Search

Healthy public policy and its potential Public policies, defined here as policies formulated at any level of government) have been key in bringing about some of the great public health [...], Public policy plays a key role in improving population health and in the control of diseases, including non- communicable diseases. However, an evidence-based approach to formulating healthy public policy has been difficult to implement, partly on account of barriers that hinder integrated work between researchers and policy-makers. This paper describes a 'policy effectiveness- feasibility loop'(PEFL) that brings together epidemiological modelling, local situation analysis and option appraisal to foster collaboration between researchers and policy-makers. Epidemiological modelling explores the determinants of trends in disease and the potential health benefits of modifying them. Situation analysis investigates the current conceptualization of policy, the level of policy awareness and commitment among key stakeholders, and what actually happens in practice, thereby helping to identify policy gaps. Option appraisal integrates epidemiological modelling and situation analysis to investigate the feasibility, costs and likely health benefits of various policy options. The authors illustrate how PEFL was used in a project to inform public policy for the prevention of cardiovascular diseases and diabetes in four parts of the eastern Mediterranean. They conclude that PEFL may offer a useful framework for researchers and policy-makers to successfully work together to generate evidence-based policy, and they encourage further evaluation of this approach. La politique publique joue un role cle dans l'amelioration de la sante de la population et dans la lutte contre les maladies, notamment les maladies non transmissibles. il a cependant ete difficile de mettre en ceuvre une approche fondee sur des preuves pour formuler une politique publique saine, en partie en raison des barrieres qui entravent le travail integre entre chercheurs et decideurs. Cet article decrit une <> (PEFL) reunissant la modelisation epidemiologique, ranalyse de la situation locale et revaluation des options afin de favoriser la collaboration entre chercheurs et decideurs. La modelisation epidemiologique explore les determinants des evolutions de maladie et les avantages sanitaires potentiels resultant de leur modification. L'analyse de situation etudie la conceptualisation actuelle de la politique, le niveau de conscience politique et rengagement des principaux intervenants, et ce qui se passe reellement dans la pratique, aidant ainsi a identifier les lacunes de la politique. L'evaluation des options integre la modelisation epidemiologique et l'analyse de situation pour etudier la faisabilite, les couts et les avantages sanitaires potentiels de diverses options politiques. Les auteurs montrent comment la PEFL a ete utilisee dans un projet visant a eclairer la politique publique sur la prevention des maladies cardiovasculaires et du diabete dans quatre regions de la Mediterranee orientale. IIs concluent que la PEFL peut offrir un cadre utile, permettant aux chercheurs et aux decideurs de reussir a travailler ensemble pour creer une politique basee sur des preuves, et lis encouragent une evaluation plus approfondie de cerre approche. Las politicas publicas desempenan un papel fundamental en la mejora de la salud de la pobladon y el control de enfermedades, incluidas las enfermedades no transmisibles. Sin embargo, ha sido dificil implementar un enfoque basado en datos probatorios para formular una politica sanitaria publica, debido en parte a los obstaculos que impiden el trabajo integrado entre investigadores y legisladores. El presente documento describe una politica de circuito cerrado eficacia-viabilidad (PEFL, por sus siglas en ingles) que reune la modelizacion epidemiologica, el analisis de la situacion local y la valoracion de las opciones para promover la colaboracion entre investigadores y legisladores. El modelo epidemiologico examina los factores determinantes de las tendencias de una enfermedad y los beneflcios sanitarios posibles resultantes de una modificacion de los mismos. El analisis de la situadon investiga la conceptualizacion actual de la politica, el nivel de conciencia y compromiso con esa politiica entre Jas partes clave interesadas y lo que sucede en la practica, ayudando, por tanto, a identificar las lagunas en la politica. La valoracion de las opdones integra el modelo epidemiologico y el analisis de la situacion para averiguar la viabilidad, los costes y los beneflcios sanitarios posibles de varias politicas posibles. Los autores ilustran como se empleo el PEFL en un proyecto para informar acerca de una politica publica para la prevencion de enfermedades cardiovasculares y diabetes en cuatro areas dei Mediterraneo Oriental. Concluyen que el PEFL puede ofrecer un marco util a los investigadores y legisladores para trabajar con exito juntos con objeto de crear una politica basada en datos probatorios, y animan a seguir evaluando dicho enfoque.

An epidemiological study of the impact of industrial pollution from a coking works in north-east England on the health of a population resident nearby uncovered strong but localised public concern about the possible dangers of air pollution. This paper discusses these popular concerns in the context of empirical findings from the study which examined evidence of ill-health alongside evidence on air quality levels. The substantive issues this paper examines relate to local variations in popular beliefs about health risks, and the relation between such beliefs and measurable differences in health states and status. The methodological issues addressed centre on the difficulties of interpreting this relationship between popular beliefs and concerns, on the one hand, and health experience, or apparent health experience, on the other. Key words - environmental controversy, public views, health status, health risk

