by John Lynch, PhD, and Sam Harper, PhD, of McGill University, and produced by the Michigan Public Health Training Center (MPHTC). Through this gateway, you will be able to:
Register your CD-ROM and access the password
Get Continuing Education credit for nurses, CHES, and physicians
View or post errata on the content of the CD-ROM
View or post comments on the content of the CD-ROM
If the MPHTC can further assist you with this site, the CD-ROM, or other matters, please contact us:
Robyn Nolan
Student Services Coordinator
Michigan Public Health Training Center
University of Michigan School of Public Health
611 Church Street, Room 256
Ann Arbor, MI 48104-3028"

DCPP - Global Burden of Disease and Risk Factors

2006-04-26T21:18:00.000-03:00

DCPP - Global Burden of Disease and Risk Factors: "This book emerges from two separate, but intersecting, strands of work that began in the late 1980s, when the World Bank initiated a review of priorities for the control of specific diseases. The review generated findings about the comparative cost-effectiveness of interventions for most diseases important in developing countries. The purpose of the cost-effectiveness analysis (CEA) was to inform decision making within the health sectors of highly resource-constrained countries. This process resulted in the publication of the first edition of Disease Control Priorities in Developing Countries (DCP1).

Also important for informing policy is a consistent, quantitative assessment of the relative magnitudes of diseases, injuries, and their risk factors. DCP1 included an initial assessment of health status for low- and middle-income countries as measured by deaths from specific causes; importantly, the numbers of cause-specific deaths for each age-sex group were constrained by the total number of deaths as estimated by demographers. This consistency constraint led to downward revision of the estimates of deaths from many diseases.

These two strands of work—CEA and burden of disease—were further developed during preparation of the World Development Report 1993: Investing in Health. This report drew on both the CEA work in DCP1 and on a growing academic literature on CEA. /...."

Health Promotion - Home - Victorian Government Health Information, Australia

2006-04-22T21:31:00.001-03:00

Health Promotion - Home - Victorian Government Health Information, Australia: "Welcome to the Health Promotion web site
This web site provides a gateway to health promotion activities within the Department of Human Services and other key health promotion resources.
It provides a comprehensive, starting point for exploring health promotion on the internet, and aims to facilitate and improve communication about quality health promotion practice in the following areas."

Health Promotion - Home - Victorian Government Health Information, Australia

2006-04-22T21:31:00.000-03:00

Indicadores sociais 2005 - IBGE

2006-04-12T23:13:00.000-03:00

IBGE - Instituto Brasileiro de Geografia e Estatística
Síntese de Indicadores Sociais 2005

Reúne indicadores sobre a realidade social brasileira, abrangendo informações sobre aspectos demográficos, educação, trabalho e rendimento, domicílios, famílias e grupos populacionais específicos - crianças, adolescentes e jovens, mulheres e idosos - entre outros aspectos, acompanhados de breves comentários sobre as características observadas nos diferentes estratos geográficos e populacionais do País relativamente aos temas selecionados.

Os indicadores estão apresentados em tabelas e gráficos, para o Brasil, grandes regiões e unidades da federação e, para alguns aspectos, também para regiões metropolitanas. Estes são elaborados, principalmente, a partir dos resultados da Pesquisa Nacional por Amostra de Domicílios realizada em 2004, que, neste ano, ampliou sua cobertura para todo o Território Nacional e agrega, pela primeira vez, as informações das áreas rurais de Rondônia, Acre, Amazonas, Roraima, Pará e Amapá.

A publicação apresenta, ainda, um glossário com os termos e conceitos considerados relevantes para a compreensão dos resultados.

O conjunto dessas informações está disponível no CD-ROM.

A elaboração e sistematização desses indicadores atende às recomendações internacionais e contribui para a compreensão das modificações no perfil demográfico, social e econômico da população, possibilitando, assim, o monitoramento de políticas sociais e a disseminação de informações relevantes para toda sociedade brasileira.

É certo uma doméstica ganhar mais que um professor?

2006-04-10T09:41:00.000-03:00

(Recomendado por Maria Inês Reinert Azambuja [miazambuja@terra.com.br])

GILBERTO DIMENSTEIN
É certo uma doméstica ganhar mais do que um professor?
O salário médio de uma empregada doméstica na cidade de São Paulo é de R$ 800, informa a Federação Nacional das Trabalhadoras Domésticas. É mais do que os R$ 615 pagos a uma professora iniciante da rede municipal, com uma carga horária de 20 horas. Se comparássemos com uma doméstica diarista, a diferença seria muito maior: sua média de rendimentos é de R$ 1.600 mensais.
O professor iniciante paulistano não pode, aliás, nem mesmo contar vantagem diante dos pedintes dos semáforos. Segundo estimativa da Secretaria Municipal do Desenvolvimento Social, esse trabalhador tira, em média, R$ 25 por dia.
Com o rendimento inferior ao de uma empregada doméstica e quase empatado com o de um pedinte, entende-se por que os professores entraram em greve em São Paulo. O problema não é só dinheiro: eles vivem sob intenso estresse, devido às salas superlotadas, alunos indisciplinados e agressivos, além de serem vítimas das mais diversas formas de violência.
Nessa questão salarial se revelam, na verdade, os valores de uma nação. Na prática, essas comparações significam, por mais absurdo que pareçam, que a sociedade dá mais valor à posição social de uma empregada do que a de um professor público -é assim que se medem, e não no palavrório, as verdadeiras prioridades do país.
Poderíamos medir a prioridade não só pelo salário mas pela baixa repercussão que essa greve tem na opinião pública. Imaginem o barulho que haveria se a paralisação fosse em escolas de elite, e os filhos das famílias mais ricas tivessem de ficar em casa por duas semanas. No caso da rede pública, as mães muitas vezes não têm nem com quem deixar seus filhos.
Se achamos que, sem boa educação pública, uma nação não consegue se desenvolver com um mínimo de igualdade e que a produtividade econômica estará ameaçada, o lógico seria que existissem esforços continuados e obsessivos para estimular a carreira do professor. Como podemos atrair pessoas mais talentosas e preparadas sem estímulo salarial?
Evidentemente o que vemos hoje não é culpa desse ou daquele governo, mas de uma falta de reverência a compartilhar de conhecimento entre todos.
Como as famílias mais ricas têm seus filhos em escolas privadas, uma greve como a que está ocorrendo provavelmente só entra na conversa -isso se
entrar- se a empregada lamentar com a patroa que não tem com quem deixar o filho.
Há traduções óbvias e repetidas para essa fragilidade: repetência, evasão e baixíssimo aprendizado. Uma das traduções não tão óbvias foi apontada, na semana passada, pelo presidente Lula, ao dar uma estocada, sem citar o nome, em Geraldo Alckmin, seu principal adversário e cada vez mais ameaçador, como mostra hoje o Datafolha.
No esforço de ir minando a imagem do ex-governador, o PT se prepara para mostrar as imagens de selvageria da Febem, que, na semana passada, voltou a exibir mais uma rebelião. Essas imagens apenas reforçam o que todos
sabemos: o desempenho do governo estadual está muito abaixo, nessa área, do que o esperado. Pelo volume de dinheiro que se despeja na prisão de crianças e adolescentes e pelo que já conhecemos sobre a inutilidade de grandes instalações como a do Tatuapé, melhores resultados poderiam ter sido apresentados.
Lula lembrou que se construíssem mais escolas haveria menos prisões.
Colocada nesses termos simplistas, a frase tem efeito apenas eleitoral. Mas, em essência, é isso mesmo.
O problema da Febem não é, a rigor, apenas a Febem. Antes fosse. O problema é nossa incapacidade de prevenir a delinqüência juvenil, e, aí, a discussão se torna extremamente complexa.
Se houvesse mais e melhores escolas, provavelmente haveria menos unidades da Febem, menos assaltos e menos assassinatos. Como ter boas escolas se, na cidade mais rica do país, um professor ganha tanto quanto um pedinte e menos do que uma empregada doméstica? Será que esse indivíduo terá recursos para comprar livros ou ir ao teatro? Pode alguém ser, de fato, um bom professor sem uma vivência cultural?
Evidentemente que não. Isso significa que a escola vira mais um espaço de exclusão, especialmente para aqueles em situação de risco, do que de inclusão, servindo de incubadora para candidatos a internos da Febem.
Se os ataques sobre a Febem, de Alckmin, servirem para esse tipo de reflexão, ruim para o ex-governador, bom para o país. Se forem apenas para ficar nos chavões, será perda de tempo.
P.S- Para melhorar o desempenho dos professores, gosto de uma idéia que, em geral, os professores detestam. Em vez de aumentos salariais indiscriminados, os educadores poderiam ganhar um bônus a partir do desempenho de seus alunos. Nos lugares em que tal idéia foi testada e, ao mesmo tempo, se ajudou na qualificação do educadores, os resultados foram estimulantes. O professor passa a ser sócio do sucesso do aluno, e não do fracasso.

