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Rio political declaration on social determinants of health
... Yet human rights law and the right to health in particular offer important normative and strategic frameworks for public and global health, with the capacity to make considerable contributions to identifying and challenging power disparities. This capacity holds in spite of the legal and political weaknesses of the right to health, which like other economic, social and cultural rights has been subject to considerable albeit diminishing contestation as an inappropriately legal right and 'empty aspirational slogan' (Tobin, 2012). Indeed, the legal, political and social force of the right to health has experienced a considerable transformation over the past 20 years, fuelled in no small part by an emerging field of scholarship on health and human rights (Beyrer & Pizer, 2007;Farmer, 2008;Gruskin, Mills, & Tarantola, 2007;Hunt, 2006), motivated by widespread human rights violations experienced within the global HIV/AIDS pandemic (Gruskin & Tarantola, 2001;Mann, 1996;Youde, 2008). ...
... The Comment provides considerably greater interpretive specificity to the right to the highest attainable standard of health, defining its normative scope, identifying its essential elements, and demarcating the entitlements and correlative obligations that comprise its essence. While not a binding document, General Comment 14 is widely considered to be an authoritative interpretation of the right to health (Backman et al., 2008;Miller, Kismödi, Cottingham, & Gruskin, 2015;Tobin, 2012). It has made progress towards resolving the long-standing vagueness of the right to health that has muddied its legal enforcement and policy implementation, and acts as a guide to courts, policy-makers, social movements and scholars who wish to realise, enforce or advance interpretation of this right (Forman, 2013). ...
... In these circumstances, international human rights law offers powerful remedial tools such as litigation and rights-based advocacy to vulnerable populations claiming equitable access to healthcare services (Forman, 2013). These mechanisms permit social actors to access the immense potential of the normative and operational framework of the right to health (Tobin, 2012). ...
Scholarly interrogations of power and politics are not endemic to the disciplines primarily tasked with exploring health policy and planning in the domestic or global domains. Scholars in these domains have come late to investigating power, prompted in part by the growing focus in domestic and global health research on the intersections between governance, globalization and health inequities. Recent prominent reports in this area increasingly point to human rights as important norms capable of responding in part to power differentials that sustain and exacerbate health inequities. Yet human rights law is not traditionally incorporated into health policy scholarship or education, despite offering important normative and strategic frameworks for public and global health, with distinctive contributions in relation to identifying and challenging certain forms of power disparity. This paper overviews two of these reports and how they see power functioning to sustain health inequities. It then turns to investigate what human rights and the right to health in particular may offer in addressing and challenging power in the health policy context.
... Inequities in health status, access to care and health outcomes are growing within and between countries [2] and are therefore squarely on the global development agenda. Concerns over growing inequities were a major stimulus for the World Health Organization's Commission on Social Determinants of Health, established in 2005 [2,3], and the importance of addressing inequities was reaffirmed in the 2011 Rio Political Declaration on Social Determinants of Health [4] . Both called for collaborative action by multiple players from government to civil society. ...
... Both called for collaborative action by multiple players from government to civil society. In the Rio Declaration, achieving health equity was described as a " shared responsibility [that] requires the engagement of all sectors of government, of all segments of society, and of all members of the international community " [4], p. 1. ...
... Global calls to address inequities and health argue that action on inequities is not limited to governments, but includes multiple players, including civil society and the global community [3,4, 89]. Given this commitment to reducing inequities, it is important to look at the role that various organizations play, including INGOs, to continue to find the best ways for INGOs to address inequities , and to examine and address any challenges that these organizations face when trying to implement equity principles. ...
IntroductionAddressing inequities is a key role for international non-governmental organizations (INGOs) working in health and development. Yet, putting equity principles into practice can prove challenging. In-depth empirical research examining what influences INGOs¿ implementation of equity principles is limited. This study examined the influences on one INGO¿s implementation of equity principles in its HIV/AIDS programs.Methods
This research employed a case study with nested components (an INGO operating in Kenya, with offices in North America). We used multiple data collection methods, including document reviews, interviews (with staff, partners and clients of the INGO in Kenya), and participant observation (with Kenyan INGO staff). Participant observation was conducted with 10 people over three months. Forty-one interviews were completed, and 127 documents analyzed. Data analysis followed Auerbach and Silverstein¿s analytic process (2003), with qualitative coding conducted in multiple stages, using descriptive matrices, visual displays and networks (Miles and Huberman, 1994).ResultsThere was a gap between the INGO¿s intent to implement equity principles and actual practice due to multiple influences from various players, including donors and country governments. The INGO was reliant on donor funding and needed permission from the Kenyan government to work in-country. Major influences included donor agendas and funding, donor country policies, and Southern country government priorities and legislation. The INGO privileged particular vulnerable populations (based on its reputation, its history, and the priorities of the Kenyan government and the donors). To balance its equity commitment with the influences from other players, the INGO aligned with the system as well as pushed back incrementally on the donors and the Kenyan government to influence these organizations¿ equity agendas. By moving its equity agenda forward incrementally and using its reputational advantage, the INGO avoided potential negative repercussions that might result from pushing too fast or working outside the system.Conclusions
The INGO aligned the implementation of equity principles in its HIV/AIDS initiatives by working within a system characterized by asymmetrical interdependence. Influences from the donors and Kenyan government contributed to an implementation gap between what the INGO intended to accomplish in implementing equity principles in HIV/AIDS work and actual practice.
... There has been a broad consensus that communities should be actively involved in improving their own health1234. Yet evidence for the effect of community participation – here broadly defined as members of a community getting involved in planning, designing, implementing, and/or adapting strategies and inter- ventions [5] – on specific health outcomes is limited. ...
... Yet evidence for the effect of community participation – here broadly defined as members of a community getting involved in planning, designing, implementing, and/or adapting strategies and inter- ventions [5] – on specific health outcomes is limited. The rationale for community participation in health programmes has included responding better to communities' needs, designing programmes that account for contextual influences on health (such as the effects of local knowledge or cultural practices), increasing public accountability for health, and it being a desirable end in itself [4,6,7]. Involving communities is thought to be crucial in improving health equity, healthcare service delivery and uptake [8], and has been repeatedly recommended in international conferences and charters1234. ...
