Healthy markets - healthy people/ : reforming health care in Cambodia

Health care reform has been described as a global epidemic. This thesis deals with nature and experience of health care reform in developing countries. Increasing privatisation, economic transition, and structural adjustment have provided the context for health system changes. Different approaches to reform have been developed by international organisations such as the World Bank, WHO and UNICEF. What has driven national health care reforms? Are such policies really appropriate to developing countries? Has a consensus now emerged in relation to international health policy? Has a new health care ‘model’ appeared? The study of health care reform in Cambodia is a timely opportunity to investigate the implementation of health care reform under extreme conditions. These conditions include a legacy of genocide, long-term conflict, political isolation, and economic transition. This case study uses both qualitative and quantitative methods and multiple sources of data to analyse the reform program. The study reinforces the conclusion that, under conditions of extreme poverty, market based reforms are likely to have limited positive impact. Rather, understanding the cultural conditions that determine demand, delivering health care of a satisfactory quality, providing appropriate incentives for health practitioners, and supporting services with adequate public funding are the prerequisites for improved service delivery and utilisation. Cambodia's strategy of integrated district health service development and universal population coverage may provide an instructive example of reform. Emerging policy issues identified by this case study include the fundamental role of equity in service provision, the influence of the social determinants of health and illness and interest in the appropriate use of evidence in international health policy-making.

Incorporation and metabolism of punicic acid in healthy young humans

The objective of this study was to investigate the incorporation and metabolism of punicic acid (PA, cis9,trans11,cis13-18:3) in healthy young humans. The study was a randomized controlled trial. After 7 days adaptation with sunflower seed kernels supplementation, 30 subjects were then divided into the control and test group (n = 15). The test group was supplemented with Trichosanthes kirilowii (TK) seed kernels containing 3 g of PA per day in the form of triacylglycerols for 28 days. The control group was provided with sunflower seed kernels. After consumption of TK seeds containing 3 g PA per day for 28 days, the proportion of PA was increased from 0.00 to 0.47% in plasma and 0.00 to 0.37% in red blood cell membranes (RBCM), respectively. The proportion of cis9,trans11-18:2 was increased from 0.05 to 0.23% in plasma and 0.03 to 0.17% in RBCM after 28 days of intervention, respectively. Our results suggest that PA can be effectively incorporated into human plasma and RBCM, and is also associated with the increasing proportion of cis9,trans11-18:2 in humans, presumably as a result of metabolism by a saturation reaction. Edible TK seeds could be a potential dietary source of conjugated linoleic acids.

A healthy diet consistent with Australian health recommendations is too expensive for welfare-dependant families

Objective: Examine the cost of healthy food habits for welfare-dependent families in Australia.

Method:  A seven-day meal plan was developed, based on Australian public health recommendations, for two typical welfare-dependent families: a couple-family (two adults, two children) and a one-parent family (one adult, two children). The cost of the meal plan was calculated using market brand and generic brand grocery items, and total cost compared to income.

Results: In Australia, the cost of healthy food habits uses about 40% of the disposable income of welfare-dependent families. Families earning an average income would spend only 20% of their disposable income to buy the same healthy food. Substituting generic brands for market brands reduced the weekly food cost by about 13%. This is one of few economic models to include generic brands.

Conclusion: Compared with average-income Australian families, healthy food habits are a fiscal challenge to welfare-dependent families.

Implications: These results provide a benchmark for economic and social policy analysis, and the influence disposable income has on prioritising healthy food habits.

Living high but healthy : high-rise housing, nature, health and wellbeing

This exploratory mixed method study investigated the factors, including access to nature (i.e. parks and gardens), impacting on inner city high-rise residents' health and wellbeing. Analysis of the integrated findings revealed that a range of factors (including accessibility, choice and control and tenure) impact on residents' health and wellbeing.

Healthy or burnout

A model of stress, employee health and intention to quit, was tested among psychiatric nurses. Results indicated that organizational support and employees' sense of control positively mediate the stressor-health relationship at individual and organizational levels, while work-family conflict worsens employee health and increases intention to quit. The professional portfolio explores the association between depression and cognitive functioning, and its impact on the use of cognitive behavioural therapy in the treatment of depression.

Healthy settings : past, present and future

Based on previously published work and data from elite interviews, this thesis identifies four challenges for settings-based health promotion - clarifying theory; building bridges; reconfiguring for the 21st century; and promoting a culture of evaluation, learning and development. It concludes by mapping future directions for health settings research, policy and practice.

Evidence-informed process to identify policies that will promote a healthy food environment in the Pacific Islands

Objective: To implement a systematic evidence-informed process to enable Fiji and Tonga to identify the most feasible and targeted policy interventions which would have most impact on diet-related non-communicable diseases.

Design: A multisectoral stakeholder group of policy advisers was formed in each country. They used participatory approaches to identify the problem policies and gaps contributing to an unhealthy food environment. Potential solutions to these problems were then identified, and were assessed by them for feasibility, effectiveness, cost-effectiveness and side-effects. Data were gathered on the food and policy environment to support the assessments. A shortlist of preferred policy interventions for action was then developed.

Results: Sixty to eighty policy problems were identified in each country, affecting areas such as trade, agriculture, fisheries and pricing. Up to 100 specific potential policy solutions were then developed in each country. Assessment of the policies highlighted relevant problem areas including poor feasibility, limited effectiveness or cost-effectiveness and serious side-effects. A shortlist of twenty to twenty-three preferred new policy options for action in each country was identified.

Conclusions: Policy environments in these two countries were not conducive to supporting healthy eating. Substantial areas of potential action are possible, but some represent better choices. It is important for countries to consider the impact of non-health policies on diets.