Some questions that are seldom asked...

2006-04-09T09:14:00.000-03:00

Human Rights Reader 131
SOME QUESTIONS WITH HUMAN RIGHTS IMPLICATIONS THAT ARE SELDOM ASKED.
1. To start with, on matters of our time:
1.1. Does the war against terror not really divert the world’s attention from the underlying causes of growing global insecurity (and the underlying human rights situation…?)
1.2. Should we not transcend old adversarial models and processes of seeking solutions (defining ourselves by what we stand against) and bring more light to these processes by encouraging the development of a more positive way of relating to the problems as they exists today (defining ourselves rather by what we stand for)? (J. Buderer)

2. On Health:
2.1. With Health For All by the Year 2000 having failed, should we be content with Health For Half by 2015?
2.2. Why is it that decentralization of health services has often led to privatization and fragmentation along socio-economic lines, exacerbating the class divide?

3. On Science:
3.1. Does the use of statistics by any science make it beyond dispute or are statistics merely just one method of measurement? [Somebody said that, if you torture the data long enough, they will create the evidence you want; they call this ‘evidence making’].
3.2. And, have you ever heard of ‘stadigraphy’? [It actually is a new, but minor science; a novel way to tell lies…]. (C. Fuentes)
3.3. Do you feel that science, more often than you want, keeps off the path of ethics and politics? If so, is that right? Would you agree that the teaching and practice of values and of an ideology is what gives our lives and words their full meaning?
3.4. Ergo, do we have (or have not) the responsibility to profess political principles to govern our respective professions? (G. Cannon)

5. On the Media:
5.1. Why do many of the media we are exposed to no longer inform us, but only create the illusion of doing so?
5.2. As general public, are we being manipulated?
5.4. Have you noticed that wars are a bit trivialized and that Western victims are more important than others?
5.5. Why is the focus of news more on drama than on the big picture?
5.6. Why if there are no images, increasingly, there is no news report?
5.7. Would you agree that rural audiences stay out altogether of the public debate? --are they the ‘deliberately unheard’? (A. Roy)
5.8. Is the press thus, with few exceptions, ‘partisan’ and often even unethical in a subtle way?
5.9. If the purpose is ‘to minimize the noise and maximize the signal’, are internet mailing lists and websites a powerful means of establishing a common alternative space in restricted and often repressive media environments?
5.10. Can this medium become a space for open public debate for the expression of dissenting political opinion, for constructive criticism and a space for social and political mobilization --a space to act ‘glocally’? (D+C 32:5 May 2005, F&D 42:1 March 2005).

6. On poverty:
6.1. What is more appropriate to speak of: ‘the feminization of poverty or the ‘povertization’ of women?
6.2. Should development objectives be specifically stated in distributional terms and as poverty-redressing objectives?
6.4. Why have we, both in the North and in the South, not been able to deprive tyrants of their ability to finance themselves against-the-interest-of-their-own-people who always end up poorer?
6.5. Should international debt not having been used in the public interest be legally enforceable? [Many think no, and they call this type of debt ‘odious debt’]. (F+D, 42:2, June 2005)

7. On human rights:
7.1. It has been said that basic needs are about ‘having’ while human rights (HR) are about ‘being’. Think about it. Would you agree? (U. Jonsson)
7.2. To state the obvious, those who have the power are not those who have the problems: What is the best response: weakening the strong or strengthening the weak? [Note that HR work is about both --and that is the right approach!] (G. Kent)
7.3. Should we not get the street protesters (e.g., at WTO or WB/IMF meetings) from the barricades and have them join us in an organized, common, creative and constructive HR cause? Is there untapped young energy there?
7.4. Should a rights-based approach now be used to frame public policy?
7.5. If yes, does this call for a social contract that would then have to be given political expression in both legislation and in public policy?
7.6. How do you interpret the following?: ‘HR are not just something that society or governments simply achieve: they are an imperative which citizens have to actively demand for’.
7.7. What are and how can we seek viable ways of strengthening citizens’ claims to such rights in highly inequitable and poor societies?
7.8. How can we build a social consensus regarding those rights and set up/strengthen institutions that will act upon that consensus? [Economic, social and cultural rights have to be internalized first by all the various actors so that day-to-day practice and policy decisions are all geared towards a rights-based society].
7.9. Have you noticed that the results of the ballot have virtually no impact on the actual conduct of state economic, social and HR policies?

8. On the semantics of human rights:
8.1. Are we witnessing a process of ‘neutering’ and denigration of basic HR language by those who are still for a status-quo? (G. Cannon)
8.2. Should we not talk about ending rather than reversing HR violations?
8.3. Should we not talk about ‘neoliberal global restructuring’ or ‘global marketization’ instead of just ‘globalization’ --as one of the important causes of HR violations?
8.4. Does not charity --e.g., giving out handouts-- allow the giver to maintain control, i.e., on what to give, to whom, how and when? Is charity thus not disempowering to recipients and antithetical to HR? Is that why some have called for not talking about aid, but rather about ‘restitution’?

Did some of these questions make you feel uncomfortable? Or confused as to the better answer?
There is no pass-or-fail in this quiz; but remember:
It is OK and important to have your own opinion on the importance of HR; Why not proactively share it then!?

Claudio Schuftan,Ho Chi Minh City
claudio@hcmc.netnam.vn

Global Burden of Disease

2006-04-05T11:57:00.000-03:00

Global Burden of Disease and Risk Factors

A copublication of Oxford University Press and The World Bank, April 2006
ISBN: 0-8213-6262-3

EDITORS: Alan D. Lopez, Colin D. Mathers, Majid Ezzati. Dean T. Jamison, Christopher J. L. Murray
The Disease Control Priorities Project (DCPP) is a joint enterprise of The World Bank, the Fogarty International Center (FIC) of the National Institutes of Health (NIH), the World Health Organization (WHO), and the Population Reference Bureau. The NIH National Library of Medicine (NLM) is also a partner. DCPP is funded principally through a grant from the Bill & Melinda Gates Foundation.
Website: http://www.dcp2.org/pubs/GBD
PDF version [506p.] at: http://files.dcp2.org/pdf/GBD/GBD.pdf
“…..Over the past six years, the World Health Organization has undertaken a new assessment of the global burden of disease for 2000-2. The World Health Organization has also invested in improving the conceptual, methodological, and empirical basis of burden of disease assessments and the assessment of the disease and injury burden from major risk factors. During 1999-2004, the authors of this volume and many collaborators from around the world worked intensively to assemble an updated, comprehensive assessment of the global burden of disease and its causes.
The Global Burden of Disease and Risk Factors is the definitive, scientific account of these efforts and of the health conditions of the world's population at the beginning of the 21st century. This book includes a full account of methods, the complete results of recent work, and an assessment of trends for total mortality and for major causes of death among children under five. In addition, two chapters cover sensitivity and uncertainty analyses in relation to a broad range of potentially important parameters….”