... The rationale for community participation in health programmes has included responding better to communities' needs, designing programmes that account for contextual influences on health (such as the effects of local knowledge or cultural practices), increasing public accountability for health, and it being a desirable end in itself [4,6,7]. Involving communities is thought to be crucial in improving health equity, healthcare service delivery and uptake [8], and has been repeatedly recommended in international conferences and charters1234. Despite the apparent consensus about the value of participation, there is no single agreed concept of what participation is or should be91011121314 and programmes often develop without an explicit definition [12]. ...
Despite a broad consensus that communities should be actively involved in improving their own health, evidence for the effect of community participation on specific health outcomes is limited. We examine the effectiveness of community participation interventions in maternal and newborn health, asking: did participation improve outcomes? We also look at how the impact of community participation has been assessed, particularly through randomised controlled trials, and make recommendations for future research. We highlight the importance of qualitative investigation, suggesting key areas for qualitative data reporting alongside quantitative work.
Systematic review of published and 'grey' literature from 1990. We searched 11 databases, and followed up secondary references. Main outcome measures were the use of skilled care before/during/after birth and maternal/newborn mortality/morbidity. We included qualitative and quantitative studies from any country, and used a community participation theoretical framework to analyse the data. We found 10 interventions. Community participation had largely positive impacts on maternal/newborn health as part of a package of interventions, although not necessarily on uptake of skilled care. Interventions improving mortality or use of skilled care raised awareness, encouraged dialogue and involved communities in designing solutions-but so did those showing no effect.
There are few high-quality, quantitative studies. We also lack information about why participation interventions do/do not succeed - an area of obvious interest for programme designers. Qualitative investigation can help fill this information gap and should be at the heart of future quantitative research examining participation interventions - in maternal/newborn health, and more widely. This review illustrates the need for qualitative investigation alongside RCTs and other quantitative studies to understand complex interventions in context, describe predicted and unforeseen impacts, assess potential for generalisability, and capture the less easily measurable social/political effects of encouraging participation.
... [46,47] Health equity is a shared responsibility of all nations worldwide, and it is a fundamental right of each human being to receive the highest standard of health care. [46,48] As such, the RIO Political Declaration on Social Determinants of Health endorses global collaboration and benchmarking between countries to identify good practices and adopt coherent policies to promote consistent practices. [48] WHO identifies that the most effective pharmaceutical care is provided when clinical pharmacists become integrated into the health care team and play an active role in patient care. ...
... [46,48] As such, the RIO Political Declaration on Social Determinants of Health endorses global collaboration and benchmarking between countries to identify good practices and adopt coherent policies to promote consistent practices. [48] WHO identifies that the most effective pharmaceutical care is provided when clinical pharmacists become integrated into the health care team and play an active role in patient care. [1] Pharmacists possess the relevant skills, knowledge and expertise to make valuable contributions to the quality use of medicines and medication safety. ...
Objectives:
To describe pharmacist practice and roles performed in the neonatal intensive care unit (NICU) worldwide and to map these findings along the medicines management pathway (MMP).
Method:
Quasi-systematic review.
Search strategy:
Google Scholar, Medline/PubMed and Embase were searched utilising the selected MeSH terms.
Results:
Thirty sources of information were reviewed. Overall, pharmacist practice in the NICU involves a wide-range of roles, with the most commonly reported involving patient medication chart review, therapeutic drug monitoring and the provision of medication information. Studies highlight that pharmacist contribution to total parenteral nutrition (TPN) regimens and patient medication chart review is beneficial to patient outcomes. Roles beyond the regular scope of practice included involvement in immunisation programmes and research. Most of the data were collected from the USA (13 of 30), followed by the UK (6 of 30) and reports from other countries. The American, British, South African and Australian articles have reported very similar roles, with a pharmacist firmly integrated into the overall structure of the NICU team.
Conclusion:
The literature identifies that there is insufficient evidence to describe what roles are currently performed in NICUs worldwide. This is due to the lack of recently published articles leading to a large gap in knowledge in understanding what contemporary pharmaceutical services in the NICU comprise. Further research is required to address these gaps in knowledge, and identify the impact of the pharmacist's role on neonatal patient outcomes as well as to determine how to better resource NICUs to access pharmacy services.
... Researchers suggest that adolescence is a time in life where boys and girls, more intensely than before, are trying to figure out their own gender identity (Hill & Lynch, 1983). Gender intensification as a theoretical perspective is supported by empirical research as well (Aubé, Fichman, Saltaris, & Koestner, 2000;Wichstrom, 1999). This idea has been examined in association to self-reported depression in order to explain why gender differences in depression emerge in this period in life. ...
... One study shows that assuming too much responsibility and having trouble being assertive, traits that the authors label as typically feminine, are associated with depression (Aubé, et al., 2000). Similarly, another study shows that reporting depressed moods is associated with high scores of typically feminine traits but not with typically masculine traits (Wichstrom, 1999). To my knowledge, there is no similar research on gender intensification theory and self-reported general health, somatic complaints, or stress. ...
... Sosiale determinanter refererer til de økonomiske og sosiale forhold -og deres fordeling i befolkningen -som bidrar til helseforskjeller mellom individer og grupper. Eksempler på sosiale determinanter er utdanning, inntekt, sosial ulikhet og kontroll over egen livssituasjon [160][161][162]. Om sosiale helsedeterminanter sier WHO at "…unequal distribution of health-damaging experiences is not in any sense a 'natural' phenomenon but is the result of a toxic combination of poor social policies, unfair economic arrangements [where the already well-off and healthy become even richer and the poor who are already more likely to be ill become even poorer], and bad politics" [163]. ...
