Evidence-based public health: what does it offer developing countries?

The global burden of disease and illness is primarily situated in developing countries. As developing countries have limited resources, it is particularly important to invest in public health and health promotion strategies that are effective. Systematic reviews are central to evidence-based public health and health promotion practice and policy. This paper discusses issues surrounding the relevance of evidence-based public health and systematic reviews to the health of developing countries. It argues that there is a lack of systematic reviews relevant to the health priorities of developing countries; many interventions reviewed can not be implemented in resource-poor situations; and, a limited amount of primary research is conducted in developing countries. The paper further argues that improvements in public health are determined not only by effective health services and interventions, but through an approach that includes other sectors and influences broader structural and systematic barriers to health. Given the social complexity of human development, and the inter-sections amongst different development goals, there is no question that gains in developing country public health are unlikely to emerge from systematic reviews alone, but will require decisions about inter-sectoral collaboration and social policy initiatives. Nonetheless, evidence around intervention effectiveness has an important role to play in addressing health priorities in developing countries and resource-poor areas. The public health evidence base urgently needs strengthening, with dedicated effort towards increasing the relevance of primary evidence and systematic reviews.

Sustainability and health : supporting global ecological integrity in public health

Radical changes in the biosphere and human interaction with the environment are increasingly impacting on the health of populations across the world. Diseases are crossing the species barrier, and spreading rapidly through globalized transport systems. From new patterns of cancer to the threat of global pandemics, it is imperative that public health practitioners acknowledge the interdependence between the sustainability of the environment and the sustainability of the human species.* Why are issues of global and local sustainability of increasing importance to the public's health?* Why do issues of sustainability require new practices within the professions of public health?* How can future and current public health practitioners develop those new practices?Drawing on scientific evidence of global and local environmental changes, Sustainability and Health offers a thorough background and practical solutions to the overlapping issues in environment and health. It examines potential and existing responses to global and local environment and health issues, involving individuals, community, industry and government. The authors introduce a range of emerging conceptual frameworks and theoretical perspectives, link IT and epidemiology and explain how scoping can link program design, delivery, data collection and evaluation in projects from their very beginning. Public health practitioners need to be able to manage health issues that cut across environmental, economic and social systems and to develop the capacity for leadership in facilitating change. Incorporating learning activities, readings, international case studies and an open learning approach, this is a valuable resource for students of public and environmental health, as well as medical, environmental and health science professionals.

Public health

Public health is crucial for the promotion and protection of health. Links between preventive action and improved health status (eg, in the case of smoking-related cancers, the decline in sudden infant death syndrome and rates of cardiovascular disease) present strong arguments for increased investment in public health infrastructure. The Public Health Education and Research Program has ensured a well-trained public health workforce to support national, state and local initiatives.

Knowledge synthesis, translation and exchange in public health and health promotion: the role of a Cochrane review group

The Cochrane Collaboration is an international non-profit organisation that aims to produce high quality systematic reviews of the effectiveness of health interventions. This work is conducted by 51 Review Groups that span a  range of topics (e.g. pregnancy and childbirth, HIV/AIDS). The role of Fields within the Collaboration has been to actively engage relevant stakeholders internationally to improve the quality and relevance of reviews. Since the inception in 1996 of the Cochrane Public Health and Health Promotion Field, the Cochrane Collaboration has begun to embrace reviews related to public health and health promotion and is adapting to the changing needs of end-users. The introduction of a Cochrane health promotion and public health review group will help ensure that reviews will be oriented towards building evidence for equity and reducing inequalities and best meet the needs of decision-makers, practitioners and consumers. Our role as a Field has led to us working with a range of partners including reviewers,  researchers, practitioners and consumers. Knowledge synthesis, translation and exchange (KST&E) has emerged as an issue in need of further  exploration for practice to influence decision-makers and for policy to  influence practitioners. 2007 will be an exciting year for evidence-informed Health Promotion and Public Health (HPPH) both within the Cochrane Collaboration and for our partners in policy, practice and research.

People, places and public health : evaluating the benefits of civic environmentalism in an urban local government context