Priorities in Health

2006-04-05T11:45:00.000-03:00

Available online at: http://www.dcp2.org/pubs/PIH
PDF version [236p.] at: http://files.dcp2.org/pdf/PIH/PIH.pdf
Delivering efficacious and inexpensive health interventions leads to dramatic reductions in mortality and disability at modest cost. Globalization has been diffusing the knowledge about what these interventions are and how to deliver them. The pace of this diffusion into a country–more than its level of income–determines the tempo of health improvement in that country.
Two overarching themes emerge from the extensive research and analyses:
· Current resources can yield substantial health gains if knowledge of cost-effective interventions were applied more fully.
· Additional resources are needed in low-income countries to minimize the glaring inequities in health care. Increased resources would provide highly-effective interventions, expand research, and extend basic health coverage to more people.
Translations For DownloadFrench (PDF 4.1MB) Portuguese (PDF 4.2MB) Russian (PDF 4.1MB) Spanish (PDF 3.7MB)

WHO | Tackling social factors to improve health

2006-04-03T14:37:00.000-03:00

WHO Tackling social factors to improve health
Professor Sir Michael Marmot was born in London. He earned his MD in 1968 at the University of Sydney, Australia, and a PhD in epidemiology from the University of California, Berkeley, United States. He started his career as a doctor at the Royal Prince Alfred Hospital, University of Sydney in 1969. Marmot has been at the forefront of research in health inequalities for the past 20 years, most famously as Principal Investigator of the Whitehall studies of British civil servants. He is Professor of Epidemiology and Public Health at University College London (UCL) and Director of the UCL International Institute for Society and Health, which he set up in 2005. Marmot was appointed Chair of WHO’s Commission on the Social Determinants of Health in 2005.
Many governments recognize that factors such as status, education and employment have an impact on people’s health, but few have tackled these social determinants head on. WHO established a commission in March 2005 to come up with recommendations on how countries can address these. One year later, the Commission’s chair Professor Sir Michael Marmot tells the Bulletin how WHO’s Commission on the Social Determinants of Health is helping governments tackle underlying factors to improve the health and well-being particularly of disadvantaged populations.

growth isn’t working: the uneven distribution of benefits and costs from economic growth

2006-03-31T15:19:00.000-03:00

Search Results: "Growth isn’t working: the uneven distribution of benefits and costs from economic growth, shows that globalisation is failing the world’s poorest as their share of the benefits of growth plummet, and accelerating climate change hurts the poorest most.
The report, the first in nef's series of 'Re-thinking poverty' reports, reveals that the share of benefits from global economic growth reaching the world’s poorest people is actually shrinking, while they continue to bear an unfair share of the costs. New figures show that growth was less effective at passing on benefits to the poorest in the 1990’s than it was even in the 1980’s- the so-called ‘lost decade for development’ - and an age of rising climate chaos will worsen their prospects.

'You are' where you are born, say doctors

2006-03-31T09:26:00.000-03:00

icWales - 'You are' where you are born, say doctors:
"'You are' where you are born, say doctors Mar 31 2006
Madeleine Brindley, Western Mail

THE community in which people are born will shape their lifelong health, a leading expert says today.
Generations living in some of Wales' most deprived communities will be condemned to lives dominated by poor health, unless they or society can pull them out.
And as more evidence emerges about the links between ill health and social factors such as housing, employment, and education, experts have called for a new wider focus for health promotion and prevention.
Dr David Salter, acting chief medical officer for Wales, said health professionals must work in tandem with employers, education and housing chiefs to improve the inherently poor health of certain parts of the country.
And Professor Mansel Aylward, professor of psychosocial and disability research at Cardiff University, added, "The time has come to stop messing about and to look at the broader landscape to make significant change.
Health is not just about public health or healthcare delivery, it's about what housing people live in, the culture, criminality.
"Unless we address these factors, then we won't get any change.
"In simple terms, we can treat disease with pills but we don't yet have any pills for psychosocial ills."
New community profiles, which map ill health by local authority boundaries, reveal that the South Wales Valleys remain blighted by ill health.
Life expectancy is at its lowest in Merthyr Tydfil and Blaenau Gwent; deaths from all types of diseases are highest across the South Wales coalfield, and people living in the Valleys are more likely to binge drink and to smoke and less likely to meet government guidelines on fruit and vegetable consumption and exercise.
This is in sharp contrast to the rural and relatively affluent area of Ceredigion, which constantly has low levels of some of the most lethal diseases in Wales.
The community profiles, were developed by the Chief Medical Officer and the Wales Centre for Health.
They also reveal a correlation between poor health, poor housing, unemployment and low educational achievement.
Prof Aylward said, "There is little doubt that the community in which you are born really sets the tone for the rest of your life, unless you or society makes efforts to move you up.
"Our physiology, pre-disposition to disease, and the diseases we get, are all part of our social background.
"We know that people who are in the less well-off areas are more likely to be out of work or working in industries that are much more rigid, less well-paid and more hazardous than people in the upper brackets.
"We know that housing is likely to be poorer - more damp, fewer facilities.
"These social determinants of ill health are there all the way through people's lives."
Dr Salter said, "Addressing social, economic and environmental circumstances of individuals and communities is central to improving health across Wales.
"Health Challenge Wales, the national focus and driver for efforts to improve health, is making connections between a broad range of services not only from the health sector but also from the employment sector, schools, colleges, workplaces, local government and the voluntary sector.
"The Welsh Assembly Government along with many other organisations and individuals have all been taking up the challenge to do more to help people improve their health and reduce health inequalities.
"This is a very good start but if we are to change the geography of ill health and unhealthy lifestyles in Wales, we are going to require a sustained commitment to health improvement from even more organisations and individuals - we all need to be part of the challenge."
Overall mortality - Deaths from all causes, including respiratory and heart conditions, are likely to be higher in deprived areas - an indication of poorer overall health and poor lifestyles, including higher rates of smoking.
High rates: South Wales Valleys areas of Blaenau Gwent, Merthyr Tydfil, Rhondda Cynon Taf, Caerphilly and Neath Port Talbot.
Low rates: Ceredigion, Monmouthshire, Powys, Gwynedd and Anglesey.
Life expectancy (men and women) - Poor life expectancy rates in the South Wales valleys mirrors the increased death rates.
Best: Ceredigion, Monmouthshire, Powys and Anglesey.
Worst: Merthyr Tydfil, Blaenau Gwent, Rhondda Cynon Taf and Caerphilly.
Long-term limiting illness - The 2001 Census identified high rates of long-term limiting illnesses in Merthyr Tydfil, which is reflected in the large numbers of people claiming sickness benefits.
Hot spots: Merthyr Tydfil, Blaenau Gwent, Neath Port Talbot, Rhondda Cynon Taf and Caerphilly.
Not spots: Monmouthshire, Cardiff, Vale of Glamorgan, Flintshire and Powys.
Cancer (men and women) - Cancer does not appear to follow deprivation, with all sectors of society at risk. But higher rates of smoking and drinking and poorer lifestyles in some communities could increase the risk of certain types of the disease.
Higher levels: Denbighshire, Anglesey, Conwy and Swansea
Lower levels: Monmouthshire and Ceredigion
High blood pressure, mental illness (including anxiety and depression), arthritis, back pain and diabetes - All of these conditions are closely linked to lifestyle - diet and exercise.
Difficulties accessing food shops, fresh produce and lack of money all influence how healthy, or not, an individual's lifestyle is.
High rates: Merthyr Tydfil and Blaenau Gwent had
Lower rates: Powys, Gwynedd, Monmouthshire and Conwy
Lifestyles (including smoking, binge drinking, exercise and fruit and vegetable consumption) - Despite the almost prohibitive price of tobacco, people in deprived communities are more likely to smoke.
Less healthy lifestyles: Rhondda Cynon Taf, Blaenau Gwent and Merthyr Tydfil
Healthiest lifestyle: Ceredigion and Conwy

RS mapeia avanço nos Objetivos do Milênio

2006-03-30T18:55:00.000-03:00

PNUD Brasil:
"O Rio Grande do Sul deverá ter, até julho, um mapa da situação social dos 496 municípios do Estado, com base nos indicadores dos Objetivos de Desenvolvimento do Milênio (ODM)— uma série de metas socioeconômicas que os países da ONU se comprometeram a atingir até 2015. O projeto é uma iniciativa do Fórum Permanente de Responsabilidade do Rio Grande do Sul (Fórum RS), uma associação que busca promover ações de responsabilidade social, e da Fundação de Economia e Estatística (FEE), com o apoio do PNUD."