... Det er fire grunner til at det er viktig å forstå betydningen av sosiale determinanter for psykisk helse: (1) Sosiale faktorer virker i samspill med genetiske og andre biologiske faktorer og enkeltindividers opplevelse og erfaring sterkt inn både på utvikling og opprettholdelse av både positiv psykisk helse og en rekke psykiske lidelser. (2) Forståelse av de sosiale årsakene til individers og gruppers psykiske helsestatus åpner mulighet for å kunne iverksette helsefremmende og sykdomsforebyggende tiltak på befolkningsnivå, for å redusere sosial ulikhet i psykisk helse[160][161][162]. (3) Forståelse av de sosiale determinantene som sådan gjør det mulig å målrette tiltak mot disse determinantene langt mer systematisk og effektivt. ...
Tema for denne rapporten er psykisk helse som global utfordring og betydningen av psykisk helse i norsk bistands- og utviklingspolitikk. Den tar for seg forhold som fremmer og som svekker psykisk helse, med vekt på den tidlige barndommens betydning for menneskets utvikling og på sosiale determinanter det kan gjøres noe med. I tillegg setter den søkelyset på psykiske lidelser som samfunnsbelastning og på belastninger som samfunnet legger på mennesker som sliter med disse lidelsene i form av sosial utstøting, diskriminering, vold og menneskerettighetsbrudd. Rapporten oppsummerer hva som er blitt gjort for å få global psykisk helse opp på den internasjonale agendaen, søker å finne svar på hvilken status psykisk helse har i norsk global helsepolitikk og kommer med forslag til hva Norge kan bidra med på dette området. Rapporten konkluderer:
• Befolkningens psykiske helse er blant de minst systematisk utnyttede ressursene med det største utviklingspotensialet i mange lavinntektsland. Det er stort behov for helseanalyse, forskning, kapasitetsbygging og kunnskapsbasert rådgivning som kan bidra til kostnadseffektivt å fremme befolkningenes psykiske helse, styrke landenes mentale kapital og forebygge at nye tilfeller av psykisk sykdom oppstår.
• I mange lavinntektsland er det behov for å kartlegge og analysere hvordan psykiske helseinitiativ og tjenester i bred forstand leveres.
• Normalisering og avstigmatisering av psykiske lidelser er en grunnleggende forutsetning for å endre dagens psykiske helsesituasjon og kan bli en norsk merkevare.
• Innsatsen på psykisk helse bør samordnes med innsatsen på fysisk helse, med primærhelsetjenesten som grunnmur. Planer for psykisk helse, nevrologiske lidelser og rusmiddelmisbruk må så langt som mulig integreres i bredere planer for post-2015 mål. Integrering er smart, det sikrer nærhet, kontinuitet og koster mindre enn parallelle særomsorger.
• Tiltak knyttet til svangerskap, barseltid og småbarnsalder har størst potensial. Norge kan gi et vesentlig bidrag ved å støtte integrering av psykisk helse i programmer for mødre- og barnehelse.
• Løft psykisk helse på den internasjonale menneskerettighetsagendaen. I mange land er mennesker med psykiske lidelser fratatt alminnelige politiske og borgerlige rettigheter, og utsettes mer enn andre for sosial utstøting, diskriminering og vold.
• Styrk lovgiving for psykisk helse. God psykisk helselovgivning og hensyntaken til psykisk helse i annen lovgivning («mental health in all policies») er svært viktige instrumenter i arbeidet for å fremme psykisk helse, sikre menneskerettigheter for psykisk syke og beskytte enkeltmenneskers autonomi.
• Invester i kunnskap som kan hjelpe barn og unge som har opplevd krig og konflikter. Det er behov for bedre kunnskapsgrunnlag for hva som er virksomme og effektive tiltak for barn og unge som er berørt av væpnete konflikter.
• Norges ledende posisjon i desentralisering av psykiske helsetjenester bør kunne gi kraft til arbeid med utvikling og modernisering av psykiske helsetjenester.
• Norges erfaring med elektronisk kommunikasjon (m-helse, e-helse, telemedisin) kan utnyttes i arbeidet med psykisk helse, fortrinnsvis integrert med eksisterende tiltak på annen helse.
... Structural factors – including poverty and limited livelihood options, stigma and discrimination, gender inequality and violence, among others – help drive and sustain the epidemic, as well as undermine the effectiveness of proven HIV interventions [2]. There is, therefore, renewed interest in interventions that seek to address such factors [2,3] ISSN 0269-9370 Q 2014 Wolters Kluwer Health | Lippincott Williams & Wilkinsinterventions, both to modify the broader socioeconomic environment that shapes HIV risk and to enhance the uptake and effectiveness of core HIV prevention and treatment services456. Although evidence of the effectiveness of these interventions is limited, a few rigorous studies have demonstrated the potential of enhanced microfinance or cash transfer schemes to reduce HIV-related risk factors and ultimately HIV infections, while simultaneously improving other development indicators [7,8]. ...
... In this context, structural interventions with multiple outcomes could become more attractive. Rather than displacing financing to other sectors, HIV funds that support structural approaches could leverage such resources, catalyzing synergistic investments across health and development sectors, as promoted by the HIV investment framework and several other policy agendas and academic works [3,13,16171819202122. Despite the potential of structural interventions, there is a risk that they will not be prioritized within HIV programme resources, given the perception that they are beyond the remit of the HIV 'sector'232425. ...
Structural interventions can reduce HIV vulnerability. However, HIV-specific budgeting, based on HIV-specific outcomes alone, could lead to the undervaluation of investments in such interventions and suboptimal resource allocation. We investigate this hypothesis by examining the consequences of alternative financing approaches.
We compare three approaches for deciding whether to finance a structural intervention to keep adolescent girls in school in Malawi. In the first, HIV and non-HIV budget holders participate in a cross-sectoral cost-benefit analysis and fund the intervention if the benefits outweigh the costs. In the second silo approach, each budget holder considers the cost-effectiveness of the intervention in terms of their own objectives and funds the intervention on the basis of their sector-specific thresholds of what is cost-effective or not. In the third cofinancing approach, budget holders use cost-effectiveness analysis to determine how much they would be willing to contribute towards the intervention, provided that other sectors are willing to pay for the remaining costs. In addition, we explore approaches for determining the HIV share in the cofinancing scenario.
