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Byline: Syed Ammad, Khadija Malik Bari and Syed Muhammad Zia Keywords: Social Accountability, Public Satisfaction, Health Care, Social Awareness Introduction Public health care is the most rudimentary and crucial service [...]

The views expressed in this editorial are those of the author and do not necessarily reflect the position of the Canadian Medical Association or its subsidiaries. Canadians have never really [...]

We argue that Canadian provincial governments should contain medical care spending in order to invest more in the social determinants of health (SDH). Others have said this, many times. Doing it has not proven easy. We therefore emphasize the potential contribution of the priority-setting and resource allocation literature. This literature identifies formal tools and approaches that have built cultures of support for resource shifts, while providing pragmatic means for advancing efficiency and equity. Although reallocation towards SDH from other areas of the health care system is financially viable and supported by existing research, it will require new emphasis on the design of population health interventions that make reallocation politically expedient. KEY WORDS: Priority setting; resource allocation; social determinants of health Nous soutenons que les gouvernements provinciaux du Canada devraient limiter les depenses de soins medicaux afin d'investir davantage dans les determinants sociaux de la sante (DSS). D'autres ont dit la meme chose, a maintes reprises. Mettre ceci en pratique n'a pas ete aise. Nous insistons donc sur la contribution possible de la documentation sur l'etablissement de priorites et l'allocation de ressources. Dans cette documentation, on repertorie les outils et les approches qui renforcent des cultures de soutien a la reorientation des ressources, tout en proposant des facons pragmatiques de favoriser l'efficience et l'equite. Bien que la reaffectation vers les DSS a partir d'autres elements du systeme de soins de sante soit financierement viable et etayee par la recherche existante, elle necessitera une nouvelle insistance sur la conception d'interventions en sante des populations qui rendent une telle reaffectation politiquement rentable. MOTS CLES : etablissement de priorites; allocation de ressources; determinants sociaux de la sante La traduction du resume se trouve a la fin de l'article. Can J Public Health 2016;107(1):e130-e132 doi: 10.17269/CJPH.107.5184, There are several reasons to contain Canada's medical care spending. These include: i) efficiency considerations reveal we are not getting bang for our buck; ii) medical care is a modest [...]