Preventing Chronic Disease: April 2006: Table of Contents

2006-03-25T22:30:00.000-03:00

Preventing Chronic Disease: April 2006: Table of Contents

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established to provide a forum for public health researchers and practitioners to share study results and practical experience. The journal is published by the National Center for Chronic Disease Prevention and Health Promotion, one of eight centers within the Centers for Disease Control and Prevention.
The mission of the journal is to address the interface between applied prevention research and public health practice in chronic disease prevention. PCD focuses on preventing diseases such as cancer, heart disease, diabetes, and stroke, which are among the leading causes of death and disability in the United States.

Bias in published cost effectiveness studies: systematic review -- Bell et al. 332 (7543): 699 -- BMJ

2006-03-24T22:18:00.000-03:00

Bias in published cost effectiveness studies: systematic review -- Bell et al. 332 (7543): 699 -- BMJ: "Conclusion Most published analyses report favourable incremental cost effectiveness ratios. Studies funded by industry were more likely to report ratios below the three thresholds. Studies of higher methodological quality and those conducted in Europe and the US rather than elsewhere were less likely to report ratios below $20 000/QALY.
Introduction
Cost effectiveness analysis can help inform policy makers on better ways to allocate limited resources.1-3 Some form of cost effectiveness is now required for health interventions to be covered by many insurers.1 4 5 The quality adjusted life year (QALY) is used to compare the effectiveness of a wide range of interventions. Cost effectiveness analysis produces a numerical ratio�the incremental cost effectiveness ratio�in dollars per QALY. This ratio is used to express the difference in cost effectiveness between new diagnostic tests or treatments and current ones.
Interpreting the results of cost effectiveness analysis can be problematic, making it difficult to decide whether to adopt a diagnostic test or treatment. The threshold for adoption is thought to be somewhere between $20 000 (�11 300, 16 500)/QALY and $100 000/QALY, with thresholds of $50-60 000/QALY frequently proposed.6-9 "

ONGs BR >5% do PIB!

2006-03-24T17:53:00.000-03:00

PNUD Brasil: "As instituições sem fins lucrativos são responsáveis por 5% do Produto Interno Bruto (PIB) do Brasil — uma participação superior à de setores expressivos da economia brasileira, como a indústria de extração mineral (petróleo, minério de ferro, gás natural, carvão, entre outros), e maior que a de 22 Estados brasileiros (só fica atrás de São Paulo, Rio de Janeiro, Minas Gerais, Rio Grande do Sul e Paraná)."

PNAD-Suplemento: Características Adicionais de Educação - 2004

2006-03-23T22:51:00.000-03:00

PNAD-Suplemento: Características Adicionais de Educação - 2004: "Aspectos Complementares de Educação e Acesso a Transferências de Renda de Programas Sociais - 2004
Em 2004, a Pesquisa Nacional por Amostra de Domicílios investigou, como temas suplementares, questões relacionadas à segurança alimentar, características adicionais das crianças e adolescentes relativamente à educação e, nas unidades domiciliares, o acesso a algumas transferências de rendimentos proporcionadas por programas sociais governamentais.."

Jeffrey Sachs reflexions

2006-03-23T13:24:00.000-03:00

(recomendado por Mário Maranhão)
"Tragam o Estado de volta"
22.03.2006
Economista diz que as forças de mercado não são a solução para a pobreza e outros problemas fundamentais do mundo moderno

NYT
Sachs: "Os países ricos dão uma ajuda irrisória"
Por André Lahóz EXAME
Um dos arautos do neoliberalismo nos anos 80, Jeffrey Sachs é hoje um dos mais veementes defensores da importância do Estado como motor do desenvolvimento. Engajado num trabalho das Nações Unidas para erradicar a pobreza no mundo -- o Projeto Milênio --, o economista americano falou a EXAME sobre o papel dos governos no século 21.
1 - É possível acabar com a pobreza sem a ajuda do Estado?Não. A erradicação da pobreza extrema exige investimentos em saúde, educação e infra-estrutura. A iniciativa privada não irá colocar dinheiro nas áreas mais pobres do planeta, simplesmente porque não há mercado nesses lugares. Há hoje mais de 1 bilhão de pessoas na luta pela sobrevivência. Com ações bem programadas do Estado, podemos acabar com esse problema até 2025.
2 - Sua tese de que o Estado tem um papel fundamental no desenvolvimento não vai na contramão de tudo o que muitos economistas defendem?A questão não é Estado grande versus Estado pequeno. Defendo gastos públicos eficientes em áreas importantes. Veja o que ocorreu na África. Há uns 20 anos, o Banco Mundial dizia que a agricultura naquele continente não funcionava devido à intervenção do Estado. E o que foi feito? Acabaram com os subsídios a pequenos fazendeiros. Resultado: a situação ficou ainda pior. 3 - Os críticos dizem que os recursos se perdem no meio do caminho por causa da corrupção na máquina estatal, especialmente nos países pobres. Como é possível resolver esse problema?A corrupção existe, mas ela não é a principal causa da miséria. Essa idéia é conveniente para os Estados Unidos, pois exime o país e outras nações ricas da responsabilidade sobre o problema. A pobreza só vai ser erradicada com investimentos. Esse dinheiro tem de vir dos países ricos. 4 - Mas os países ricos já não ajudam as nações mais pobres?A ajuda é irrisória. Os Estados Unidos enviam por ano 3 bilhões de dólares para a África. E têm uma economia que movimenta hoje 12 trilhões de dólares por ano. Em termos percentuais, a África recebe 3 cents de cada 100 dólares do PIB americano. É muito pouco.
5 - Quanto os Estados Unidos e outros países teriam de investir para erradicar a pobreza?O problema seria resolvido se as nações ricas investissem por ano entre 0,5% e 1% de seu PIB. Isso significaria algo como o dobro ou o triplo dos níveis atuais de auxílio.
6 - O Brasil estaria na relação de países beneficiados por esse tipo de ajuda?O Brasil tem muitos desafios, mas é uma economia muito poderosa e moderna, quando comparada à dos países mais pobres. O auxílio internacional deveria ser canalizado para lugares como Haiti, Bolívia, Laos e Índia.
7 - Qual a sua avaliação sobre os programas de combate à pobreza do governo brasileiro?O Brasil avançou bastante nos últimos anos, sobretudo na área da educação. Esse processo começou com Fernando Henrique Cardoso e teve continuidade com o presidente Lula. É o rumo certo. Mas é preciso fazer muito mais. Um país que deseja passar de um nível de renda médio para um patamar mais alto deve investir pesadamente em sofisticação tecnológica. E isso só é possível quando há uma boa base educacional. A Coréia descobriu esse caminho nos anos 70. Por isso, é hoje um país muito mais rico que o Brasil.

Population Health Approach

2006-03-21T11:41:00.000-03:00

Public Health Agency of Canada - Population Health Approach - Population Health: "What is Population Health?
Population health is an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups. In order to reach these objectives, it looks at and acts upon the broad range of factors and conditions that have a strong influence on our health. more.. "

Inequality

2006-03-18T19:07:00.000-03:00

Inequality: "Inequality Quotes

Sense - and some nonsense - uttered through the ages by saints, sinners, Star Trek's Mr. Spock and others. Compiled by Sam Pizzigati with James Lardner and Sheila Kinney."

