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From the journalsEvidence and Healthy Public Policy: Insights from Health and Political Sciences Policy-makers are often challenged when producing public policy to consider the role of evidence, especially scientific evidence. Evidence and Healthy Public Policy: Insights from Health and Political Sciences, focuses on two linked questions: what constitutes evidence in policy-making, and what models of policy-making are available in political science that can inform our understanding of how evidence is used or not used to develop healthy public policy? Health Workforce and International Migration: Can New Zealand Compete? Why NZ MUST get prevention and primary care right – because we don’t have enough doctors to treat people when they get sick. This absolutely fascinating paper by the OECD examines health workforce and migration policies in New Zealand, with a special focus on the international recruitment of doctors and nurses. NZ has fewer doctors per 100,000 population than the OECD average. Looking at doctors coming into NZ, over half of NZ doctors are foreign-born and foreign-trained. This proportion of overseas doctors is higher than for any other country in the OECD. Looking at NZ doctors leaving NZ, we export about 1/3 of NZ-born doctors. Even if NZ kept all NZ doctors and did not have any leave the country we would still rely on importing overseas-born and trained doctors to have the number of doctors that we do now. The number of New Zealand-born doctors living in other OECD countries represents half the number of foreign-born doctors in New Zealand. New Zealand has a higher than average ratio of nurses to population that the OECD average. We seem to import about the same number of nurses as we export. (about 7,500). The Public Health Approach to Eliminating Disparities in Health David Satcher is the director of the Satcher Health Leadership Institute and the Center of Excellence on Health Disparities, Morehouse School of Medicine, Atlanta, Ga, and the 16th Surgeon General of the United States. Eve J. Higginbotham is Dean and Senior Vice President for academic affairs at Morehouse School of Medicine, Atlanta. American Journal of Public Health - March 1 2008, Volume 98, Issue 3 Abstract: http://www.ajph.org/cgi/content/abstract/98/3/400. "...Reducing and eliminating disparities in health is a matter of life and death. Each year in the United States, thousands of individuals die unnecessarily from easily preventable diseases and conditions. It is critical that we approach this problem from a broad public health perspective, attacking all of the determinants of health: access to care, behaviour, social and physical environments, and overriding policies of universal access to care, physical education in schools, and restricted exposure to toxic substances. We describe the historical background for recognizing and addressing disparities in health, various factors that contribute to disparities, how the public health approach addresses such challenges, and two successful programs that apply the public health approach to reducing disparities in health. Public health leaders must advocate for public health solutions to eliminate disparities in health..." Promotion and protection of all human rights, civil, political, economic, social and cultural rights Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health This report (A/HRC/7/11) was submitted to the Human Rights
Council on 31 January 2008. It is available lable online ( "...At the heart of the right to the highest attainable standard
of health lies an effective and integrated health system,
encompassing health care and the underlying determinants of health,
responsive to national and local priorities, and accessible to all. There is a growing recognition that a strong health system is an essential element of a healthy and equitable society. In any society, an effective health system is a core social institution, no less than a fair justice system or democratic political system. However, according to a recent publication of the World Health Organization, health systems in many countries are failing and collapsing. The report briefly identifies some of the historical landmarks in the development of health systems, such as the Declaration of Alma-Ata on primary health care (1978). Taking into account health good practices, as well as the right to the highest attainable standard of health, the report identifies a general approach to strengthening health systems (chap. II, sect. C). This general approach should be applied, consistently and systematically, across the numerous elements - or “building blocks” - that together constitute a functioning health system. By way of illustration, the report takes the general approach outlined in the report and begins to apply it to two of the health system “building blocks” (chap. II, sect. E). Section F signals how the right to a fair trial has helped to strengthen court systems and argues that, in a similar way, the right to the highest attainable standard of health can help to strengthen health systems..." Fatherhood and health outcomes in Europe WHO Regional Office for Europe - Copenhagen, Denmark – 2008 Available online ( Examination of the research literature shows, generally speaking, that increased involvement by men in fatherhood can benefit men, as well as women and children, in the form of better health. For example, men can give important psychological and emotional support to the woman during pregnancy and delivery. This, in turn, can reduce pain, panic and exhaustion during delivery. Studies have also shown that men’s involvement in maternal and child health programmes can reduce maternal and child mortality during pregnancy and labour by being prepared, for example, for obstetric emergencies. However, increased involvement in fatherhood can also benefit men’s own health and well-being. ...The support for men’s increased involvement in parenthood and reproductive health also depends on more multifaceted support from the welfare state and employment. For example, numerous studies have showed that a generous parental leave system, enabling longer paid parental leave, gives parents better opportunities to combine work and family life; several studies have found that this positively affects both gender equality and health outcomes. However, this support varies greatly between the different countries in Europe but generally is very poor. The same situation applies to employment, where fathers most often are not seen as parents and therefore get limited support for combining work and family life..." Tackling health inequalities: 2007 Status Report on the Programme for Action "...If evidence-based policy