Recent political, economic and social trends pose threats to the sustainability both of ecosystems and of human health. Australia’s environmental management record is poor, and while by international standards Australians enjoy good health, this is variable (AIHW, 2000). Within developed nations, heart disease, depression, alcohol dependence and stroke are major health issues (Mathers et al. 2002). In Australia, mental disorder is the number one contributor to the disease burden (Vos & Mathers 2000). Recent research has highlighted the role of social capital as a key determinant of health (Kawachi et al., 1997). Despite this, Putnam (1995) observes that social connectedness and civic engagement are in decline. People have less time for leisure and for volunteering, as many juggle paid work and caring for children. Anecdotal evidence suggests that engagement in civic environmentalism has human health benefits, relating to a combination of exposure to natural environments and increased social capital (Maller, Brown, Townsend & St. Leger, 2002). This link is supported by Furnass (1996) who defines well-being as including: satisfactory human relationships, meaningful occupation, opportunities for contact with nature, creative expression, and making a positive contribution to human society. Research conducted by Deakin University confirms the efficacy of linking people and places through civic environmentalism for addressing both ecosystem sustainability and human health and wellbeing. The research has included a pilot study to explore the human health benefits of membership of a local parkland ‘Friends’ group, and a more detailed follow-up study. The aims of the pilot study included:- To identify the range of motivations for joining the Friends group;- To document members’ perceptions of the benefits gained from membership of the group;- To assess the potential for Friends groups to be used as an ‘upstream’ health promotion measure.Face-to-face interviews were conducted with eleven members of a ‘Friends’ group in the eastern suburbs of Melbourne. Data was analysed thematically and key findings included:- Motivations: environmental; social; and pragmatic.- General benefits: community belonging; personal satisfaction; learning opportunities; physical activity; and better environment.- Health benefits: physical health; mental health; and social support. There was unanimous support for the use of ‘Friends’ groups as a tool for health promotion.The follow-up study, in the western suburbs of Melbourne, expanded on the pilot study by measuring the group’s social capital and by collecting self-report data on levels of health service usage. Data was collected through face-to-face interviews and a questionnaire. The findings were similar to the pilot study in relation to the motivations, benefits and the health promotion potential of such groups. However, health service usage data highlighted an apparent anomaly: while respondents perceived significant health benefits, some were nevertheless utilising health services at a relatively high level. This poses some questions requiring further exploration: Is this due to the poorer baseline health of the high health service usage members compared with their fellow members? Does involvement in the group offer health benefits that enable people who would otherwise be too unhealthy to participate in community groups to continue such involvement?If this is the case, then we may do well to look to locally-based mechanisms for promoting ecological sustainability as a tool also for promoting human health. Instead of prescribing a pill, connecting people and places through engagement with a local friends group may address our health problems at the same time as addressing local environmental problems.

Strategies for bridging sectors and silos : a training model in mental health promotion

Issue addressed: The determinants of individual and community mental health and wellbeing are diverse and many lie outside the sphere of action of the health sector. Developing the confidence and skills of these other sectors to contribute to improved mental health has been identified as a priority at State and national levels that requires the development of specific workforce capacity-building strategies. Methods: VicHealth developed and implemented a two day short course to raise the capacity of organisations from a range of sectors to contribute to the mental health and wellbeing of communities. The model of this short course was constructed to reflect the diverse sectors targeted, which included health, local government, community arts, sport and recreation, justice, and education. Results: Evaluation of the two year pilot program, with more than 1,000 participants, has identified a high degree of satisfaction with the content and delivery model of the course, with clear changes in knowledge, skills and practice having been achieved. Cross-sector understanding and collaborations between participants increased as a result of the course. Conclusions: Continuing demand for the course demonstrates clearly that mental health and well-being is relevant to the core business of a broad range of community and professional organisations. The course has increased the confidence and capacity of these sector representatives to take action on mental health as well as increased cross-sector dialogue and partnerships. The recruitment of trainers from diverse sectors was successful in promoting a key component of the program, which was the message that mental health promotion should be the business of all sectors.

The contribution of psychological assessment to community mental health services

Specialist psychological assessment plays a potentially important role in multidisciplinary community mental health settings. This portfolio describes and evaluates this psychological assessment and provides four case studies.

Implementation strategies and effectiveness of nutritional messages for improving health

There are missed opportunities for General Practitioners to assist overweight patients with dietary and exercise weight management and additional assistance may be required. An online weight loss program has potential, although no difference in weight loss was observed whether the participants received exercise advice only or exercise plus dietary advice.

Health-related empowerment in cancer: validity of scales from the health education impact questionnaire

Empowerment refers to an individual's feelings of being able to manage the challenges of the cancer experience and of having a sense of control over one's life. However, empowerment questionnaires that have been validated for the cancer setting are lacking. The objective of this study was to validate scales from the Health Education Impact Questionnaire (heiQ), which assesses the effects of health education programs among individuals with chronic conditions. The heiQ scales Social integration and support, Health service navigation, Constructive attitudes and approaches, Skill and technique acquisition, and Emotional distress were identified as key dimensions of empowerment for the cancer context.

