Public policy for pensions, health and sickness insurance

Includes bibliography

An assessment of the economic impact of climate change on the health sector In Guyana

Climate change is considered to be the most pervasive and truly global of all issues affecting humanity. It poses a serious threat to the environment, as well as to economies and societies. Whilst it is clear that the impacts of climate change are varied, scientists have agreed that its effects will not be evenly distributed and that developing countries and small island developing States (SIDS) will be the first and hardest hit. Small island developing States, many of whom have fewer resources to adapt socially, technologically and financially to climate change, are considered to be the most vulnerable to the potential impacts of climate change. An economic analysis of climate change can provide essential input for identifying and preparing policies and strategies to help move the Caribbean closer to solving the problems associated with climate change, and to attaining individual and regional sustainable development goals. Climate change is expected to affect the health of populations. In fact, the World Health Organization (WHO), in Protecting Health from Climate Change (2008), states that the continuation of current patterns of fossil fuel use, development and population growth will lead to ongoing climate change, with serious effects on the environment and, consequently, on human lives and health. Assessing the economics of potential health impacts of climate variability and change requires an understanding of both the vulnerability of a population and its capacity to respond to new conditions. The Intergovernmental Panel on Climate Change (IPCC) defines vulnerability as the degree to which individuals and systems are susceptible to, or unable to cope with, the adverse effects of climate change, including climate variability and extremes (WHO and others, 2003). The United Nations Economic Commission for Latin America and the Caribbean (ECLAC), in collaboration with the Caribbean Community Centre for Climate Change (CCCCC), is pursuing a regional project to ―Review the Economics of Climate Change in the Caribbean‖ (RECCC). The purpose of the project is to assess the likely economic impacts of climate change on key sectors of Caribbean economies, through applying robust simulation modelling analyses under various socio-economic scenarios and carbon emission trajectories for the next 40 years. The findings are expected to stimulate local and national governments, regional institutions, the private sector and civil society to craft and implement policies, cost-effective options and efficient choices to mitigate and adapt to climate change.

Report of the second expert group meeting on the development account supported project in MDG/IADG monitoring in the Caribbean

The Economic Commission for Latin America and the Caribbean (ECLAC), Subregional Headquarters for the Caribbean, held a two-day expert group meeting on Millennium Development Goals (MDG) monitoring and reporting with a particular focus on health-related indicators in Port of Spain, Trinidad and Tobago, on 16-17 June 2009. This meeting was convened within the framework of the United Nations Development Account-funded project ‘Strengthening the Capacity of National Statistical Offices in the Caribbean Small Island Developing States to fulfil the Millennium Development Goals (MDGs) and other Internationally Agreed Development Goals (IADGs)’.

Planting coconuts in Indian villages: ethnoecological aspects and evaluation of a "sustainable development" project