We find that efficient structural interventions may be less likely to be prioritized, financed and taken to scale where sectors evaluate their options in isolation. A cofinancing approach minimizes welfare loss and could be incorporated in a sector budgeting perspective.
Structural interventions may be underimplemented and their cross-sectoral benefits foregone. Cofinancing provides an opportunity for multiple HIV, health and development objectives to be achieved simultaneously, but will require effective cross-sectoral coordination mechanisms for planning, implementation and financing.
... Although the CSDH officially completed its work in 2008, the sustainability and effectiveness of the commission is demonstrated by a variety of global, regional and national activities. This includes first, the Regional Office for Eastern Mediterranean of the WHO identifying a regional strategic direction for operationalizing the Rio Political Declaration, which is a global political commitment for the implementation of a social determinants of health approach to reduce health inequities and to achieve other global priorities [44]; and the recognition from the WHO that the tackling of the social determinants of health is a fundamental approach to its work and a priority area in the 12th WHO general program of work (2014–2019). The longevity of activities that have arisen from the Commission of Social Determinants of Health indicates the usefulness of targeting and advocating for the systemic , and thus cross-sectoral, nature of addressing the global burden of disease through a health equity lens. ...
... HIAs, which may be undertaken at local, regional, national or international levels, are intended to inform decision-making. The use of HIA is supported by the World Health Organisation (WHO) which has called for assessment of the implications for health and the distribution of health impacts to be routinely considered in policy-making and practice [1,4567. Since the 1990s, there has been a rapid expansion in the use of HIA globally [8] . ...
Health Impact Assessment (HIA) involves assessing how proposals may alter the determinants of health prior to implementation and recommends changes to enhance positive and mitigate negative impacts. HIAs growing use needs to be supported by a strong evidence base, both to validate the value of its application and to make its application more robust. We have carried out the first systematic empirical study of the influence of HIA on decision-making and implementation of proposals in Australia and New Zealand. This paper focuses on identifying whether and how HIAs changed decision-making and implementation and impacts that participants report following involvement in HIAs.
We used a two-step process first surveying 55 HIAs followed by 11 in-depth case studies. Data gathering methods included questionnaires with follow-up interview, semi-structured interviews and document collation. We carried out deductive and inductive qualitative content analyses of interview transcripts and documents as well as simple descriptive statistics.
We found that most HIAs are effective in some way. HIAs are often directly effective in changing, influencing, broadening areas considered and in some cases having immediate impact on decisions. Even when HIAs are reported to have no direct effect on a decision they are often still effective in influencing decision-making processes and the stakeholders involved in them. HIA participants identify changes in relationships, improved understanding of the determinants of health and positive working relationships as major and sustainable impacts of their involvement.
This study clearly demonstrates direct and indirect effectiveness of HIA influencing decision making in Australia and New Zealand. We recommend that public health leaders and policy makers should be confident in promoting the use of HIA and investing in building capacity to undertake high quality HIAs. New findings about the value HIA stakeholders put on indirect impacts such as learning and relationship building suggest HIA has a role both as a technical tool that makes predictions of potential impacts of a policy, program or project and as a mechanism for developing relationships with and influencing other sectors. Accordingly when evaluating the effectiveness of HIAs we need to look beyond the direct impacts on decisions.
... The right to health has also played a central role in human rights activism including most prominently in relation to AIDS treat- ment [51] and sexual and reproductive health rights [52] . These developments have prompted growing recognition by scholars and policy-makers of the right to health's contributions in relation to global economic forces and trade law, global health governance, social determinants of health and non-communicable disease5152535455565758 . Given the prominence of the MDG and post- MDG processes, there has also been considerable scholarship focused on initial divergences between human rights and the MDG process [24,59] and conversely, the contribution that human rights make to the MDGs and post-2015 process [60,61]. ...
Global health institutions increasingly recognize that the right to health should guide the formulation of replacement goals for the Millennium Development Goals, which expire in 2015. However, the right to health's contribution is undercut by the principle of progressive realization, which links provision of health services to available resources, permitting states to deny even basic levels of health coverage domestically and allowing international assistance for health to remain entirely discretionary.
To prevent progressive realization from undermining both domestic and international responsibilities towards health, international human rights law institutions developed the idea of non-derogable "minimum core" obligations to provide essential health services. While minimum core obligations have enjoyed some uptake in human rights practice and scholarship, their definition in international law fails to specify which health services should fall within their scope, or to specify wealthy country obligations to assist poorer countries. These definitional gaps undercut the capacity of minimum core obligations to protect essential health needs against inaction, austerity and illegitimate trade-offs in both domestic and global action. If the right to health is to effectively advance essential global health needs in these contexts, weaknesses within the minimum core concept must be resolved through innovative research on social, political and legal conceptualizations of essential health needs.
We believe that if the minimum core concept is strengthened in these ways, it will produce a more feasible and grounded conception of legally prioritized health needs that could assist in advancing health equity, including by providing a framework rooted in legal obligations to guide the formulation of new health development goals, providing a baseline of essential health services to be protected as a matter of right against governmental claims of scarcity and inadequate international assistance, and empowering civil society to claim fulfillment of their essential health needs from domestic and global decision-makers.
... For example, studies have been conducted on coronary disease and cancer, polio, tuberculosis, HIV, Hepatitis, STDs, children's health and physical activity1819202122232425. The Rio Political Declaration on the Social Determinants of Health, which emanated from the World Conference on Social Determinants of Health held in Brazil in October 2011, firmly placed social determinants of health on the agenda of the health sector, but also on the agendas of all the stakeholders and scientists [26,27]. The present study was conducted in 42 of the 53 municipalities in Aydın and all headmen in the city center participated. ...