Experiences of racism, racial/ethnic attitudes, motivated fairness and mental health outcomes among primary and secondary school students

While studies investigating the health effects of racial discrimination for children and youth have examined a range of effect modifiers, to date, relationships between experiences of racial discrimination, student attitudes, and health outcomes remain unexplored. This study uniquely demonstrates the moderating effects of vicarious racism and motivated fairness on the association between direct experiences of racism and mental health outcomes, specifically depressive symptoms and loneliness, among primary and secondary school students. Across seven schools, 263 students (54.4% female), ranging from 8 to 17 years old (M = 11.2, SD = 2.2) reported attitudes about other racial/ethnic groups and experiences of racism. Students from minority ethnic groups (determined by country of birth) reported higher levels of loneliness and more racist experiences relative to the majority group students. Students from the majority racial/ethnic group reported higher levels of loneliness and depressive symptoms if they had more friends from different racial/ethnic groups, whereas the number of friends from different groups had no effect on minority students' loneliness or depressive symptoms. Direct experiences of racism were robustly related to higher loneliness and depressive symptoms in multivariate regression models. However, the association with depressive symptoms was reduced to marginal significance when students reported low motivated fairness. Elaborating on the negative health effects of racism in primary and secondary school students provides an impetus for future research and the development of appropriate interventions.

The use of kernel density estimation to examine associations between neighborhood destination intensity and walking and physical activity

BACKGROUND: Local destinations have previously been shown to be associated with higher levels of both physical activity and walking, but little is known about how the distribution of destinations is related to activity. Kernel density estimation is a spatial analysis technique that accounts for the location of features relative to each other. Using kernel density estimation, this study sought to investigate whether individuals who live near destinations (shops and service facilities) that are more intensely distributed rather than dispersed: 1) have higher odds of being sufficiently active; 2) engage in more frequent walking for transport and recreation. METHODS: The sample consisted of 2349 residents of 50 urban areas in metropolitan Melbourne, Australia. Destinations within these areas were geocoded and kernel density estimates of destination intensity were created using kernels of 400m (meters), 800m and 1200m. Using multilevel logistic regression, the association between destination intensity (classified in quintiles Q1(least)-Q5(most)) and likelihood of: 1) being sufficiently active (compared to insufficiently active); 2) walking≥4/week (at least 4 times per week, compared to walking less), was estimated in models that were adjusted for potential confounders. RESULTS: For all kernel distances, there was a significantly greater likelihood of walking≥4/week, among respondents living in areas of greatest destinations intensity compared to areas with least destination intensity: 400m (Q4 OR 1.41 95%CI 1.02-1.96; Q5 OR 1.49 95%CI 1.06-2.09), 800m (Q4 OR 1.55, 95%CI 1.09-2.21; Q5, OR 1.71, 95%CI 1.18-2.48) and 1200m (Q4, OR 1.7, 95%CI 1.18-2.45; Q5, OR 1.86 95%CI 1.28-2.71). There was also evidence of associations between destination intensity and sufficient physical activity, however these associations were markedly attenuated when walking was included in the models. CONCLUSIONS: This study, conducted within urban Melbourne, found that those who lived in areas of greater destination intensity walked more frequently, and showed higher odds of being sufficiently physically active-an effect that was largely explained by levels of walking. The results suggest that increasing the intensity of destinations in areas where they are more dispersed; and or planning neighborhoods with greater destination intensity, may increase residents' likelihood of being sufficiently active for health.

Patterns of sedentary behaviour and cardiovascular health in children

 Children engaged in high levels of sedentary time, particularly during class and leisure time. Different types of screen behaviours and patterns of sitting time were adversely associated with cardiovascular health. Not all screen behaviours may be equal and the way sitting time is accumulated may be important to cardiovascular health.

Identifying educational priorities for occupational therapy students to prepare for mental health practice in Australia and New Zealand: opinions of practising occupational therapists

BACKGROUND: The effective preparation of occupational therapy students for mental health practice is critical to facilitate positive consumer outcomes, underpin optimal practice and support new graduates' professional identity. This project was established to determine a set of 'educational priorities' for occupational therapy students to prepare them for current (and future) entry-level practice in mental health, from the perspective of mental health occupational therapists in Australia and New Zealand. METHODS: The study included two phases. In Phase One, participants identified what they considered to be important educational priorities for occupational therapy students to prepare them for practice in mental health. For Phase Two, an 'expert panel' was assembled to review and rank these using a Policy Delphi approach. RESULTS: Eighty-five participants provided educational priorities in Phase One. These were grouped into a total of 149 educational themes. In Phase Two, the expert panel (consisting of 37 occupational therapists from diverse locations and practice settings) prioritised these themes across three Delphi rounds. A final priority list was generated dividing educational themes into three prioritised categories: 29 'Essential', 25 'Important' and 44 'Optional' priorities. Highest-ranked priorities were: clinical reasoning, client-centred practice, therapeutic use of self, functional implications of mental illness, therapeutic use of occupation and mental health fieldwork experience. CONCLUSION: The priority list developed as part of this project provides additional information to support the review of occupational therapy curricula across Australia and New Zealand to ensure that new graduates are optimally prepared for mental health practice.