Inequalities in Health Michael Marmot, Ph.D / New England Journal of Medicine, v.345, n.2 12jul01

2006-03-15T08:10:00.000-03:00

Inequalities in Health Michael Marmot, Ph.D / New England Journal of Medicine, v.345, n.2 12jul01:
"Geographic variations in health within rich countries arc substantial. White men in the 10 'healthiest' counties in the United States have a life expectancy above 76.4 years. Black men in the 10 least healthy counties have a life expectancy of 61 years in Philadelphia, 60 in Baltimore and New York, and 57.9 in the District of Columbia.2 The 20-year gap in life expectancy between whites in the healthiest counties and blacks in the least healthy is as big as differences between countries at very different stages of economic development. The best off are like Japan; the worst off hover around the level of Kazakhstan and Bangladesh.3 The low life expectancy in poor countries may be the result of starvation, infected water, and poor sanitation. The low life expectancy of people who live in poor areas within rich countries is not. The major contributors to excess deaths among men in Harlem are circulatory disease, homicide, and infection with the human immunodeficiency virus.4"

Pacto Global - Brasil

2006-03-14T13:00:00.000-03:00

Pacto Global - Brasil

O Pacto Global é resultado de um convite efetuado ao setor privado pelo Secretário Geral das Nações Unidas, Kofi Annan, para que juntamente com algumas agências das Nações Unidas e atores sociais, contribuísse para avançar a prática da responsabilidade social corporativa, na busca de uma economia global mais sustentável e inclusiva. As agências das Nações Unidas envolvidas com o Pacto Global são o Alto Comissariado para Direitos Humanos, Programa das Nações Unidas para o Meio Ambiente (PNUMA), Organização Internacional do Trabalho (OIT), Organização das Nações Unidas para o Desenvolvimento Industrial (UNIDO) e o Programa das Nações Unidas para o Desenvolvimento (PNUD)

Coca-Cola adere ao Pacto Global da ONU

2006-03-14T12:26:00.000-03:00

PNUD Brasil:
"A Coca-Cola, uma das maiores empresas produtoras de bebidas do mundo, aderiu ao Pacto Global, uma iniciativa das Nações Unidas criada em 2000 para incentivar a prática da responsabilidade social corporativa. Uma das estratégias da empresa deverá ser a intensificação da fiscalização de parceiros e fornecedores."

Half a world : regional inequality in five great federations

2006-03-13T10:40:00.000-03:00

Data & Research - Report Details: "Summary: The paper studies regional (spatial) inequality in the five most populous countries in the world: China, India, the United States, Indonesia, and Brazil in the period 1980-2000. They are all federations or quasi-federations composed of entities with substantial economic autonomy. Two types of regional inequalities are considered: Concept 1 inequality, which is inequality between mean incomes (GDP per capita) of states/provinces, and Concept 2 inequality, which is inequality between population-weighted regional mean incomes. The first inequality speaks to the issue of regional convergence, the second, to the issue of overall inequality as perceived by citizens within a nation. All three Asian countries show rising inequality in terms of both concepts in the 1990s. Divergence in income outcomes is particularly noticeable for the most populous states/provinces in China and India. The United States, where regional inequality is the least, shows further convergence. Brazil, with the highest level of regional inequality, displays no trend. A regression analysis fails to establish robust association between the usual macroeconomic variables and the two types of regional inequality./.../
"

Sample Chapter for Milanovic, B.: Worlds Apart: Measuring International and Global Inequality.

2006-03-13T10:25:00.000-03:00

Sample Chapter for Milanovic, B.: Worlds Apart: Measuring International and Global Inequality.: "THE THREE CONCEPTS OF INEQUALITY DEFINED

THERE are three concepts of world inequality that need to be sharply distinguished. Yet, they are often confounded; even the terminology is unclear. So, we shall now first define them and give them their proper names.

The first (Concept 1) is unweighted international inequality. This concept takes country as the unit of observation, uses its income (or GDP) per capita, disregards its population, and thus compares, as it were, representative individuals from all the countries in the world. It is a kind of UN General Assembly where each country, small or large, counts the same. Imagine a world populated with ambassadors from some 200 countries, each of whom carries a sign on which is written the GDP per capita of his/her country. These ambassadors are then ranked from the poorest to the richest, and a measure of inequality is calculated across such ranking of nations (ambassadors). Note that this is properly a measure of international inequality, since it is compares countries. It is 'unweighted' because each country counts the same. Concept 1 is not a measure of inequality among citizens of the world./.../"

Does IQ explain socioeconomic inequalities in health? Evidence from a population based cohort study in the west of Scotland -- Batty et al. 332 (7541)

2006-03-12T19:21:00.000-03:00

Does IQ explain socioeconomic inequalities in health? Evidence from a population based cohort study in the west of Scotland -- Batty et al. 332 (7541): 580 -- BMJ: "Main outcome measures Total mortality and coronary heart disease mortality (ascertained between 1987 and 2004); respiratory function, self reported minor psychiatric morbidity, long term illness, and self perceived health (all assessed in 1988).

Results In sex adjusted analyses, indices of socioeconomic position (childhood and current social class, education, income, and area deprivation) were significantly associated with each health outcome. Thus the greatest risk of ill health and mortality was evident in the most socioeconomically disadvantaged groups, as expected. After adjustment for IQ, a marked attenuation in risk occurred for poor mental health (range of attenuation in risk ratio across the five socioeconomic indicators: 15-58%), long term illness (25-53%), poor self perceived health (41-56%), respiratory function (44-66%), coronary heart disease mortality (31-111%), and total mortality (45-131%). Despite the clear reduction in the magnitude of these effects after controlling for IQ, in half of the associations examined the risk of ill health in socioeconomically disadvantaged people was still at least twice that of advantaged people. Statistical significance was lost for only 5/25 separate socioeconomic health gradients that showed significant"

WHO | World Health Survey

2006-02-16T09:35:00.000-02:00

WHO | World Health Survey: "World Health Survey Results!

The first set of country tables providing basic tabulations from each of the different modules of the World Health Survey are now available. National reports based on these table results are currently under preparation by partners in each country where a WHS was implemented. The final cleaned data sets will be available to bonafide researchers in a phased manner following a period of exclusivity to countries.

The Canadian Institutes of Health Research have announced a request for applications from researchers to analyse data from the World Health Survey."

Prognostic Index for 4-Year Mortality in Older Adults, February 15, 2006, Lee et al. 295 (7): 801

2006-02-15T11:06:00.000-02:00

JAMA -- Abstract: Development and Validation of a Prognostic Index for 4-Year Mortality in Older Adults, February 15, 2006, Lee et al. 295 (7): 801: "Sei J. Lee, MD; Karla Lindquist, MS; Mark R. Segal, PhD; Kenneth E. Covinsky, MD, MPH

JAMA. 2006;295:801-808.

Context Both comorbid conditions and functional measures predict mortality in older adults, but few prognostic indexes combine both classes of predictors. Combining easily obtained measures into an accurate predictive model could be useful to clinicians advising patients, as well as policy makers and epidemiologists interested in risk adjustment.

Objective To develop and validate a prognostic index for 4-year mortality using information that can be obtained from patient report.

Design, Setting, and Participants Using the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling US adults older than 50 years, we developed the prognostic index from 11 701 individuals and validated the index with 8009. Individuals were asked about their demographic characteristics, whether they had specific diseases, and whether they had difficulty with a series of functional measures. We identified variables independently associated with mortality and weighted the variables to create a risk index."

Redução da Pobreza e Crescimento

2006-02-14T21:33:00.000-02:00

Grupo Banco Mundial: "Novo relatório para a América Latina e Caribe revela que pobreza pode ser obstáculo para crescimento

14 de fevereiro de 2006 – O Banco Mundial lançou hoje em Washington o relatório Redução da Pobreza e Crescimento: Círculos Virtuoso e Vicioso (Poverty Reduction and Growth, Virtuous and Vicious Circles), parte da série anual de trabalhos sobre a América Latina e Caribe. Segundo o novo relatório, os países da América Latina precisam combater a pobreza de modo mais agressivo, para promover um maior crescimento e competir com a China e outras economias asiáticas dinâmicas.

Embora o crescimento seja um fator importante para a redução da pobreza, esta mesma pobreza impede que sejam atingidas taxas de crescimento elevadas e sustentadas na América Latina, que se mantém como uma das regiões com mais alto nível de desigualdade do mundo.

Segundo o estudo, uma queda de 10% nos níveis de pobreza poderá gerar um aumento de 1% no crescimento econômico. Por sua vez, uma elevação de 10% nos níveis de pobreza reduzirá as taxas de crescimento em 1% e de investimento em até 8% do PIB.

Veja o relatório na seção de publicações."

Transparency International - 2006

2006-02-11T10:14:00.000-02:00

download gcr / gcr / publications / home - Transparency International: "The GCR 2006 focuses on corruption and health. The book includes expert reports on:

* the risks of corruption in different health care systems
* the scale of the problem: from high-level corruption in Costa Rica to counterfeit medicines in Nigeria to
* health care fraud in the United States
* the costs of corruption in hospital administration and the problem of informal payments for health care
* the impact of corruption at various points of the pharmaceutical chain
* anti-corruption challenges posed by the fight against HIV/AIDS"

Empowerment & Health. Evidence.