Problem The Chinese central government launched the Health System Reform Plan in 2009 to strengthen disease control and health promotion and provide a package of basic public health services. Village doctors receive a modest subsidy for providing public health services associated with the package. Their beliefs about this subsidy and providing public health services could influence the quality and effectiveness of preventive health services and disease surveillance. Approach To understand village doctors' perspectives on the subsidy and their experiences of delivering public health services, we performed 10 focus group discussions with village doctors, 12 in-depth interviews with directors of township health centres and 4 in-depth interviews with directors of county-level Centers for Disease Control and Prevention. Local setting The study was conducted in four counties in central China, two in Hubei province and two in Jiangxi province. Relevant changes Village doctors prioritize medical services but they do their best to manage their time to include public health services. The willingness of township health centre directors and village doctors to provide public health services has improved since the introduction of the package and a minimum subsidy, but village doctors do not find the subsidy to be sufficient remuneration for their efforts. Lessons learnt Improving the delivery of public health services by village doctors is likely to require an increase in the subsidy, improvement in the supervisory relationship between village clinics and township health centres and the creation of a government pension for village doctors. Probleme Le gouvernement central chinois a lance le plan de reforme du systeme de sante en 2009 pour renforcer la lutte contre les maladies et l'amelioration de la sante, et pour fournir un paquet de services de base en termes de sante publique. Les medecins de village recoivent une subvention modeste pour offrir des services de sante publique lies a ce paquet. Leurs opinions sur cette subvention et la fourniture de services de sante publique pourraient avoir une influence sur la qualite et l'efficacite des services de sante preventive et sur la surveillance des maladies. Approche Pour comprendre les perspectives des medecins de village sur la subvention et leur experience dans le domaine de la fourniture les medecins de village dans les provinces du Hubei et du de services de sante publique, nous avons organise 10 discussions de groupe cible avec des medecins de village, 12 entrevues approfondies avec des directeurs de centres de sante cantonaux et 4 entrevues approfondies avec des directeurs departementaux de centres pour la lutte et la prevention des maladies. Environnement local L'etude a ete effectuee dans quatre comtes du centre de la Chine, deux dans la province de Hubei et deux dans la province du Jiangxi. Changements significatifs Les medecins de village donnent la priorite aux services medicaux, mais ils font de leur mieux pour gerer leur temps de maniere a inclure les services de sante publique. La volonte des directeurs de centres de sante cantonaux et des medecins de village d'offrir des services de sante publique s'est accrue depuis l'introduction du paquet et d'une subvention minimale, mais les medecins de village ne considerent pas que cette subvention constitue une remuneration suffisante pour leurs efforts. Lecons tirees Il est possible que l'amelioration de la fourniture de services de sante publique par les medecins de village necessite une augmentation de la subvention, l'amelioration de la relation de supervision entre cliniques de village et centres de sante cantonaux et la creation d'une pension gouvernementale pour les medecins de village. Situacion En el ano 2009, el gobierno central chino puso en marcha el plan de reforma del sistema sanitario con el objetivo de reforzar el control de las enfermedades y fomentar la salud, asi como proporcionar un paquete de servicios basicos de salud publica. Los medicos rurales perciben una modesta subvencion por la prestacion de los servicios de salud publica relacionados con dicho paquete. Sus opiniones acerca de dicha subvencion y la prestacion de los servicios de salud publica podrian influir en la calidad y la eficacia de los servicios sanitarios preventivos y de la vigilancia de las enfermedades. Enfoque Con objeto de comprender los puntos de vista de los medicos rurales acerca de la subvencion y sus experiencias en la prestacion de servicios sanitarios, hemos llevado a cabo 10 debates con grupos focales de medicos rurales, 12 entrevistas en detalle con directores de centros de salud municipales y 4 entrevistas en detalle con directores de Centros para el Control y Prevencion de las Enfermedades provinciales. Marco regional El estudio se llevo a cabo en cuatro condados del centro de China, dos de ellos en la provincia de Hubei y otros dos en la de Jiangxi. Cambios importantes Los medicos rurales dan prioridad a los servicios medicos, pero hacen todo lo posible por gestionar su tiempo a fin de incluir los servicios de salud publica. La disposicion de los directores de los centros sanitarios municipales y de los medicos rurales para prestar los servicios de salud publica ha aumentado desde la introduccion del paquete y de la subvencion minima, si bien los medicos rurales no consideran que sea una retribucion suficiente por sus esfuerzos. Lecciones aprendidas Es probable que, para mejorar la prestacion de servicios de salud publica por parte de los medicos rurales, sea necesario un aumento de la subvencion, una mejora en la relacion de supervision entre las clinicas rurales y los centros de salud municipales, asi como la creacion de una pension gubernamental para los medicos rurales., Introduction In rural China, health services are delivered through a three-tiered system of village clinics, township health centres and county hospitals. (1) Village clinics are at the bottom tier, where [...]

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1468-0009.2009.00556.x Byline: ROGAN KERSH (1) Keywords: Obesity politics; issue framing; calorie labeling; school nutrition; foods of minimal nutritional value (FMNV); reformulation; issue regime Abstract: Context: The continuing rise in obesity rates across the United States has proved impervious to clinical treatment or public health exhortation, necessitating policy responses. Nearly a decade's worth of political debates may be hardening into an obesity issue regime, comprising established sets of cognitive frames, stakeholders, and policy options. Methods: This article is a survey of reports on recently published studies. Findings: Much of the political discussion regarding obesity is centered on two 'frames,' personal-responsibility and environmental, yielding very different sets of policy responses. While policy efforts at the federal level have resulted in little action to date, state and/or local solutions such as calorie menu labeling and the expansion of regulations to reduce unhealthy foods at school may have more impact. Conclusions: Obesity politics is evolving toward a relatively stable state of equilibrium, which could make comprehensive reforms to limit rising obesity rates less feasible. Therefore, to achieve meaningful change, rapid-response research identifying a set of promising reforms, combined with concerted lobbying action, will be necessary. Author Affiliation: (1)New York University Article note: Address correspondence to: Rogan Kersh, NYU Wagner School, 295 Lafayette Street, New York, NY 10012 (email: rk79@nyu.edu).