Apesar de cientistas e tomadores de decisão abraçarem o conceito geral de "desenvolvimento sustentável", há pouco acordo sobre como se atingir esta meta em situações específicas. Assim, projetos de desenvolvimento sustentável são amplamente criticados por etno-cientistas quanto à forma como são inter-culturalmente formulados. Aqui reportamos um caso controverso de plantio de coco-da-Bahia em aldeias Kayapó do sul do Pará, e fazemos a nossa autocrítica. Nós partimos da premissa de que o reflorestamento e o estado geral de saúde/nutrição caminham lado a lado. Portanto, o desenvolvimento da cultura de cocos por si só deve contribuir para a conservação da floresta no longo prazo e, simultaneamente, contribuir para o bom estado nutricional do povo Kayapó que protege a floresta da ameaça de práticas não-sustentáveis. Nós buscamos descobrir como que o comportamento dos Kayapó afeta o desenvolvimento da cultura de cocos quando amparada com suporte externo. Nós apresentamos resultados de duas viagens de campo para a terra Kayapó, onde detectamos fatores sócio-ecológicos relevantes para o sucesso de nosso projeto de apoio à cultura de coqueiros nas aldeias indígenas. Primeiro, em novembro de 2007, nós visitamos as aldeias Kikretum, Moikarakô e Aukre (dentre 10 aldeias que receberam mudas de coqueiros de nosso programa de apoio) para entregar um segundo carregamento de mudas de coqueiro (o primeiro carregamento aconteceu em abril de 2006). E descrevemos quantitativamente um aspecto do comportamento dos dispersores de sementes de coco (os Kayapó). Especificamente, como as palmeiras pré-existentes nas aldeias são distribuídas dentre as famílias dos índios e como este carregamento sobreviveu a fatores etno-ecológicos. Segundo, em julho de 2008 nós visitamos as aldeias Kokraimoro e Pykararankre e estimamos a posição dos coqueiros pré-existentes e dos novos em relação a outras árvores cultivadas, fazendo uso de censos partindo do centro das aldeias para seus limites exteriores. Nas três aldeias indígenas visitadas em 2007, virtualmente todos os coqueiros pré-existentes pertenciam a poucas famílias e a distribuição de frutos era, na maior parte dos casos, altamente concentrada dentre os membros destas famílias. Entretanto, assumindo que todos os coqueiros jovens que sobreviveram ao primeiro ano chegarão à maturidade (do primeiro carregamento em abril de 2006), eles representam um aumento considerável no numero projetado de coqueiros adultos nas três aldeias visitadas (48, 195 e 101% em Kikretum, Moikarakô e Aukre, respectivamente). E uma redução substancial na desigualdade de acesso aos cocos. Na expedição de 2008, encontramos que os índios geralmente plantam coqueiros bem próximos das suas casas onde a competição com outras árvores cultivadas podem limitar o desenvolvimento das palmeiras.

Bovine Tb Eradication Project – Recognizing Hot Button Issues

The Michigan Departments of Agriculture, Community Health, and Natural Resources, US Department of Agriculture (USDA) and Michigan State University work cooperatively together as the bovine TB eradication project partners. The interagency group combines expertise in epidemiology, veterinary and human medicine, pathology, wildlife biology, animal husbandry, regulatory law and policy and risk communications. The stakeholders, those impacted by the disease, include agriculture and tourism industry representatives, “Mom-and-Pop” businesses, hunters, wildlife enthusiasts, farmers, Local Health Departments and legislators. The regulatory agencies are the above mentioned project partners, excluding MSU and USDA Wildlife Services, both of which offer services to agencies and stakeholders. Eradicating bovine TB would not be difficult if there were no social issues surrounding it. The economy, hunting traditions, animal management, tourism and human health are all impacted by regulatory response to the disease. Often the social issues play a large role in decision making, therefore it is important to understand your clientele and anticipate public reaction to policy changes and requirements.

Use of policy, education, and enforcement to reduce binge drinking among university students: The NU Directions project

This paper describes a program, conducted over a 5-year period, that effectively reduced heavy drinking and alcohol-related harms among university students. The program was organized around strategies to change the environment in which binge drinking occurred and involved input and cooperation from officials and students of the university, representatives from the city and the neighborhood near the university, law enforcement, as well as public health and medical officials. In 1997, 62.5% of the university’s approximately 16,000 undergraduate student population reported binge drinking. This rate had dropped to 47% in 2003. Similar reductions were found in both self-reported primary and secondary harms related to alcohol consumption.

PHOTOGRAPHIC RECORDS — THEIR IMPORTANCE IN TODAY'S ENVIRONMENTALLY SENSITIVE BIRD MANAGEMENT PROGRAMS

We are living in a day of change. Environmental awareness is a part of our everyday life in a way unprecedented in history. The courts, in their infinite wisdom, have initiated the joint and several liability (deep pocket) rules that make everyone at risk in almost all situations. Bird management programs, by their very nature, are extremely sensitive. Any project, if not evaluated, planned, carried out, and documented properly can result in adverse regulatory agency action, bad publicity, and even fines or lawsuits. Proper photographic documentation can play a vital part in helping to provide the necessary records to help prevent problems and/or defend yourself in case of lawsuit or regulatory action. In the preparation of this paper, we surveyed state pesticide lead agencies, state Department of Conservation (Fish and Wildlife) agencies, some U.S. Fish and Wildlife Law Enforcement personnel, and several individuals to get their reaction to and their comments about this concept of supplemental recordkeeping. Of those responding, a majority thought the concept of supplemental photographic recordkeeping would be an asset to individuals and organi¬zations conducting bird management projects.