Social determinants have been described as having a greater influence than other determinants of health status. The major social determinants of health and the necessary policy objectives have been defined; it is now necessary to evaluate the effectiveness of these policies. Previous studies have shown that descriptions of the awareness level of citizens and local decision makers, practice-based research and evidence, and intersectoral studies are the best options for investigating the social determinants of health at the community level. The objective of the present study was to define local decision makers' awareness of the social determinants of health in the Aydin province of Turkey.
A total of 53 mayors serve the Aydin city center, districts and towns. Aydin city center has 22 neighborhoods and 22 headmen responsible for them. The present study targeted all mayors and headmen in Aydin - a total of 75 possible participants. A questionnaire was used to collect the data. The questionnaire was faxed to the mayors and administered face-to-face with the headmen.
Headmen identified the three most important determinants of public health as environmental issues, addictions (smoking, alcohol) and malnutrition. According to the mayors, the major determinant of public health is stress, followed by malnutrition, environmental issues, an inactive lifestyle, and the social and economic conditions of the country. Both groups expressed that the Turkish Ministry of Health, municipalities and universities are the institutions responsible for developing health policy. Headmen were found to be unaware and mayors were aware of the social determinants of health as classified by the World Health Organisation. Both groups were classified as unaware with regard to their awareness of the Marmot Review policy objectives.
Studies such as the present study provide important additional information on the social determinants of health, and help to increase the awareness levels of both local decision-makers and the community. Such studies must be considered a vital first step in future public health research on health determinants and their impact on national and international policies.
This position paper critically analyses the process to implement the UNESCO Recommendation on the Historic
Urban Landscape (2011), exploring evaluation tools, innovative business / management models and financing tools for the conservation and regeneration of Historic Urban Landscape (HUL), to make it operational in the perspective of a circular economy model of sustainable development for city / territory system regeneration.
Through evaluation tools, it is possible to pass from general principles to operational practices; to produce empirical evidence of the economic, social and environmental benefits of HUL integrated conservation and regeneration. The challenge of generating a symbiosis between conservation and transformation issues requires adequate evaluation methods, business, management and financing tools, engaging civil society and local stakeholders, capturing both HUL tangible and intangible values to turn the historic urban landscape into a driver of sustainable growth. The analysis carried out in this paper shows that through the suggested tools it is possible to make operational the UNESCO Recommendations, transforming conflicts into opportunities, producing economic attractiveness and strengthen social awareness and cohesion.
This review article addresses the concept of the social determinants of health (SDH), selected
theories, and its application in studies of chronic disease. Once ignored or regarded only as distant or
secondary influences on health and disease, social determinants have been increasingly acknowledged
as fundamental causes of health afflictions. For the purposes of this discussion, SDH refers to
SDH variables directly relevant to chronic diseases and, in some circumstances, obesity, in the
research agenda of the Mid-South Transdisciplinary Collaborative Center for Health Disparities
Research. The health effects of SDH are initially discussed with respect to smoking and the social
gradient in mortality. Next, four leading SDH theories—life course, fundamental cause, social
capital, and health lifestyle theory—are reviewed with supporting studies. The article concludes with
an examination of neighborhood disadvantage, social networks, and perceived discrimination in
SDH research.
In this paper we address a frontier topic in the humanities, namely how the cultural and natural construction that we call landscape affects well-being and health. Following an updated review of evidence-based literature in the fields of medicine, psychology, and architecture, we propose a new theoretical framework called " processual landscape, " which is able to explain both the health-landscape and the medical agency-structure binomial pairs. We provide a twofold analysis of landscape, from both the cultural and naturalist points of view: in order to take into account its relationship with health, the definition of landscape as a cultural product needs to be broadened through naturalization, grounding it in the scientific domain. Landscape cannot be distinguished from the ecological environment. For this reason, we naturalize the idea of landscape through the notion of affordance and Gibson's ecological psychology. In doing so, we stress the role of agency in the theory of perception and the health-landscape relationship. Since it is the result of continuous and co-creational interaction between the cultural agent, the biological agent and the affordances offered to the landscape perceiver, the processual landscape is, in our opinion, the most comprehensive framework for explaining the health-landscape relationship. The consequences of our framework are not only theoretical, but ethical also: insofar as health is greatly affected by landscape, this construction represents something more than just part of our heritage or a place to be preserved for the aesthetic pleasure it provides. Rather, we can talk about the right to landscape as something intrinsically linked to the well-being of present and future generations.
Pengendalian tuberkulosis telah meningkatkan angka kesembuhan dan menyelamatkan banyak jiwa, tetapi kurang berhasil menurunkan insiden tuberkulosis. Oleh karena itu, pengendalian tuberkulosis menekankan pada kebijakan determinan sosial karena determinan sosial secara langsung dan melalui faktor risiko tuberkulosis berpengaruh terhadap tuberkulosis. Hasil telaah literatur menunjukkan bahwa stratifikasi determinan sosial menyebabkan clustering tuberkulosis, berupa pengelompokkan penderita tuberkulosis menurut lokasi geografis yang secara statistik signifikan. Pengetahuan tentang clustering sangat bermanfaat dalam pengendalian tuberkulosis, khususnya untuk menurunkan insiden tuberkulosis karena dapat memberikan informasi tentang lokasi populasi yang berisiko. Selain itu, telaah literatur menunjukkan bahwa implementasi analisis spasial memerlukan dukungan sumber daya yang tidak sedikit. Oleh karena itu, sebelum analisis cluster berbasis spasial dapat diterapkan, perlu didukung oleh penelitian yang menunjukkan kesiapan sumber daya dan efektivitas biaya.
Tuberculosis control has increased cure rate and saved million people, but has less success in reducing tuberculosis incidence. Therefore, tuberculosis control needs to put more emphasis on social determinants policy, since social determinants directly or through tuberculosis-risk factors affect tuberculosis. Literature reviews show that stratification of social determinants will cause tuberculosis clustering, a grouping of tuberculosis patients according geographical area that is statistically significant. Knowledge on the clustering is very useful to support tuberculosis-control program, especially for reducing tuberculosis incidence through highlighting the area of vulnerable population. On the other hand, literature reviews also show that implementation of spatial analysis requires adequate resources. Therefore, before tuberculosis cluster analysis can be implemented routinely, it shouldbe supported by researches that indicate resources readiness and cost effectiveness.
