საინფორმაციო ბიულეტენი N 2 (მარტი 2015 – მაისი 2015)

[PAHO/WHO Equity list & Knowledge network]

1.   Health literacy toolkit for low- and middle-income countries: series of information sheetsto empower communities and strengthen health systems

The World Health Organization – Regional Office for South-East Asia. New Delhi; 2015

Overview

This series of information sheets introduces health literacy, its relevance to public policy, and the ways it can be used to inform

The promotion of good health, the prevention and management of communicable and noncommunicable diseases, and the reduction of health inequities. It provides information and links to further resources to assist organizations and governments to incorporate health literacy responses into practice, service delivery systems, and policy.

This publication seeks to inform: governments, politicians and policy makers at all levels; academic institutions; public, civil society, and non-governmental organizations; and practitioners; relevant private sectors promoting health and well-being; communities, community-based organizations and social networks; WHO and other UN partners and development organizations.

Keywords

Health Literacy, Public Policy, Health Promotion, Social Determinants of Health, Health Information Systems.

Download this publication / Descargar la publicación: click here.

http://apps.searo.who.int/PDS_DOCS/B5148.pdf?ua=1

 

[PAHO/WHO Equity list & Knowledge network]

2.   Strengthening the protection of sexual and reproductive health and rights in the African Region through human rights

Charles Ngwena, Ebenezer Durojaye

Pretoria University Law Press, 2014

ISBN: 978-1-920538-31-6

Published online [2015]

Overview

Strengthening the protection of sexual and reproductive health and rights in the African region through human rights uses rights-based frameworks to address some of the serious sexual and reproductive health challenges that the African region is currently facing. More importantly, the book provides insightful human rights approaches on how these challenges can be overcome. The book is the first of its kind. It is an important addition to the resources available to researchers, academics, policymakers, civil society organisations, human rights defenders, learners and other persons interested in the subject of sexual and reproductive health and rights as they apply to the African region. Human rights issues addressed by the book include: emergency obstetric care; HIV/AIDS; adolescent sexual health and rights; early marriage; and gender-based sexual violence. 

Keywords / Palabras clave:Human Rights; Sexual Reproductive Health; Gender; Violence Against Women; African Region

Download this publication / Descargar la publicación: English

http://www.pulp.up.ac.za/pdf/2014_14/2014_14.pdf

 

[PAHO/WHO Equity list & Knowledge network]

3.   Closing the Gap: Past Performance of Health Insurance in Reducing Racial and Ethnic Disparities in Access

Susan L. Hayes, Pamela Riley, David C. Radley, Douglas McCarthy

The Commonwealth Fund

Issue Brief, March 2015, pub. 1805, vol. 5.

Published online: March 2015

Abstract / Resumen:

This historical analysis shows that in the years just prior to the Affordable Care Act’s expansion of health insurance coverage, black and Hispanic working-age adults were far more likely than whites to be uninsured, to lack a usual care provider, and to go without needed care because of cost. Among insured adults across all racial and ethnic groups, however, rates of access to a usual pro­vider were much higher, and the proportion of adults going without needed care because of cost was much lower. Disparities between groups were narrower among the insured than the uninsured, even after adjusting for income, age, sex, and health status. With surveys pointing to a decline in uninsured rates among black and Hispanic adults in the past year, particularly in states extending Medicaid eli­gibility, the ACA’s coverage expansions have the potential

Keywords / Palabras clave:

Human Rights; Ethnicity; Health Insurance; Insurance Coverage; Healthcare Disparities

Access this article: click here.

 

[PAHO/WHO Equity list & Knowledge network]

4.   Income inequality and health: A causal review

Kate E. Pickett, Richard G. Wilkinson

Social Science & Medicine, 128(2015), 316-326

Published: March 2015

Abstract

There is a very large literature examining income inequality in relation to health. Early reviews came to different interpretations of the evidence, though a large majority of studies reported that health tended to be worse in more unequal societies. More recent studies, not included in those reviews, provide substantial new evidence. Our purpose in this paper is to assess whether or not wider income differences play a causal role leading to worse health. We conducted a literature review within an epidemiological causal framework and inferred the likelihood of a causal relationship between income inequality and health (including violence) by considering the evidence as a whole. The body of evidence strongly Suggests that income inequality affects population health and wellbeing. The major causal criteria of temporality, biological plausibility, consistency and lack of alternative explanations are well supported. Of the small minority of studies which find no association, most can be explained by income inequality being measured at an inappropriate scale, the inclusion of mediating variables as controls, the use of subjective rather than objective measures of health, or follow up periods which are too short. The evidence that large income differences have damaging health and social consequences is strong and in most countries inequality is increasing. Narrowing the gap will improve the health and wellbeing of populations.