International collaborative project to compare and monitor the nutritional composition of processed foods

Background: Chronic diseases are the leading cause of premature death and disability in the world with overnutrition a primary cause of diet-related ill health. Excess energy intake, saturated fat, sugar, and salt derived from processed foods are a major cause of disease burden. Our objective is to compare the nutritional composition of processed foods between countries, between food companies, and over time. Design: Surveys of processed foods will be done in each participating country using a standardized methodology. Information on the nutrient composition for each product will be sought either through direct chemical analysis, from the product label, or from the manufacturer. Foods will be categorized into 14 groups and 45 categories for the primary analyses which will compare mean levels of nutrients at baseline and over time. Initial commitments to collaboration have been obtained from 21 countries. Conclusions: This collaborative approach to the collation and sharing of data will enable objective and transparent tracking of processed food composition around the world. The information collected will support government and food industry efforts to improve the nutrient composition of processed foods around the world.

Early and One-Year Stroke Case Fatality in Sao Paulo, Brazil: Applying the World Health Organization's Stroke STEPS

Case fatality rate is considered a main determinant of stroke mortality trends. We applied the World Health Organization's Stroke STEPS to identify case fatality rates in a community hospital in Brazil. We evaluated all patients with first-ever stroke seeking acute care at the hospital's emergency ward between April 2006 and December 2008 to verify early and late case fatality according to stroke subtype. We used years of formal education as a surrogate for socioeconomic status. Of 430 first-ever stroke events, 365 (84.9%) were ischemic and 65 (15.1%) were intracerebral hemorrhage. After 1 year, we adjudicated 108 deaths (86 ischemic; 22 hemorrhagic). Age-adjusted case fatality rates for ischemic stroke and intracerebral hemorrhage were 6.0% v 19.8% at 10 days, 10.6% v 22.1% at 28 days, 17.6% v 29.1% at 6 months, and 21.0% v 31.5% at 1 year. Illiteracy or no formal education was a predictor of death at 6 months (odds ratio [OR], 4.31; 95% confidence interval [CI] 1.34-13.91) and 1 year (OR, 4.21; 95% CI, 1.45-12.28) in patients with ischemic stroke, as well as at 6 months (OR, 3.19; 95% CI, 1.17-8.70) and 1 year (OR, 3.30; 95% CI, 1.30-8.45) for all stroke patients. Other variables, including previous cardiovascular risk factors and acute medical care, did not change this association to a statistically significant degree. In conclusion, case fatality, particularly up to 6 months, was higher in hemorrhagic stroke, and lack of formal education was associated with increased stroke mortality.

The impact of the medical speciality in primary health-care problem solving in Belo Horizonte, Brazil: homeopaths versus family doctors: a preliminary quantitative study

Introduction: This research project examined influence of the doctors' speciality on primary health care (PHC) problem solving in Belo Horizonte (BH) Brazil, comparing homeopathic with family health doctors (FH), from the management's and the patients' viewpoint. In BH, both FH and homeopathic doctors work in PHC. The index of resolvability (IR) is used to compare resolution of problems by doctors. Methods: The present research compared IR, using official data from the Secretariat of Health and test requests made by the doctors and 482 structured interviews with patients. A total of 217,963 consultations by 14 homeopaths and 67 FH doctors between 1 July 2006 and 30 June 2007 were analysed. Results: The results show significant differences greater problem resolution by homeopaths compared to FH doctors. Conclusion: In BH, the medical speciality, homeopathy or FH, has an impact on problem solving, both from the managers' and the patients' point of view. Homeopaths request fewer tests and have better IR compared with FH doctors. Specialisation in homeopathy is an independent positive factor in problem solving at PHC level in BH, Brazil. Homeopathy (2012) 101, 44-50.