Background
There is a significant body of evidence that highlights the importance of addressing the social determinants of child and youth health. In order to tackle health inequities Australian governments are being called upon to take action in this area at a policy level. Recent research suggests that the health and well-being of children and youth in Australia is ‘middle of the road’ when compared to other OECD countries. To date, there have been no systematic analyses of Australian child/youth health policies with a social determinants and health equity focus and this study aimed to contribute to addressing this gap.
Methods
Document analysis of seventeen strategic level child/youth health policies across Australia used an a priori coding framework specifically developed to assess the extent to which health departments address the social determinants of child/youth health and health equity. Policies were selected from a review of all federal and state/territory strategic health department policies dated between 2008 and 2013. They were included if the title of the policy addressed children, youth, paediatric health or families directly. We also included whole of government policies that addressed child/youth health issues and linked to the health department, and health promotion policies with a chapter or extensive section dedicated to children.
Results
Australian child/youth health policies address health inequities to some extent, with the best examples in Aboriginal or child protection policies, and whole of government policies. However, action on the social determinants of child/youth health was limited. Whilst all policies acknowledge the SDH, strategies were predominantly about improving health services delivery or access to health services. With some exceptions, the policies that appeared to address important SDH, such as early childhood development and healthy settings, often took a narrow view of the evidence and drifted back to focus on the individual.
Conclusions
This research highlights that policy action on the social determinants of child/youth health in Australia is limited and that a more balanced approach to reducing health inequities is needed, moving away from a dominant medical or behavioural approach, to address the structural determinants of child/youth health.
This multi-level ethnography of the Zambian health system illustrates the importance of top-down accountability, and how it has emerged in a historically neglected sector. Maternal health care indicators are prioritised when they are benchmarked, at district and national levels. The realisation that Zambia was lagging behind African countries making progress towards MDG 5 (to reduce the maternal mortality ratio by three quarters) appears to have invoked reputational concerns and revealed inspirational possibilities. Growing prioritisation also stems from a change in incentives, with some partner funding being conditional on the proportion of deliveries attended by skilled health personnel.
Health, both individual and collective, always has been essential for both human and social
development; this is why the debate on the best way to protect and care for it is so broad, and
why there are several approaches proposed on how to do so. Health impact assessment (HIA) is
one of these approaches, where the objective is to improve and safeguard individual health by offering
a practical, evidence-based tool that enables governments to improve their planning processes.
This article critically examines federal, state and facility-level policies, as well as clinical practice guidelines regarding postnatal depression in Mexico. Thirteen documents including national health plans, national
action plans, federal and state laws and regulations, clinical practice guidelines, and public-sector healthcare facility policies were collected and evaluated according to whether they included a statement of intent and/or actions related to the care of women at risk for or experiencing postnatal depression. While postnatal depression is included in several policies in Mexico, it is not addressed in ways that guide actions to manage postnatal depression. Specific direction on postnatal depression in policies would bridge a gap in maternal mental healthcare given that medication, treatment, and timing of interventions is
unique in the postpartum context.
This article analyzes intersectorial health-related policies (IHRP) based on a case study performed in 2008-2009 that mapped the social policies of the city of Piracicaba, State of Sao Paulo, Brazil. The research strategy comprised quantitative and qualitative methodologies and converging information sources. Legal and theoretical conceptual frameworks were applied to the Piracicaba study results and served as the basis for proposing a typology of IHRP. Three types of IHRP were identified: health policies where the health sector is coordinator but needs non-health sectors to succeed; policies with a sector other than health as coordinator, but which needs health sector collaboration to succeed; and thirdly, genuine intersectorial policies, not led by any one sector but by a specifically-appointed intersectorial coordinator. The authors contend that political commitment of local authorities alone may not be enough to promote efficient intersectorial social policies. Comprehension of different types of IHRP and their interface mechanisms may contribute to greater efficiency and coverage of social policies that affect health equity and its social determinants positively. In the final analysis,, this will lead to more equitable health outcomes.
Until recently medical education has been largely silent on those aspects of the physician's life, both professional and unprofessional, that differ from place to place. This has contributed to health inequity through an undersupply of health care workers to many communities. A growing movement for social accountability in medical education has made consideration of place an emergent topic in the field. We describe the history of place in medical education, consider how our own institution has attempted to construct a place-based education program, and suggest how the wider place-based education literature can inform the construction of place-sensitive medical education curricula.
This paper proposes measurement tracks of health equity (HE) and presents practical illustrations to influence, inform and guide the uptake of equity-sensitive policies. It discusses the basic requirements that allow the effective use of the proposed measurement tracks. Egypt is used as a demonstration of this practice. The paper differentiates between the policy needs of two groups of countries. The first set of measurement tracks are specifically tailored to countries at the early stages of considering health equity, requiring support in placing HE on the policy agenda. Key messages for this group of countries are that the policy influence of measurement can be strengthened through the implementation of four self-reinforcing tracks that recognize the need to effectively use the available current databases prior to engaging in new data collection, emphasize the importance of a social justice reframing of the documented health inequities, present health inequity facts in simple visual messages and move beyond the why to what needs to be done and how. The tracks also recognizes that placing an issue on the policy agenda is a complex matter requiring reinforcement from many actors and navigation among competing forces and policy circles. For the second group of countries the paper discusses the monitoring framework. The key messages include the importance of moving toward a more comprehensive system that sustains the monitoring system which is embedded within affective participatory accountability mechanisms. The paper discusses the basic requirements and the institutional, financial, technical and human capacity-building considerations for implementing the proposed measurement tracks.