Key Points: Evidence that income inequality is associated with worse health is reviewed. It meets established epidemiological and other scientific criteria for causality. The causal processes may extend to violence and other problems with social gradients. Reducing income inequality will improve population health and wellbeing.

Keywords 

Income Distribution; Review; Population Health; Causality

How to obtain this article / Como obtener el artículo: click here.

 

5. Promoting better integration of health information systems: best practices and challenges

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English (PDF, 1.2 MB)

By Kai Michelsen, Helmut Brand, Peter Achterberg and John Wilkinson

Health Evidence Network synthesis report

2015, viii + 32 pages

ISBN 978 92 890 5077 7

HF 20.00

C In developing countries CHF 14.00.

This report addresses the current trends in Member States of the European Union (EU) and European Free Trade Association (EFTA) in how to promote better integration of health information systems. To understand what better integration means from a pragmatic perspective, experts from 13 EU Member States were interviewed and the results combined with the findings from a literature search.

This synthesis report identifies the following policy options for further consideration: the needs:

  1. to continue the work on some basics (such as data availability and quality, inventories of data and registries, standardization
  2. to define what better integration means and to demonstrate concrete benefits of integration; 
  3. to build leadership for capacity building in further integration of health information systems; and 
  4. to pursue further international exchange about activities underway in this area.

 

6. Residential heating with wood and coal: health impacts and policy options in Europe and North America

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English (PDF, 2.9 MB)

Pусский (PDF, 2.0 MB)

2015, viii + 49 pages

ISBN 978 92 890 5076 0

Residential heating with wood and coal is an important source of ambient (outdoor) air pollution;

it can also cause substantial indoor air pollution through either direct exposure or infiltration from outside. Evidence links emissions from wood and coal heating to serious health effects such as illness and death from respiratory and cardiovascular diseases. Burning wood and coal also emits carcinogenic compounds. 

The report describes the health effects of and policy options for dealing with residential heating with wood and coal in Europe and the United States. The results presented indicate that it will be difficult to tackle problems with outdoor air pollution in many parts of the world without addressing this source sector. National, regional and local administrations, politicians and the public at large need a better understanding of the role of wood biomass heating as a major source of harmful outdoor air pollutants (especially fine particles).

This report is intended to help increase such an understanding. 

http://www.euro.who.int/en/publications/abstracts/residential-heating-with-wood-and-coal-health-impacts-and

-policy-options-in-europe-and-north-america?utm_source=WHO%2FEurope+mailing+list&utm_campaign

=92edd45061-Publication_News_March_20153_11_2015&utm_medium=email&utm_term=

0_60241f4736-92edd45061-94562105

 

7. Building primary care in a changing Europe

Dionne S. Kringos
Wienke G.W. Boerma
Allen Hutchinson
Richard B. Saltman

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English (PDF, 4.7 MB)

by Dionne S. Kringos, Wienke G.W. Boerma, Allen Hutchinson, Richard B. Saltman

2015, xxv + 1-172 pages

ISBN 978 92 890 5031 9

CHF 40.00

Order no. 13400150

For many citizens primary care is the first point of contact with their health care system, where most

of their health needs are satisfied but also acting as the gate to the rest of the system. In that respect primary care plays a crucial role in how patients value health systems as responsive to their needs and expectations.

This volume analyses the way how primary care is organised and delivered across European countries, looking at governance, financing and workforce aspects and the breadth of the service profiles. It describes wide national variations in terms of accessibility, continuity and coordination. Relating these differences to health system outcomes the authors suggest some priority areas for reducing the gap between the ideal and current realities.

The study also reviews the growing evidence on the added value of strong primary care for the performance of the health system overall and explores how primary care is challenged by emerging financial constraints, changing health threats and morbidity, workforce developments and the growing possibilities of technology.

In a second, companion volume, that is available on-line, structured summaries of the state of primary care in 31 European countries are presented. These summaries explain the context of primary care in each country; governance and economic conditions; the development of the primary care workforce; how primary care services are delivered; and the quality and efficiency of the primary care system.