Previous research has indicated that, while large parts of Middlesbrough and Sunderland appear to be equally severely deprived, premature mortality in the early 1980s was substantially worse in Middlesbrough. Postcoded mortality data from 1975 to 1986 were assembled, to ascertain whether this disparity reflected a temporary or consistent difference between these two towns. In addition, to enable detailed consideration of the differentials in premature mortality, data on cause of death for 23 cause-groups were assembled for the 6-year period 1978 to 1983. The results show that, throughout the 12-year period, death rates below the age of 65 years in Middlesbrough's poorer areas consistently exceeded death rates in comparable areas of Sunderland by a large margin. This disparity is demonstrated to affect both sexes and all age-groups below 65. Middlesbrough's excess mortality was evident for most causes of death (19 out of 22 causes among men, and 16 out of 23 causes among women), with cerebrovascular disease and genitourinary malignancy among women being the only major exceptions. Possible explanations for this wide difference are considered. The conclusions of research in Lancashire, suggesting that the antecedents of present differences may be found in infant health disparities from the 1920s and 1930s, do not seem to apply in this instance. The possibility that unmeasured differences in levels of poverty or the suddenness of its onset may be contributory influences remains problematic. Individual lifestyle is not considered a plausible explanation, but possible differences in the provision and use of health services between the two towns are thought worthy of closer investigation. It is also suggested that environmental differences, in terms of the built environment and atmospheric pollutants, require closer scrutiny. Key words--inequalities in health, premature mortality, social deprivation.

Abstract Background The objective was to examine how the indigenous naming, indigenous self-diagnosis and management of diabetes evolved with awareness in order to develop a socially oriented theoretical model for its care. Methods The data was collected through a one-year extended participant observation in Bafut, a rural health district of Cameroon. The sample consisted of 72 participants in a rural health district of Cameroon (men and women) with type 2 diabetes. We used participant observation to collect data through focus group discussions, in depth interviews and fieldwork conversations. The method of analysis entailed a thick description, thematic analysis entailing constant comparison within and across FGD and across individual participants and content analysis. Results The core concepts identified were the evolution of names for diabetes and the indigenous diagnostic and self-management procedures. Participants fell into one of two naming typologies: (a) Naming excluding any signs and symptoms of diabetes; (b) naming including signs and symptoms of diabetes. Participants fell into two typologies of diagnostic procedures: (a) those that use indigenous diagnostic procedures for monitoring and controlling diabetes outcomes and b) those that had initially used it only for diagnosis and continued to use them for self management. These typologies varied according to how participants' awareness evolved and the impact on self-diagnosis and management. Conclusion The evolution of names for diabetes was an important factor that influenced the subsequent self-diagnosis and management of diabetes in both traditional and modern biomedical settings.

Abstract Background The objective of the study was to explore the cultural aspect of compliance, its underlying principles and how these cultural aspects can be used to improve patient centred care for diabetes in Cameroon. Methods We used participant observation to collect data from a rural and an urban health district of Cameroon from June 2001 to June 2003. Patients were studied in their natural settings through daily interactions with them. The analysis was inductive and a continuous process from the early stages of fieldwork. Results The ethnography revealed a lack of basic knowledge about diabetes and diabetes risk factors amongst people with diabetes. The issue of compliance was identified as one of the main themes in the process of treating diabetes. Compliance emerged as part of the discourse of healthcare providers in clinics and filtered into the daily discourses of people with diabetes. The clinical encounters offered treatment packages that were socially inappropriate therefore rejected or modified for most of the time by people with diabetes. Compliance to biomedical therapy suffered a setback for four main reasons: dealing with competing regimes of treatment; coming to terms with biomedical treatment of diabetes; the cost of biomedical therapy; and the impact of AIDS on accepting weight loss as a lifestyle measure in prescription packages. People with diabetes had fears about and negative opinions of accepting certain prescriptions that they thought could interfere with their accustomed social image especially that which had to do with bridging their relationship with ancestors and losing weight in the era of HIV/AIDS. Conclusion The cultural pressures on patients are responsible for patients' partial acceptance of and adherence to prescriptions. Understanding the self-image of patients and their background cultures are vital ingredients to improve diabetes care in low-income countries of Sub-Sahara Africa like Cameroon.

This analysis challenges a tendency in public health and the social sciences to associate India's medical pluralism with a distinction between biomedicine, as a homogeneous entity, and its non-biomedical 'others'. We argue that this overdrawn dichotomy obscures the important part played by 'informal' biomedical practice, an issue with salience well beyond India. Based on a qualitative study in rural Andhra Pradesh, South India, we focus on a figure little discussed in the academic literature - the Registered Medical Practitioner ( RMP) - who occupies a niche in the medical market-place as an informal exponent of biomedical treatment. We explore the significance of these practitioners by tracking diagnosis and treatment of one increasingly prominent medical 'condition', namely diabetes. The RMP, who despite the title is rarely registered, sheds light on the supposed formal-informal sector divide in India's healthcare system, and its permeability in practice. We develop our analysis by contrasting two distinctive conceptualisations of 'informality' in relation to the state in India - one Sarah Pinto's, the other Ananya Roy's. [ABSTRACT FROM AUTHOR]