In South Africa inequalities in health have been extensively reported. The poor suffer more ill health than the rich. This paper discusses the need to understand the historical, social and political contexts and power relations that have shaped inequalities in South Africa. This can be achieved in part through a cohesive intersectoral approach that addresses ‘the causes of the causes’. Yet more fundamentally, the authors suggest that success in tackling inequalities in health will only come when existing power structures in South African society are acknowledged.
Efforts to reduce the widening gap between the health and social well-being of people within and between countries have become an urgent priority for politicians and policymakers. The Rio Declaration called on governments worldwide to promote and strengthen universal access to social services and to work in partnership to promote health equity and foster more inclusive societies. This paper contributes to international debates about the role of social work in promoting social justice by reducing social and health inequalities. Despite clear commitments to promote good health, there is a notable absence of a social determinants of health perspective in international social work curricula standards. The current review of social work education in England presents a timely opportunity to integrate such a perspective in teaching and learning and to disseminate this more widely. Employing the concepts of downstream and upstream interventions, the first part of the paper examines the distinctiveness of the social work contribution to this global agenda. In the second part of the paper, we consider how the content of learning activities about health inequalities can be incorporated in international social work curricula, namely, human rights, using Gypsy and Traveller families as an exemplar, inter-professional education and international perspectives.
This commentary contextualises and documents the process of a twinning learning exchange between the US Racial and Ethnic Approaches to Community Health initiative and the Communities for Health initiative in England to enable the transfer and adaptation of ideas for similar community-focused initiatives in various contexts globally. The multi-partner twinning exchange built on and shared knowledge around community health promotion interventions, targeting 'marginalised' populations and focused on addressing the social determinants of health to effectively reduce health inequalities. This commentary presents the methodology of the exchange; provides key themes, outcomes and lessons learnt that arose from discussions and the experience; and provides insights, considerations and recommendations for adaptation. Finally, it highlights the importance of such exchanges in the current global context and the need for their replication and adaptation. These experiences contribute to building the evidence base on successful interventions and identifying strategies that work for improving health outcomes and reducing health inequalities. They strengthen the need for all governments to address the social determinants of health as a priority whilst providing insights to inform successful policy.
OBJECTIVE: to unravel some theoretical and factual elements required to implement more effective health promotion strategies and practices in the field of health services whilst following the great challenges that globalization has imposed on the health systems, which are inevitably expressed in the local context (glocalization).METHODOLOGY: a narrative review taking into account the concepts of globalization and health promotion in relation to health determinants. The authors approach some courses of action and strategies for health promotion based on the social principles and universal values that guide health promotion, health service reorientation and primary healthcare, empowerment, social participation, and inter–sectoral and social mobilization.DISCUSSION: the discussion focuses on the redirection of health promotion services in relation to the wave of health reforms that has spread throughout the world under the neoliberal rule. The author also discusses health promotion, its ineffectiveness, and the quest for renewal. Likewise, the author sets priorities for health promotion in relation to social determinants.CONCLUSION: the current global order, in terms of international relations, is not consistent with the ethical principles of health promotion. In this paper, the author advocates for the implementation of actions to change the social and physical life conditions of people based on changes in the use of power in society and the appropriate practice of politics in the context of globalization in order to achieve the effectiveness of the actions of health promotion.
ISSN 1020-4989.
The social determinants of health are the circumstances in which people are born, grow, live, work and age. These circumstances are created by the circulation of money, power and resources at global, national and local levels. The social determinants of health are mostly to blame for health inequities, the inequitable and preventable differences in health status seen within and between countries
The prevalence of intellectual disabilities (ID) has been estimated at 10.4/1000 worldwide with higher rates among children and adolescents in lower income countries. The objective of this paper is to address research priorities for development disabilities, notably ID and autism, at the global level and to propose the more rational use of scarce funds in addressing this under-investigated area.
An expert group was identified and invited to systematically list and score research questions. They applied the priority setting methodology of the Child Health and Nutrition Research Initiative (CHNRI) to generate research questions and to evaluate them using a set of five criteria: answerability, feasibility, applicability and impact, support within the context and equity.
The results of this process clearly indicated that the important priorities for future research related to the need for effective and efficient approaches to early intervention, empowerment of families supporting a person with developmental disability and to address preventable causes of poor health in people with ID and autism.
For the public health and other systems to become more effective in delivering appropriate support to persons with developmental disabilities, greater (and more targeted) investment in research is required to produce evidence of what works consistent with international human rights standards.
Background:
Addressing inequitable coverage of maternal and child health care services among different socioeconomic strata of population and across states is an important part of India's contemporary health program. This has wide implications for the achievement of the Millennium Development Goal targets.
Objective:
This paper assesses the inequity in coverage of maternal, newborn, and child health (MNCH) care services across household wealth quintiles in India and its states.
Design:
Utilizing the District Level Household and Facility Survey conducted during 2007-08, this paper has constructed a Composite Coverage Index (CCI) in MNCH care.
Results:
The mean overall coverage of 45% was estimated at the national level, ranging from 31% for the poorest to 60% for the wealthiest quintile. Moreover, a massive state-wise difference across wealth quintiles was observed in the mean overall CCI. Almost half of the Indian states and union territories recorded a ≤50% coverage in MNCH care services, which demands special attention.
Conclusion:
India needs focused efforts to address the inequity in coverage of health care services by recognising or defining underserved people and pursuing well-planned time-oriented health programs committed to ameliorate the present state of MNCH care.
Objective:
To describe the use and reporting of Health Impact Assessment (HIA) in Australia and New Zealand between 2005 and 2009.
Methods:
We identified 115 HIAs undertaken in Australia and New Zealand between 2005 and 2009. We reviewed 55 HIAs meeting the study's inclusion criteria to identify characteristics and appraise the quality of the reports.
Results:
Of the 55 HIAs, 31 were undertaken in Australia and 24 in New Zealand. The HIAs were undertaken on plans (31), projects (12), programs (6) and policies (6). Compared to Australia, a higher proportion of New Zealand HIAs were on policies and plans and were rapid assessments done voluntarily to support decision-making. In both countries, most HIAs were on land use planning proposals. Overall, 65% of HIA reports were judged to be adequate.