2006-02-10T16:20:00.000-02:00

WHO/Europe - Health Evidence Netw... - Summary: "Within the last decades, social exclusion, disparities, and absolute poverty - almost 3 billion people living on less than US $2.00 per day - have grown despite globalization and rising per-capita income in many developing nations. Income ratios of the richest 20% of the population to the poorest 20% are now at 82 to 1 compared to 30 to 1 in 1960. World-wide health disparities are increasing due to vulnerability to disease from severe malnutrition, rapid re-emergence of water and blood-borne infectious diseases, environmental degradation, disinvestment in the health infrastructure and violence. Within this same period, empowerment strategies, participation, and other bottom-up approaches have become prominent paradigms within public health and the development aid for reducing these disparities. As 'empowerment' increasingly enters mainstream discourse, those using the term need to clarify definitions, dimensions and outcomes of the range of interventions called empowering."/.../

Neglected diseases of neglected populations: Thinking to reshape the determinants of health in Latin America and the Caribbean

2006-02-08T22:27:00.000-02:00

BioMed Central Full text Neglected diseases of neglected populations: Thinking to reshape the determinants of health in Latin America and the Caribbean: "People living in poverty throughout the developing world are heavily burdened with neglected communicable diseases and often marginalized by the health sector. These diseases are currently referred to as Neglected Diseases of Neglected Populations. The neglected diseases create social and financial burdens to the individual, the family, the community, and the nation.
Discussion
Numerous studies of successful individual interventions to manage communicable disease determinants in various types of communities have been published, but few have applied multiple interventions in an integrated, coordinated manner. We have identified a series of successful interventions and developed three hypothetical scenarios where such interventions could be applied in an integrated, multi-disease, inter-programmatic, and/or inter-sectoral approach for prevention and control of neglected diseases in three different populations: a slum, an indigenous community, and a city with a mix of populations.
Summary
The objective of this paper is to identify new opportunities to address neglected diseases, improve community health and promote sustainable development in neglected populations by highlighting examples of key risk and protective factors for neglected diseases which can be managed and implemented through multi-disease-based, integrated, inter-programmatic, and/or inter-sectoral approaches. Based on a literature review, analysis and development of scenarios we visualize how multiple interventions could manage multiple disease problems and propose these as possible strategies to be tested. We seek to stimulate intra- and inter-sectoral dialogue which will help in the construction of new strategies for neglected disease"/.../

DCV e Trabalho

2006-02-08T22:15:00.000-02:00

Capítulo 13: "http://www.medicina.ufmg.br/dmps/hipertensao_arterial_trabalho.doc.
Lotufo e Lolio
DOENÇAS DO SISTEMA CIRCULATÓRIO RELACIONADAS COM O TRABALHO
Introdução
Apesar da crescente valorização dos fatores pessoais, como sedentarismo, tabagismo e dieta, na determinação das doenças cardiovasculares pouca atenção tem sido dada aos fatores de risco presentes na atividade ocupacional atual ou anterior dos indivíduos. Porém, o aumento dramático da ocorrência de transtornos agudos e crônicos do sistema cardio-circulatório na população tem feito com que as relações das doenças com o trabalho estejam merecendo maior atenção. Observa-se, por exemplo, que a literatura médica e a mídia têm dado destaque às observações quanto às relações entre a ocorrência de infarto agudo do miocárdio, doença coronariana crônica e hipertensão arterial com situações de estresse no trabalho e à condição de desemprego, entre outras.
Nos Estados Unidos, estudos estimam que cerca de 1 a 3% das mortes por doença cardiovascular estejam relacionadas ao trabalho. Tem sido registrada a associação entre baixos níveis socio-econômicos e educacionais e o aumento da incidência de doenças isquêmicas coronarianas atribuída aos fatores psicossociais de estresse e aos fatores de risco pessoal, mas também a uma maior exposição a agentes químicos, como solventes e fumos metálicos.
No Brasil, as doenças cardiovasculares representam a primeira causa de óbito, correspondendo a cerca de um terço de todas as mortes. A participação das doenças cardiovasculares na mortalidade do país vem crescendo desde meados do século XX. Em 1950, apenas 14,2% das mortes ocorridas nas capitais dos estados brasileiros eram atribuídas a molésticas circulatórias. Passaram a 21,5% em 1960, 24,8% em 1970 e 30,8% em 1980. Em 1990, as doenças cardiovasculares contribuíram com cerca de 32% de todos os óbitos nas capitais dos estados brasileiros. Além de contribuírem de modo destacado para a mortalidade, as moléstias do aparelho circulatório são causas freqüentes de morbidade, implicando 10,74 milhões de dias de internação pelo Sistema Único de Saúde (SUS), e representando a principal causa de gastos em assistência médica - 16,2% do total (Lotufo & Lolio, 1995). /.../

Doenças Cardiovasculares

2006-02-08T22:10:00.000-02:00

Doenças Cardiovasculares
Resumo: O estudo apresenta o perfil de 123 trabalhadores de uma Destilaria, quanto aos fatores de risco cardiovascular. Os resultados revelam 10,6% dos trabalhadores com obesidade grau 1, 17,0% obesidade grau 2, 11,4% com valores de pressão arterial sistólica ³ 140 mmHg,12,2% com pressão arterial diastólica ³ 90 mmHg, 60,2% possuíam o 1º grau incompleto, 40,7% referiram realizar atividade física, 16,3% eram fumantes, 65,9% indicaram consumo de bebida alcoólica, 49,6% referiram ingerir sal em excesso. Quanto aos antecedentes familiares, 32,5% referiram história familiar positiva de doença hipertensiva, 26,0% para acidente vascular cerebral e 27,6% para diabetes melito.
PALAVRAS CHAVES: Doenças Cardiovasculares; Fatores de risco; Hipertensão arterial.

Social Determinants of Health

2006-01-25T00:33:00.000-02:00

Mediasite Viewer
by Dennis Raphael
This 25 minute talk by your truly is available for viewing at
Link:
http://msl.stream.yorku.ca/mediasite/viewer/?peid=ac604170-9ccc-4268-a1af-9a9e04b28e1d

Brazil: Are Health and Nutrition Programs Reaching the Neediest?

2006-01-24T15:06:00.000-02:00

Brazil: Are Health and Nutrition Programs Reaching the Neediest?
Aluísio J. D. Barros, Cesar G. Victora, Juraci A. Cesar, Nelson Arns Neumann, and Andréa D. Bertoldi
Social inequalities represent a major problem in Latin America. As pointed out in Human Development Report 2003 (UNDP 2003), of the 12 countries that
rank highest in income concentration, 6 are in Latin America. (The other 6 are in Africa.) The Latin American countries with the greatest income inequality are Brazil, Nicaragua, Honduras, Paraguay, Chile, and Colombia, in descending order of their Gini coefficients, which range from 60.7 to 57.1.
Health inequalities are recognized by the Pan American Health Organization as “the leading health problem” in the Americas (PAHO 1998).
Reducing such inequalities is not a simple task, however. Knowledge about the impact of health interventions on the inequalities is imperfect, and some
interventions may actually increase inequalities instead of reducing them (Victora and others 2000)./.../

Investindo em Saúde

2006-01-20T15:16:00.000-02:00

Caros amigos do GT Investindo em Saúde,
Em primeiro lugar, agradecimentos pela pronta e entusiasmada resposta de todos os membros do grupo, participando 14 dos dezessete diretamente convidados de Porto Alegre em nossa reunião de instalação do dia 18 p.p. Sempre haverá gente comprometida que não possa estar presente, mas os recursos virtuais podem facilitar nosso encontro, superando as dificuldades de tempo e espaço. Existem mais outros colegas, principalmente de fora de Porto Alegre, que também expressaram interesse em nos acompanhar e participar.
Junto ao convite foi uma proposta preliminar acompanhada de uma bibliografia bastante extensa que pode ser acessada através da internet pelos endereços que estão incluídos (basta clicar). Quem não tiver recebido pode solicitar para o meu endereço ou do IEP, constantes do Blog.
Uma das finalidades deste meio de comunicação é compartilhar documentos, bibliografia e idéias de interesse comum. Todos estão convidados a fazê-lo, ou enviando material para os endereços já referidos. Comentários podem ser feitos diretamente ao pé das mensagens do Blog.
Combinamos que cada um enviaria para ser distribuído um texto resumido com as idéias básicas relacionadas com a proposta do GT, aquelas que lá já foram enunciadas por quem teve tempo para fazê-lo e outras novas. Lembrem-se: estaremos permanentemente conectados e que aos poucos, naturalmente iremos compartilhar nossas idéias, experiências, sugestões e propostas. Não é preciso, nem será possível apresentar tudo, de uma só vez. O grande potencial está na continuidade, na interação, no desenvolvimento e no intercâmbio.