Global health competencies for nurses in the Americas

This article reports the findings from an online survey of nursing faculty from the United States, Canada, Latin America, and Caribbean countries to identify their perceptions about global health competencies for undergraduate nursing students. A list of global health competencies for medical students developed by the Association of Faculties of Medicine of Canada Resource Group on Global Health and the Global Health Education Consortium was adapted for nurses and translated from English to Spanish and Portuguese. The competencies were divided into six subscales, and respondents rated each competency on a 4-point Likert scale, with high scores reflecting strong agreement that the competency was essential for undergraduate nursing students. E-mail invitations and links to the online survey were distributed using a nonprobability convenience sampling strategy. This article reports findings only from the respondents to the English and Spanish surveys. The final sample included 542 responses to the English survey and 51 responses to the Spanish survey. Cronbach's alpha reliability coefficients for the subscales ranged from .78 to .96. The mean values for all 6 subscales and for each of the 30 items were greater than 3.0 for the respondents to the Spanish survey, and the mean values for 27 of the items were greater than 3.0 for the respondents to the English survey. These findings suggest that respondents perceived the competencies as essential global health competencies for undergraduate nursing students in the Americas. Narrative comments written by respondents indicate additional competencies and specific concerns about adding additional content to an already full curricula. Results of this study can be used to guide faculty deliberations about global health competencies that should be incorporated in the nursing curricula.

Assessment of integration of the Leprosy Program into primary health care in Aracaju, State of Sergipe, Brazil

Introduction: The aim of this study was to assess the epidemiological and operational characteristics of the Leprosy Program before and after its integration into the Primary Healthcare Services of the municipality of Aracaju-Sergipe, Brazil. Methods: Data were drawn from the national database. The study periods were divided into preintegration (1996-2000) and postintegration (2001-2007). Annual rates of epidemiological detection were calculated. Frequency data on clinico-epidemiological variables of cases detected and treated for the two periods were compared using the Chi-squared (chi(2)) test adopting a 5% level of significance. Results: Rates of detection overall, and in subjects younger than 15 years, were greater for the postintegration period and were higher than rates recorded for Brazil as a whole during the same periods. A total of 780 and 1,469 cases were registered during the preintegration and postintegration periods, respectively. Observations for the postintegration period were as follows: I) a higher proportion of cases with disability grade assessed at diagnosis, with increase of 60.9% to 78.8% (p < 0.001), and at end of treatment, from 41.4% to 44.4% (p < 0.023); II) an increase in proportion of cases detected by contact examination, from 2.1% to 4.1% (p < 0.001); and III) a lower level of treatment default with a decrease from 5.64 to 3.35 (p < 0.008). Only 34% of cases registered from 2001 to 2007 were examined. Conclusions: The shift observed in rates of detection overall, and in subjects younger than 15 years, during the postintegration period indicate an increased level of health care access. The fall in number of patients abandoning treatment indicates greater adherence to treatment. However, previous shortcomings in key actions, pivotal to attaining the outcomes and impact envisaged for the program, persisted in the postintegration period.

Physical activity counseling in primary health care in Brazil: a national study on prevalence and associated factors