Conclusion:
This study is the first attempt to empirically investigate the nature of the broad range of HIAs done in Australia and New Zealand and has highlighted the emergence of HIA as a growing area of public health practice. It identifies areas where current practice could be improved and provides a baseline against which future HIA developments can be assessed.
Implications:
There is evidence that HIA is becoming a part of public health practice in Australia and New Zealand across a wide range of policies, plans and projects. The assessment of quality of reports allows the development of practical suggestions on ways current practice may be improved. The growth of HIA will depend on ongoing organisation and workforce development in both countries.
Over many years, large differences have been observed between local authorities (LAs) in England in the proportion of children
who are ‘looked after’ out of home, or the subjects of child protection plans, with deprivation being identified as the major
explanatory factor. This article proposes that such differences be reconceptualised as ‘child welfare inequalities’ and suggests
that drawing parallels with health inequalities would have value in a number of respects. Four aspects of child welfare inequalities
are suggested. An analysis of officially published data provides new evidence of inequalities between LAs in two key markers
of child welfare, and the relationship with deprivation, measured by the Index of Multiple Deprivation scores. Although this
correlation is unsurprising, there has been a lack of recent research into the extent and the underlying causes of child welfare
inequalities, a reluctance to describe differences as inequalities or to propose action on the underlying social determinants.
Reading across from the field of health inequalities opens up new directions for child welfare policy, practice, theory and
research internationally as well as creating the potential for alliances with others taking action to reduce health inequalities.
Despite extraordinary successive increases in international aid, we have not achieved desired gains in health equity. There has been a tendency to focus on vertical programmes and specific diseases, rather than supporting countries to develop sustainable health financing systems that would lead to universal coverage. Despite the statements agreed to in the Paris and Accra declarations aid has in many cases reinforced the organizational and institutional health care divide between developed and developing countries. The premise of international aid has recently changed, with the Busan Partnership for Effective Development Cooperation statement calling for greater ownership of development priorities, greater cooperation between various stakeholders for development, greater accountability for development efforts and more support for South-South and triangular cooperation. Within this framework, supporting health financing and health systems should be an important component of sustainable development. Achieving the right to health – a central goal for global health outlined in the WHO constitution – is intertwined with social, economic and environmental development. Health equity is not the only goal, as access to processes of participation in agenda setting and cross-sectoral policy mechanisms, along with transparency and accountability are crucial. In our modern globalised system, we need to ensure that citizen's right to participate is not undermined and that social inclusion is a primary goal.
Noncommunicable diseases (NCDs) are increasingly getting attention from different forums, including media outlets, health agencies, and the public and private sectors. Progress is being made in addressing NCDs, though more slowly in low- and middle-income countries (LMICs) as compared with high-income settings. Here, we offer an analysis of the challenges faced in LMICs. We discuss realistic strategies to understand and develop capacity needs (workforce, finances, and infrastructure) and systems (institutions and processes) to sustainably optimize NCD prevention and care in LMICs.
Perhaps not since John Snow removed the Broad Street pump handle and stemmed the cholera outbreak in London in 1854, or William Henry Welch and Wickliffe Rose out- lined the shape of an “institute of hygiene” in the Welch– Rose Report of 1915, thus founding the modern public health movement in the United States (Fee & Acheson, 1991), has public health and the many disciplines that contribute to its work undergone more rapid transformation than what we are witnessing today. That transformation is global, and the rap- idly evolving nature and complexity of public health prob- lems that we confront in the 21st century, together with the equally breathtaking evidence base of science now available to address these problems, have created new imperatives for ensuring that modern public health professionals possess the competencies that will enable them to practice effectively. Calls from the Institute of Medicine (2002a, 2002b, 2012) in the United States, the World Health Organization (WHO, Commission on the Social Determinants of Health, 2008; WHO, 2011), and others (e.g., International Union for Health Promotion and Education [IUHPE] & Canadian Consortium for Health Promotion Research, 2007; Livingood et al., 2011; Tulchinsky & McKee, 2011) have all pointed to the need to improve public health workforce capacity in order to meet contemporary challenges, along with the attendant implications for professional education.
Nowhere is the need to ensure the quality of practice more urgent, nor more critical, than in health promotion, the core function of public health that focuses on using educational, behavioral, and organizational strategies to assist individuals and groups to engage in health-promoting behavior and pol- icy changes that can improve population health. The chal- lenges and the opportunities to underpin health promotion and health education practitioners with new knowledge, abilities, and skills have broadened our thinking about qual- ity assurance and catalyzed a new generation of efforts to strengthen professional preparation, standards, and creden- tialing in North America and throughout Europe, as well as in other regions and countries of the world such as Australia, Canada, Latin America, and New Zealand.
The Galway Consensus Conference was the first effort to explore international collaboration on workforce develop- ment and global credentialing in health education and health
promotion. Organized and convened in 2008 by the IUHPE, Society for Public Health Education (SOPHE) and U.S. Centers for Disease Control and Prevention, the vision under- lying the Galway Consensus Conference was to identify the domains of core competency for health education and health promotion that would be universal (Allegrante, Barry, Auld, Lamarre, & Taub, 2009; Barry, Allegrante, Lamarre, Auld, & Taub, 2009). The time was right for such an effort because of the convergence of a number of factors, namely,
• concern over the growing global nature of public health threats, including the rise in noncommuni- cable diseases with epidemics of type II diabetes, obesity, and physical inactivity, as well as mortality and morbidity due to persistent infectious diseases such as HIV/AIDS and associated with a range of new communicable diseases (e.g., swine flu) that have transcended boundaries because of increased global commerce and transport;
• publication of the United Nations (2000) Millen- nium Development Goals;
• new research findings elucidating the role of the social determinants of health (World Health Orga- nization, Commission on Social Determinants of Health, 2008);
• new technologies that permit rapid communications and data sharing; and
• the devolution and realignment of governments globally in response to new political and economic realities.
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