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1468-0009.2009.00552.x Byline: JENNIFER L. POMERANZ (1), STEPHEN P. TERET (1), STEPHEN D. SUGARMAN (1), LAINIE RUTKOW (1), KELLY D. BROWNELL (1) Keywords: Food; obesity; law; marketing; addiction; litigation; regulation; preemption Abstract: Context: The law is a powerful public health tool with considerable potential to address the obesity issue. Scientific advances, gaps in the current regulatory environment, and new ways of conceptualizing rights and responsibilities offer a foundation for legal innovation. Methods: This article connects developments in public health and nutrition with legal advances to define promising avenues for preventing obesity through the application of the law. Findings: Two sets of approaches are defined: (1) direct application of the law to factors known to contribute to obesity and (2) original and innovative legal solutions that address the weak regulatory stance of government and the ineffectiveness of existing policies used to control obesity. Specific legal strategies are discussed for limiting children's food marketing, confronting the potential addictive properties of food, compelling industry speech, increasing government speech, regulating conduct, using tort litigation, applying nuisance law as a litigation strategy, and considering performance-based regulation as an alternative to typical regulatory actions. Finally, preemption is an overriding issue and can play both a facilitative and a hindering role in obesity policy. Conclusions: Legal solutions are immediately available to the government to address obesity and should be considered at the federal, state, and local levels. New and innovative legal solutions represent opportunities to take the law in creative directions and to link legal, nutrition, and public health communities in constructive ways. Author Affiliation: (1)Yale University; Johns Hopkins University; University of California at Berkeley Article note: Address correspondence to: Jennifer L. Pomeranz, Rudd Center for Food Policy and Obesity, Yale University, 309 Edwards St., Box 208369, New Haven, CT (email: jennifer.pomeranz@yale.edu).

I present a historical study of the role played by the World Health Organization and UNICEF in the emergence and diffusion of the concept of primary health care during the late 1970s and early 1980s. I have analyzed these organizations' political context, their leaders, the methodologies and technologies associated with the primary health care perspective, and the debates on the meaning of primary health care. These debates led to the development of an alternative, more restricted approach, known as selective primary health care. My study examined library and archival sources; I cite examples from Latin America.

The authors' 1990 article 'Producing Health, Consuming Health Care' presented a conceptual framework for synthesizing a rapidly growing body of findings on the nonmedical determinants of health. The article received a very positive response, and here the authors reflect on what lessons might be learned from that response about the style or content of effective interdisciplinary communication. Much substantive knowledge has been accumulated since 1990, and a number of different frameworks have been developed before and since. The authors situate theirs within this literature and consider how they might have modified it if they 'knew then what they know now.' They ask what impact this article, and the much broader stream of research on the determinants of health, has had on public policy? (Am J Public Health. 2003;93:371-379)

In El Salvador, efforts to put the public health system into private hands have provoked a wave of opposition: Last September 18, unionized doctors and workers at the Social Security [...]

Objectives. The goal of this study was to describe how the tobacco industry collects information about public health groups. Methods. Publicly available internal tobacco industry documents were reviewed and analyzed using a chronological case study approach. Results. The industry engaged in aggressive intelligence gathering, used intermediaries to obtain materials under false pretenses, sent public relations spies to the organizations' meetings, and covertly taped strategy sessions. Other industry strategies included publicly minimizing the effects of boycotts, painting health advocates as 'extreme,' identifying and exploiting disagreements, and planning to 'redirect the funding' of tobacco control organizations to other purposes. Conclusions. Public health advocates often make light of tobacco industry observers, but industry surveillance may be real, intense, and covert and may obstruct public health initiatives.

Government efforts to protect public health often include controlling health information. The government may proscribe messages conveyed by commercial entities (e.g., false or misleading), recommend messages from commercial entities (e.g., warnings and safety instructions), and convey health messages (e.g., health communication campaigns). Through well-developed, albeit evolving, case law, government control of private speech has been constrained to avoid impinging on such values as free expression, truthfulness, and autonomous decision making. No simple legal framework has been developed for the government's own health messages to mediate between the legitimate goals of health protection and these other values. Nevertheless, government recommendations on matters of health raise difficult social and ethical questions and involve important societal trade-offs. Accordingly, this article proposes legal and ethical principles relating to government control of the health information environment.

This paper models the prevailing political attack on government as a heuristic, a judgmental strategy that simplifies complex phenomena by applying simple tests to a limited set of relevant data. The heuristic of market individualism offers three tools for analyzing the problems of governing: the supremacy of the free market as a regulatory device, a belief in individual freedom of choice and personal responsibility, and the elevation of individual satisfaction as the chief goal of society. Because public health is inherently concerned with the health of the population rather than individual health, because the market itself is a major source of ill health, and because individual choice is socially mediated, use of the heuristic precludes the recognition of the value of public health work. Although some degree of accommodation to current political realities is a practical necessity, public health advocates must not neglect the task of fashioning radically different alternative visions over the long term. (Am J Public Health. 1997;87:1607-1610)