This book builds on the EU-funded project ‘Primary Health Care Activity Monitor for Europe’ (PHAMEU) that was led by the Netherlands Institute for Health Services Research (NIVEL) and co-funded by the European Commission (Directorate General Health & Consumers).

 

8. The relationship between psychosocial risk factors and health outcomes of chronic diseases:

 a review of the evidence for cancer and cardiovascular diseases (2015)

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English (PDF, 1.2 MB)

By Hynek Pikhart and Jitka Pikhartova

Health Evidence Network synthesis report

2015, viii + 29 pages

ISBN 978 92 890 5083 8

CHF 20.00

Order no. 13400153

This report summarizes the best available evidence for a link between psychosocial factors and morbidity and mortality from cardiovascular diseases and cancer in the WHO European Region. The authors searched a total of 1822 Medline and PubMed articles published in English since January 2000, and identified 37 systematic reviews and meta-analyses. The psychosocial factors repeatedly identified as related to chronic diseases, in and outside work, included: high job demand, low autonomy, low control or high effort–reward imbalance, interpersonal conflicts, and low social support or low trust. 

The evidence suggests that multiple adverse psychosocial factors are independently associated with a range of chronic diseases throughout adulthood. In addition, the social gradient in health observed throughout adulthood may partly operate through psychosocial factors on the pathway between socioeconomic characteristics and health. Psychosocial factors might therefore become part of complex total risk-reducing interventions focusing on multiple risk factors.

 

[PAHO/WHO Equity list & Knowledge network]

9. A modelling tool for policy analysis to support the design of efficient and effective policy responses for complex public health problems

doi:10.1186/s13012-015-0221-5

Jo-An Atkinson, Andrew Page, Robert Wells, Andrew Milat, Andrew Wilson published online:

Implementation Science 2015, 10:26; doi:10.1186/s13012-015-0221-5      3 March 2015

Abstract

Background: In the design of public health policy, a broader understanding of risk factors for disease across the life course, and an increasing awareness of the social determinants of health, has led to the development of more comprehensive, cross-sectoral strategies to tackle complex problems. However, comprehensive strategies may not represent the most efficient or effective approach to reducing disease burden at the population level. Rather, they may act to spread finite resources less intensively over a greater number of programs and initiatives, diluting the potential impact of the investment. While analytic tools are available that use research evidence to help identify and prioritise disease risk factors for public health action, they are inadequate to support more targeted and effective policy responses for complex public health problems. Discussion: This paper discusses the limitations of analytic tools that are commonly used to support evidence-informed policy decisions for complex problems. It proposes an alternative policy analysis tool which can integrate diverse evidence sources and provide a platform for virtual testing of policy alternatives in order to design solutions that are efficient, effective, and equitable. The case of suicide prevention in Australia is presented to demonstrate the limitations of current tools to adequately inform prevention policy and discusses the utility of the new policy analysis tool. Summary: In contrast to popular belief, a systems approach takes a step beyond comprehensive thinking and seeks to identify where best to target public health action and resources for optimal impact. It is concerned primarily with what can be reasonably left out of strategies for prevention and can be used to explore where disinvestment may occur without adversely affecting population health (or equity). Simulation modelling used for policy analysis offers promise in being able to better operationalise research evidence to support decision making for complex problems, improve targeting of public health policy, and offers a foundation for strengthening relationships between policy makers, stakeholders, and researchers.

Keywords

Social Determinants of Health; Equity; Research; Research Personnel  Suicide – Prevention; Health Research Policy;

Evidence-Based Medicine ; Australia.

http://www.implementationscience.com/content/10/1/26

 

10. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU)

Kristine Sørensen , Jürgen M. Pelikan , Florian Röthlin , Kristin Ganahl , Zofia Slonska , Gerardine Doyle , James Fullam , Barbara Kondilis , Demosthenes Agrafiotis , Ellen Uiters , Maria Falcon , Monika Mensing , Kancho Tchamov , Stephan van den Broucke , Helmut Brand

The European Journal of Public Health, 2015

First Published online: April 2015

Abstract

Background: Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations. Methods: The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain (n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews. Results: The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29–62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model. Discussion: Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe.