Na reunião lembrei preconceitos que aos poucos vão se desmascarando:

Saúde é um assunto só de médicos
Saúde Pública é da alçada somente governamental e de sanitaristas
As Doenças Crônico-Degenerativas e DCV são problemas de países ricos
A melhoria dos indicadores de Saúde é resultado da tecnologia e de intervenções médicas sofisticadas, aplicadas na fase avançada das doenças.
Saúde se planeja e executa dentro do setor saúde

Somente valores humanos são argumentos capazes de mobilizar para prevenção

Agora, cada vez mais, estes assuntos estão na pauta do dia, embora tenhamos nos preocupado com eles há mais de trinta anos.
O assunto do controle das DCNT, das DCV, da Prevenção, da Promoção da Saúde, das Parcerias, dos Determinantes sociais e Econômicos de Saúde e Doença, está nas manchetes e nos objetivos científicos cada vez mais. Instituições como a Organização Mundial da Saúde, nosso Ministério da Saúde, o Banco Mundial e a Escola Nacional de Saúde Pública, estão altamente interessados e promovendo pesquisa e intervenções neste sentido.
Iniciativa Cardiovascular em Saúde (IC-Health), braço do “Global Health Research” sediado em Delhi está promovendo uma pesquisa na qual Maria Inês e eu estamos representando o Brasil, junto com África do Sul, Índia e China. A pesquisa está sediada no IEP, teve um documento preliminar publicado em 2003, atualmente finalizando uma etapa de diagnóstico do impacto macro-econômico, preparando uma fase de intervenção preventiva, cujas estratégias devem ser definidas, tentando passar Saúde da rubrica da despesa para a de investimentos.
Foram lembrados também os seguintes temas:

A desigualdade social e econômica é um fator de risco tão ou mais importante do que os clássicos comportamentais.
Há várias iniciativas isoladas neste mesmo sentido (governamentais, instituições privadas, universidades, ONGS), com dificuldade de se unirem num esforço sinérgico.
A participação dos estratos populacionais interessados é fundamental.
A fase fetal e de início da vida é fundamental na determinação das condições de saúde do adulto e inclusive de futuras gerações (David Barker), reforçando a prioridade a ser dada para a mãe e a gestante, às futura mães e aos infantes e crianças.
O HMV já trabalha em projetos sociais, tem um corpo funcional que pode e deve ser mobilizado, tem ligações com empresas que podem se beneficiar desta nova experiência e tem um corpo profissional altamente competente que pode e precisa ser motivado para este novo paradigma.

Esperamos contar com o depoimento dos demais membros do grupo que podem ser enviados diretamente para o endereço do IEP ou para o meu, para serem colocados distribuídos no Blog. Comentários podem ser feitos ao pé de cada matéria postada. Enquanto não tiverm o recurso do lembrete de matéria nova postada, visitem com frequência nosso endereço, ou vamos enviar um lembrete por e-mail.

http://amicorcvd.blogspot.com

Dúvidas e questionamentos serão também bem vindos.

achutti@cardiol.br ou iep@hmv.org.br

Calculated cost estimates: Diabetes

2006-01-20T09:54:00.000-02:00

IDF Diabetes Atlas - Calculated cost estimates

The calculated estimates of the current direct cost of diabetes care worldwide are provided in the data tables here. This is the first time that such estimates have been made for so many countries. The calculated estimates use a formula described in the section below. The same method, together with predictions of the future burden of diabetes in these countries, is used to estimate the likely future direct cost burden of the disease in 2025. These future predictions of cost are as alarming as the future predictions of prevalence. They suggest that, unless effective prevention measures are introduced, expenditure devoted to diabetes and its complications will dominate the health economies of many countries by the end of the first quarter of this century.

Valuing Health for Regulatory Cost-Effectiveness Analysis

2006-01-20T01:34:00.000-02:00

Caros amigos,
Quero, em primeiro lugar, agradecer a participação de todos que puderam fazê-lo na reunião do dia 18 p.p. Lembrar também que combinamos, como primeira rodada do grupo, o envio de um pequeno texto com suas idéias básicas relacionadas com a proposta que motivou nosso encontro, assim como alguns conseguiram fazê-lo na reunião. Quem já o fez esperamos que reproduza neste texto sintético a idéia central do que já disse para que fique registrado e permita comentários enriquecedores dos demais.
Devo paresentar o meu texto, se possível ainda amanhã.
Segue a referência de um livro com acesso livre sobre custo-efetividade.
Saudações.
AA

Valuing Health for Regulatory Cost-Effectiveness Analysis

Wilhelmine Miller, Lisa A. Robinson, and Robert S. Lawrence, Editors, Committee to Evaluate Measures of Health Benefits for Environmental, Health, and Safety Regulation
US National Academy of Sciences.ISBN: 0-309-10077-1, (2006)

Summary: http://www.nap.edu/execsumm_pdf/11534.pdf
Full report available online at: http://www.nap.edu/books/0309100771/html/

“….Promoting human health and safety by reducing exposures to risks and harms through regulatory interventions is among the most important responsibilities of the government. Such efforts encompass a wide array of activities in many different contexts: improving air and water quality; safeguarding the food supply; reducing the risk of injury on the job, in transportation, and from consumer products; and minimizing exposure to toxic chemicals.

Estimating the magnitude of the expected health and longevity benefits and reductions in mortality, morbidity, and injury risks helps policy makers decide whether particular interventions merit the expected costs associated with achieving these benefits and inform their choices among alternative strategies. Valuing Health for Regulatory Cost-Effectiveness Analysis provides useful recommendations for how to measure health-related quality of- life impacts for diverse public health, safety, and environmental regulations. Public decision makers, regulatory analysts, scholars, and students in the field will find this an essential review text. It will become a standard reference for all government agencies and those consultants and contractors who support the work of regulatory programs….”

Content:

Executive Summary

Chapter 1 Introduction

Chapter 2 Characteristics of Major Regulations and Current Analytic Practices

Chapter 3 Measures and Strategies for Obtaining Health Benefit Values for Regulatory Analysis

Chapter 4 Beyond Ratios: Ethical and Nonquantifiable Aspects of Regulatory Decisions

Chapter 5 Recommendations for Regulatory Cost-Effectiveness Analysis

A Summary of Case Studies

B Health Indexes

Componentes do GT "Investindo em Saúde"

2006-01-20T01:13:00.000-02:00

Nome
E-mail
Contato
Aloyzio Achutti
achutti@cardiol.br
51.3233-3579
Valderês Robinson Achutti
valderes.robison@terra.com.br
51.3233-3579
Miriam Domingues Kolinger
miriamddk@terra.com.br
51.9945-2011
Murilo Foppa
murilo.foppa@hmv.org.br
51.3314-3690
Suzana Cardona Lago
suzana.lago@hmv.org.br
51. 9226-5239
Erno Harzheim
ernoharz@terra.com.br
51. 9178-3590
Maria Inês Reinert Azambuja
miazambuja@terra.com.br
51. 3342-8959
Lucia Rohde
lucia.rohde@hmv.org.br
51. 9982-9619
Jefferson Gomes Fernandes
jefferson.fernandes@hmv.org.br
51.3314-3690
Daniele Baum
daniele.baum@hmv.org.br
51.9262-0565
Bernardete Weber
bernardete@hmv.org.br
51.3314-3663
Edela Puricelli
epuricelli@uol.com.br
51.3233-6767
Jussara Carnevale
jussara.carnevale@hmv.org.br
51.8451-7933
Flávio Borges
flavio@hmv.org.br
51.3314-3661
Carisi Polanczyk
carisi@hmv.org.br
51.3222-2183
Jorge Pinto Ribeiro
jorge.ribeiro@hmv.org.br
51.9982-4984
Ana Robinson Achutti
ana.achutti@terra.com.br
51.3217-9105
Patricia Miller
iep@hmv.org.br
51.3314-3691