Abstract Background The aim of this study was to determine the prevalence and correlates of physical activity counseling among physicians and nurses working in primary health care in Brazil. Methods A phone survey was carried out in 2011 with professionals working in primary health care in Brazil. The target sample consisted of 1,600 randomly selected primary care units covering all regions of the country. We successfully interviewed 529 professionals within the sampled units; 182 physicians and 347 nurses. The overall response rate was 49.6%. Multivariable logistic regression was used to estimate correlates of counseling in the whole sample and separately for physicians and nurses. Results The prevalence of regular physical activity counseling for at least six months was 68.9% (95% CI 64.9; 72.8) and was significantly higher among physicians compared to nurses (p < 0.05). Most professionals (93.2%) interviewed were unfamiliar with current physical activity recommendations for health. In the adjusted analysis, physical activity counseling was more frequent among those who report assessing patient’s physical activity (OR = 2.16; 95% CI 1.41; 3.29), those reporting that lack of time was not a barrier for counseling (OR = 0.62 95% CI 0.42-0.93), those who felt prepared to provide physical activity counseling (OR = 2.34; 95% CI 1.50-3.66), and those working at primary care units offering physical activity programs for patients (OR = 2.06; 95% CI 1.33-3.20). In the stratified analysis, only assessing patient’s physical activity was a significant correlate among physicians whereas assessing patient’s physical activity, feeling prepared to provide counseling and working in units with physical activity interventions were significant correlates among nurses. Conclusions Physicians and nurses deemed physical activity counseling of great importance in primary health care in Brazil. However, in order to increase the quality of counseling and the number of professionals engaging in this activity, these health teams require greater knowledge about physical activity (global recommendations for health) as well as training on the application of instruments for assessing physical activity. Moreover, sufficient time must be allowed during consultations for the counseling process, and physical activity promotion programs should be implemented within the primary health care units.

Assessment of integration of the leprosy program into primary health care in Aracaju, state of Sergipe, Brazil

INTRODUCTION: The aim of this study was to assess the epidemiological and operational characteristics of the Leprosy Program before and after its integration into the Primary healthcare Services of the municipality of Aracaju-Sergipe, Brazil. METHODS: Data were drawn from the national database. The study periods were divided into preintegration (1996-2000) and postintegration (2001-2007). Annual rates of epidemiological detection were calculated. Frequency data on clinico-epidemiological variables of cases detected and treated for the two periods were compared using the Chi-squared (χ2) test adopting a 5% level of significance. RESULTS: Rates of detection overall, and in subjects younger than 15 years, were greater for the postintegration period and were higher than rates recorded for Brazil as a whole during the same periods. A total of 780 and 1,469 cases were registered during the preintegration and postintegration periods, respectively. Observations for the postintegration period were as follows: I) a higher proportion of cases with disability grade assessed at diagnosis, with increase of 60.9% to 78.8% (p < 0.001), and at end of treatment, from 41.4% to 44.4% (p < 0.023); II) an increase in proportion of cases detected by contact examination, from 2.1% to 4.1% (p < 0.001); and III) a lower level of treatment default with a decrease from 5.64 to 3.35 (p < 0.008). Only 34% of cases registered from 2001 to 2007 were examined. CONCLUSIONS: The shift observed in rates of detection overall, and in subjects younger than 15 years, during the postintegration period indicate an increased level of health care access. The fall in number of patients abandoning treatment indicates greater adherence to treatment. However, previous shortcomings in key actions, pivotal to attaining the outcomes and impact envisaged for the program, persisted in the postintegration period.

Rural development and communication: a community media project in Uttar Pradesh (India)

Loaded with 16% of the world’s population, India is a challenged country. More than a third of its citizens live below the poverty line - on less than a dollar a day. These people have no proper electricity, no proper drinking water supply, no proper sanitary facilities and well over 40% are illiterates. More than 65% live in rural areas and 60% earn their livelihood from agriculture. Only a meagre 3.63% have access to telephone and less than 1% have access to a computer. Therefore, providing access to timely information on agriculture, weather, social, health care, employment, fishing, is of utmost importance to improve the conditions of rural poor. After some introductive chapters, whose function is to provide a comprehensive framework – both theoretical and practical – of the current rural development policies and of the media situation in India and Uttar Pradesh, my dissertation presents the findings of the pilot project entitled “Enhancing development support to rural masses through community media activity”, launched in 2005 by the Department of Mass Communication and Journalism of the Faculty of Arts of the University of Lucknow (U.P.) and by the local NGO Bharosa. The project scope was to involve rural people and farmers from two villages of the district of Lucknow (namely Kumhrava and Barhi Gaghi) in a three-year participatory community media project, based on the creation, implementation and use of a rural community newspaper and a rural community internet centre. Community media projects like this one have been rarely carried out in India because the country has no proper community media tradition: therefore the development of the project has been a challenge for the all stakeholders involved.