Keywords

Health Literacy; Research; Survey; Europe

http://www.hhrjournal.org/2013/08/20/health-and-human-rights-in-scientific-literature-a-systematic-review-over-a-decade-1999-2008/

 

11. Health Insurance System Revision in the Czech Republic, Finland, France, Germany and the Slovak Republic

Zuzana Horváthová, Josef Abrhám

Mediterranean Journal of Social Sciences - MCSER Publishing, Rome-Italy, April 2015, 6(2 S5)

Published online: April 2015

Abstract

Widely used terms such as the European social model and the European social policy are not entirely accurate. Social policy belongs among the areas where the competence is shared between the Union and the Member States. Thus the European social model can be defined more as common values and social foundations, which are typical for the European area. Among the Member States are therefore substantial differences in terms of the set-up and functioning of social, health and pension systems. The aim of this paper is to evaluate the treatment of health insurance and selected aspects of health systems in selected EU countries (Czech Republic, Finland, France, Germany and the Slovak Republic), and on the basis of mutual comparison to draw up recommendations for the implementation of social policy instruments at the national level and also to explain examples of good practice. The solution-seeking methodology is based on literature research, analysis of legislation in different countries and analyses of empirical statistical data from the social systems.

Keywords

Social Policy, Welfare State, Health Insurance, States of the European Union

http://www.mcser.org/journal/index.php/mjss/article/view/6193

 

12. Global evidence on inequities in rural health protection: New data on rural deficits in health coverage for 174 countrie

Scheil-Adlung, X. (ed.)

International Labour Organization (ILO)

Published online: May 2015

Abstract

This paper presents global estimates on rural/urban disparities in access to health-care services. The report uses proxy indicators to assess key dimensions of coverage and access involving the core principles of universality and equity. Based on the results of the estimates, policy options are discussed to close the gaps in a multi-sectoral approach addressing issues and their root causes both within and beyond the health sector.

Keywords

Global Health; Social Protection; Health Insurance; Rural Worker; Access to Care; Vulnerable Groups; Scope of Coverage; Rural Area; Urban Area

http://www.social-protection.org/gimi/gess/ShowRessource.action?lang=EN&ressource.ressourceId=51297

 

 

[PAHO/WHO Equity list & Knowledge network]

Study Protocol

13.Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities

Jane Yelland, Elisha Riggs, Josef Szwarc, Sue Casey, Wendy Dawson, Dannielle Vanpraag, Chris East,

Euan Wallace, Glyn Teale, Bernie Harrison, Pauline Petschel, John Furler, Sharon Goldfeld, Fiona Mensah, Mary Anne Biro, Sue Willey, I-Hao Cheng, Rhonda Small and Stephanie Brown

Implementation Science 201510:62

Published online: 30 April 2015

Abstract (provisional)

Background: The risk of poor maternal and perinatal outcomes in high-income countries such as Australia is greatest for those experiencing extreme social and economic disadvantage. Australian data show that women of refugee background have higher rates of stillbirth, fetal death in utero and perinatal mortality compared with Australian born women. Policy and health system responses to such inequities have been slow and poorly integrated. This protocol describes an innovative programme of quality improvement and reform in publically funded universal health services in Melbourne, Australia, that aims to address refugee maternal and child health inequalities. Methods/design: A partnership of 11 organisations spanning health services, government and research is working to achieve change in the way that maternity and early childhood health services support families of refugee background. The aims of the programme are to improve access to universal health care for families of refugee background and build organisational and system capacity to address modifiable risk factors for poor maternal and child health outcomes. Quality improvement initiatives are iterative, co-designed by partners and implemented using the Plan Do Study Act framework in four maternity hospitals and two local government maternal and child health services. Bridging the Gap is designed as a multi-phase, quasi-experimental study. Evaluation methods include use of interrupted time series design to examine health service use and maternal and child health outcomes over a 3-year period of implementation. Process measures will examine refugee families’ experiences of specific initiatives and service providers’ views and experiences of innovation and change. Discussion: It is envisaged that the Bridging the Gap program will provide essential evidence to support service and policy innovation and knowledge about what it takes to implement sustainable improvements in the way that health services support vulnerable populations, within the constraints of existing resources.

Keywords

Quality Improvement; Partnerships; Universal Health Services; Refugee Families; Time Series Design;

Process Evaluation; Australia

http://www.implementationscience.com/content/10/1/62/abstract