making were to be honoured in the observance rather than the breech what might it look like? A simple description might be: review the evidence and make recommendations; use these recommendations as a base to formulate policies; monitor their effects. By this description, action on inequalities in health in England conforms rather well to evidence-based policy making. The Independent Inquiry into Inequalities in Health (the Acheson Inquiry) reviewed the scientific evidence on health inequalities. It made 39 recommendations. Importantly, Acheson took a social model of health. Thirty-six of it’s (our) recommendations ranged across the whole spectrum of government policy that influences health inequalities. Only three were specifically aimed at the health service. It was then appropriate that a cross-cutting review on health inequalities was conducted by the Treasury with the participation of 18 government departments and agencies. The result was a national Programme for Action. Government Departments entered into 82 commitments aimed at tackling health inequalities. Targets on reduction of health inequalities, for infant mortality and life expectancy were set. A key part of the Programme for Action was to monitor health inequalities and a few key determinants and components. The overseeing of this monitoring task was assumed by the Scientific Reference Group on Health Inequalities. In our first Status Report, 2005, we suggested that time was too short to see any effect of policy changes. Now, two years later, that is still a major issue. It is simply too early to say if too little has been done or the right actions were not taken. Whatever actions were taken between 2003 and 2006 there would be little short-term impact on health inequalities. Nevertheless it is important to keep close watch on what has been happening both to important policy areas such as housing, child poverty and education, as well as to health inequalities..." Available online
here (
Website Inequalities in health by social class dimensions in European countries of different political traditions Albert Espelt1, Carme Borrell, Maica Rodríguez-Sanz, Carles Muntaner, M Isabel Pasarín, Joan Benach, Maartje Schaap, Anton E Kunst and Vicente Navarro, International Journal of Epidemiology, March 13, 2008 Objective: To compare inequalities in self-perceived health in the population older than 50 years, in 2004, using Wright's social class dimensions, in nine European countries grouped in three political traditions (Social democracy, Christian democracy and late democracies). Methods: Cross-sectional design, including data of the Survey of Health, Ageing and Retirement in Europe (Sweden, Denmark, Austria, France, Germany, The Netherlands, Spain, Italy and Greece). The population aged from 50 to 74 years was included. Absolute and relative social class dimension inequalities in poor self-reported health and long-term illness were determined for each sex and political tradition. Relative inequalities were assessed by fitting Poisson regression models with robust variance estimators. Results: Absolute and relative health inequalities by social class dimensions are found in the three political traditions, but these differences are more marked in Late democracies and mainly among women. For example the prevalence ratio of poor self-perceived health comparing poorly educated women with highly educated women, was 1.75 (95% CI: 1.39–2.21) in Late democracies and 1.36 (95% CI: 1.21–1.52) in Social democracies. The prevalence differences were 24.2 and 13.7%, respectively. Conclusion: This study is one of the first to show the impact of different political traditions on social class inequalities in health. These results emphasize the need to evaluate the impact of the implementation of public policies. Website (requires subscription) Research to action to address inequities: the experience of the Cape Town Equity Gauge Vera Scott, Ruth Stern, David Sanders, Gavin Reagon, Verona Mathews - School of Public Health, University of Western Cape, South Africa, International Journal for Equity in Health – February 2008, 7:6 doi:10.1186/1475-9276-7-6. Available online at: http://www.equityhealthj.com/content/pdf/1475-9276-7-6.pdf. "...While the importance of promoting equity to achieve health is now recognised, the health gap continues to increase globally between and within countries. The description that follows looks at how the Cape Town Equity Gauge initiative, part of the Global Equity Gauge Alliance (GEGA) is endeavouring to tackle this problem. We give an overview of the first phase of our research in which we did an initial assessment of health status and the socio-economic determinants of health across the subdistrict health structures of Cape Town. We then describe two projects from the second phase of our research in which we move from research to action. The first project, the Equity Tools for Managers Project, engages with health managers to develop two tools to address inequity. The second project, the Water and Sanitation Project, engages with community structures and other sectors to address the problem of diarrhoea in one of the poorest areas in Cape Town. Methods: A participatory approach was adopted. Both quantitative and qualitative methods were used. The first phase, the collection of measurements across the health subdistricts of Cape Town, used quantitative secondary data to demonstrate the inequities. In the Equity Tools for Managers Project further quantitative work was done, supplemented by qualitative policy analysis to study the constraints to implementing equity. The Water and Sanitation Project was primarily qualitative, using in-depth interviews and focus group discussions. These were used to gain an understanding of the impact of the inequities, in this instance, inadequate sanitation provision. Results: The studies both demonstrate the value of adopting the GEGA approach of research to action, adopting three pillars of assessment and monitoring; advocacy; and community empowerment. Conclusion: The two very different, but connected projects, demonstrate the value of adopting the GEGA approach, and the importance of involvement of all stakeholders at all stages. The studies also illustrate the potential of a research institution as informed 'outsiders' in influencing policy and practice..." Us and Them - The Enduring Power of Ethnic Nationalism From Foreign Affairs, March/April 2008, Jerry Z. Muller Available online at:
http://www.foreignaffairs.org/20080301faessay87203-p0/ "...ethnonationalism has played a more profound and lasting role in modern history than is commonly understood, and the processes that led to the dominance of the ethnonational state and the separation of ethnic groups in Europe are likely to reoccur elsewhere. Increased urbanization, literacy, and political mobilization; differences in the fertility rates and economic performance of various ethnic groups; and immigration will challenge the internal structure of states as well as their borders. Whether politically correct or not, ethnonationalism will continue to shape the world in the twenty-first century..." "...Contemporary social scientists who write about nationalism tend to stress the contingent elements of group identity – the extent to which national consciousness is culturally and politically manufactured by ideologists and politicians. They regularly invoke Benedict Anderson's concept of "imagined communities," as if demonstrating that nationalism is constructed will rob the concept of its power. It is true, of course, that ethnonational identity is never as natural or ineluctable as nationalists claim. Yet it would be a mistake to think that because nationalism is partly constructed it is therefore fragile or infinitely malleable. WHO in 60 years: a chronology of public health milestones In 2008, WHO is celebrating its 60th anniversary. The chronology tells the story of WHO and public health achievements over the last 60 years. WHO60 photo exhibition: public health over the past 60 years The exhibit, based on the anniversary theme of "Our health, our future", tells the story of WHO and public health over the last 60 years. It features key public health milestones including, but not limited to: the development of the first successful polio vaccine, the eradication of smallpox, primary health care, tobacco control and the revision of the International Health Regulations. The exhibit also looks to the future and covers themes such as protecting health from climate change, the future of primary health care and the use of information and communication technologies for better health outcomes. The exhibit opened at the start of the WHO Executive Board's 122nd session on 21 January 2008. It then travels to the United Nations headquarters in New York to coincide with World Health Day on 7 April. The exhibit will then return to Geneva for the World Health Assembly in May and travel to the regions during August and September. The State of the World's Children 2008 – Child Survival United Nations Children's Fund (UNICEF) Available online as PDF file [164p.] at: http://www.unicef.org/sowc08/docs/sowc08.pdf. "...The State of the World’s Children 2008 assesses the state of child survival and primary health care for mothers, newborns and children today. These issues serve as sensitive barometers of a country’s development and wellbeing and as evidence of its priorities and values. Investing in the health of children and their mothers is a human rights imperative and one of the surest ways for a country to set its course towards a better future.." "...What is a life worth? Most of us would sacrifice a great deal to save a single child. Yet somehow on a global scale, our priorities have become blurred. Every day, on average more than 26,000 children under the age of five die around the world, mostly from preventable causes. Nearly all of them live in the developing world or, more precisely, in 60 developing countries. More than one third of these children die during the first month of life, usually at home and without access to essential health services and basic commodities that might save their lives. Some children succumb to respiratory or diarrhoeal infections that are no longer threats in industrialized countries or to early childhood diseases that are easily prevented through vaccines, such as measles. In up to half of under-five deaths an underlying cause is undernutrition, which deprives a young child’s body and mind of the nutrients needed for growth and development. Unsafe water, poor sanitation and inadequate hygiene also contribute to child mortality and morbidity..." Download the executive summary ( Use of Evaluation Tools in Policy-Making and Health Implications for Children This paper focuses on priority-setting practices in OECD countries in the environment and health domains. The first section proposes a brief description of the most commonly used decision making tools in the two areas. This description is based on a recent OECD survey as well as a review of secondary literature. The specific case of children’s environmental health is then considered. In order to better understand how children are currently protected from environmental risks, a review of the environmental legislation targeting children introduced in OECD countries follows. A summary of the discussions appears at the end of the paper. Health effects and risks of transport systems Increasing attention has been focused on the health effects of urban transport in recent years. This report highlights the framework in which integrated assessment of the effects of urban transport on health can be carried out. The discussion is based on the results of a research project called HEARTS (health effects and risks of transport systems) conducted as part of the Fifth Framework Programme of the European Union by an international consortium, including leading European research institutions and the WHO European Centre for Environment and Health. The HEARTS project provides a method for estimating the health effects of air pollution, noise and road accidents and an instrument for integrating health impact assessment in the decision-making on and assessment of transport and land-use policies in urban areas. Available online as PDF file [97p.] at: http://www.euro.who.int/document/E88772.pdf. Alternative Suburbias: Why are some societies more able to 'do' car-free planning than others? Issues Paper, November 2007 - Chris Harris Please click here. Roads, Railways and Regimes: Why some societies are able to organise suburban public transport – and why others can't Research Series, August 2007 - Chris Harris Please click here. International HIA Blog Providing the latest news and views on Health Impact Assessment (HIA) and discussing policy and practice internationally. http://healthimpactassessment.blogspot.com/. Equity-Oriented Tool Kit for Health Technology Assessment The Institute of Population Health at the University of Ottawa A needs-based health technology assessment model is used to provide methods to match the identified health needs of a population, to the most appropriate interventions. This toolkit is based on clinical and population health status and takes into account issues of gender equity, social justice and community participation. Links to download the tool kit section descriptions as well as the tool girds for each of the sections.
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