Dying Too Young: Addressing Premature Mortality and Ill Health Due to Non-Communicable Diseases and Injuries in the Russian Federation (2005)

2005-12-07T18:30:00.000-02:00

Dying Too Young: Addressing Premature Mortality and Ill Health Due to Non-Communicable Diseases and Injuries in the Russian Federation (2005) shows that non-communicable diseases (NCDs) and injuries are the leading causes of death, illness, and disability in Russia. This report assesses the factors associated with the onset of these conditions, as well as the demographic, financial and economic consequences of NCDs and injuries, summarizes relevant evidence and emerging lessons from international experience, proposes a comprehensive program for addressing this problem, and projects the health and economic gains that could result from such a program./.../

Medical costs push millions of people into poverty across the globe

2005-12-07T09:58:00.000-02:00

WHO | Medical costs push millions of people into poverty across the globe
Each year 100 million people slide into poverty as a result of medical care payments. Another 150 million people are forced to spend nearly half their incomes on medical expenses. That is because in many countries people have no access to social health protection -- affordable health insurance or government-funded health services.

Paradoxically, people in the world’s poorest countries contribute relatively more for health care than those in wealthy industrialized nations. In Germany, for example, where the average GDP per capita is US$ 32 860 and almost everyone has social health protection, 10% of all medical expenses nationwide are borne by households. In the Democratic Republic of the Congo, by contrast, where GDP per capita is only US$ 120 and where social health protection is scant, about 70% of the money spent on medical care is paid directly by households./.../

Epidemiological transition and the study of burden of disease in Brazil

2005-10-11T19:56:00.000-03:00

Ciência & Saúde Coletiva - Epidemiological transition and the study of burden of disease in Brazil: "Transição epidemiológica e o estudo de carga de doença no Brasil

Epidemiological transition and the study of burden of disease in Brazil

Joyce Mendes de Andrade Schramm; Andreia Ferreira de Oliveira; Iúri da Costa Leite; Joaquim Gonçalves Valente; Ângela Maria Jourdan Gadelha; Margareth Crisóstomo Portela; Mônica Rodrigues Campos

RESUMO
No Brasil, a transição epidemiológica não tem ocorrido de acordo com o modelo experimentado pela maioria dos países desenvolvidos. Velhos e novos problemas em saúde coexistem, com predominância das doenças crônico-degenerativas, embora as doenças transmissíveis ainda desempenhem um papel importante. Neste estudo, os diferenciais, em relação ao padrão epidemiológico, são descritos para o Brasil e grandes regiões, para o indicador de saúde dos estudos da carga de doença, o DALY. Entre os principais resultados encontrados, para o Brasil, destaca-se que o grupo das doenças não-transmissíveis, infecciosas/parasitórias/maternas/perinatais/nutricionais, e das causas externas representaram, respectivamente, 66,3%, 23,5% e 10,2% da carga total de doença estimada. A utilização do indicador DALY propicia a identificação de prioridades em função do perfil epidemiológico, facilitando a tomada de decisões e destinação adequada de recursos por parte dos gestores.
"

GATEKEEPING IN HEALTH CARE

2005-10-11T13:17:00.000-03:00

http://www.cesifo.de/pls/guestci/download/CESifo%20Working%20Papers%202005/CESifo%20Working%20Papers%20September%202005/cesifo1_wp1552.pdf
GATEKEEPING IN HEALTH CARE
KURT R. BREKKE, ROBERT NUSCHELER, ODD RUNE STRAUME
CESIFO WORKING PAPER NO. 1552 - SEPTEMBER 2005

Abstract
We study the competitive effects of restricting direct access to secondary care by gatekeeping, focusing on the informational role of general practitioners (GPs). In the secondary care market there are two hospitals choosing quality and specialisation. Patients, who are ex ante
uninformed, can consult a GP to receive an (imperfect) diagnosis and obtain information about the secondary care market. We show that hospital competition is amplified by higher GP attendance but dampened by improved diagnosing accuracy. Therefore, compulsory gatekeeping may result in excessive quality competition and too much specialisation, unless the mismatch costs and the diagnosing accuracy are sufficiently high. Second-best price regulation makes direct regulation of GP consultation redundant, but will generally not implement first-best.

Infiltration of neoliberal ideology in the World Health Organization

2005-10-01T21:21:00.000-03:00

Infiltration of neoliberal ideology in the World Health Organization
Effects on global public health policy and practice
Alison KATZ
Introduction
The infiltration of neoliberal ideology in WHO today is profound and this is despite WHO's Constitution and many founding and key documents since then, which are explicitly oriented towards social justice as a solution to health problems and a goal in its own right. The WHO/UNICEF Conference on Primary Health Care held in Alma Ata in the former Soviet Union in 1978, represented the flowering of this vision but the movement was swiftly and decisively silenced as early as 1980./.../

Equity promotes efficiency: A radical insight from the World Bank- The Economic Times

2005-09-29T18:23:00.000-03:00

Equity promotes efficiency: A radical insight from the World Bank- The Economic Times: "Equity promotes efficiency: A radical insight from the World BankAdd to Clippings

TIMES NEWS NETWORK[ WEDNESDAY, SEPTEMBER 28, 2005 12:12:07 AM]
Can equity be reconciled with efficiency? Conventional advocates of ‘market forces’ think not. To that extent, the World Bank’s World Development Report (WDR) 2006, which recasts the mutually antagonistic relationship between equity and efficiency into one of reciprocity, is welcome. More so, since the Bank is seen as one of the key institutions providing ideological leadership to the project of liberalisation. The WDR has correctly pointed out that inequities within and between countries in terms of access to quality education and healthcare, and capital, assets and other economic opportunities is bound to severely limit their economic advance. Societies, which have good social development indices, indicate that socialisation and skilling of their members are more in accord with the contemporary logic of production than of those which are caught in the time-warp of a pre-industrial political economy. Reducing malnourishment and improving health of the currently unemployed have, for one, been shown to lead to a rise in the aggregate output in the economy.

Equity, however, becomes empty rhetoric conserving a regressive status quo in the absence of any concerted attempt to correct imperfections in institutions that allocate resources and determine opportunity. The WDR’s advocacy of public action to change prevailing institutions is truly radical and underscores its growing maturity. It questions the deep-seated consensus that the modern market is intrinsically fair. True, the possibility of achieving more equity resides in the tension between existing social institutions and the new aspirations created by the market. But it takes politics to bring the possibility to life. The various national governments can do their bit by making their respective policy regimes amenable to public action. That should, ideally, be the global norm as well. Sadly, “the WDR 2006”, as Neeraj Kaushal pointed out on this page (ET, September 27), “represents the thinking of the bank staff, and not the thinking of the countries that run the Bank”."

World Development Report 2006

2005-09-26T08:27:00.000-03:00

WDR 2006: "World Development Report 2006: Equity and Development

Inequality of opportunity, both within and among nations, sustains extreme deprivation, results in wasted human potential and often weakens prospects for overall prosperity and economic growth, concludes the 2006 World Development Report, the World Bank’s major annual publication.

To correct this situation and reduce poverty more effectively, Equity and Development recommends ensuring more equitable access by the poor to health care, education, jobs, capital, and secure land rights, among others. It also calls for greater equality of access to political freedoms and political power, breaking down stereotyping and discrimination, and improving access by the poor to justice systems and infrastructure."

Indigenous Peoples, Poverty and Human Development in Latin America

2005-09-23T23:07:00.000-03:00

World Bank Discussion
Discussion with Gillette Hall and Harry Anthony Patrinos on Indigenous Peoples, Poverty and Human Development in Latin America