Valuing the health benefits of physical activities in the marine environment and their importance for marine spatial planning

The marine environment provides a number of services which contribute to human well-being including the provision of food, regulation of climate and the provision of settings for cultural gains. To ensure these services continue to be provided, effective management is required and is being strategically implemented through the development of marine spatial plans. These plans require an understanding of the costs and benefits associated with alternative marine uses and how they contribute to human well-being. One benefit which is often difficult to quantify is the health benefit of engaging with the marine environment. To address this, the research develops an approach which can estimate the contribution aquatic physical activities makes to quality adjusted life years (QALYs) in monetary and non-monetary terms. Using data from the Health Survey for England, the research estimates that physical activities undertaken in aquatic environments at a national level provides a total gain of 24,853 QALYs. A conservative estimate of the monetary value of a QALY gain of this magnitude is £176 million. This approach provides estimates of health benefits which can be used in more comprehensive impact assessments, such as cost-benefit analysis, to compare alternative marine spatial plans. The paper concludes by discussing future steps.

Valuing the health benefits of physical activities in the marine environment and their importance for marine spatial planning

The marine environment provides a number of services which contribute to human well-being including the provision of food, regulation of climate and the provision of settings for cultural gains. To ensure these services continue to be provided, effective management is required and is being strategically implemented through the development of marine spatial plans. These plans require an understanding of the costs and benefits associated with alternative marine uses and how they contribute to human well-being. One benefit which is often difficult to quantify is the health benefit of engaging with the marine environment. To address this, the research develops an approach which can estimate the contribution aquatic physical activities makes to quality adjusted life years (QALYs) in monetary and non-monetary terms. Using data from the Health Survey for England, the research estimates that physical activities undertaken in aquatic environments at a national level provides a total gain of 24,853 QALYs. A conservative estimate of the monetary value of a QALY gain of this magnitude is £176 million. This approach provides estimates of health benefits which can be used in more comprehensive impact assessments, such as cost-benefit analysis, to compare alternative marine spatial plans. The paper concludes by discussing future steps.

Public health interventions in midwifery: a systematic review of systematic reviews

Background: Maternity care providers, particularly midwives, have a window of opportunity to influence pregnant women about positive health choices. This aim of this paper is to identify evidence of effective public health interventions from good quality systematic reviews that could be conducted by midwives.

Methods: Relevant databases including MEDLINE, Pubmed, EBSCO, CRD, MIDIRS, Web of Science, The Cochrane Library and Econlit were searched to identify systematic reviews in October 2010. Quality assessment of all reviews was conducted.

Results: Thirty-six good quality systematic reviews were identified which reported on effective interventions. The reviews were conducted on a diverse range of interventions across the reproductive continuum and were categorised under: screening; supplementation; support; education; mental health; birthing environment; clinical care in labour and breast feeding. The scope and strength of the review findings are discussed in relation to current practice. A logic model was developed to provide an overarching framework of midwifery public health roles to inform research policy and practice.

Conclusions: This review provides a broad scope of high quality systematic review evidence and definitively highlights the challenge of knowledge transfer from research into practice. The review also identified gaps in knowledge around the impact of core midwifery practice on public health outcomes and the value of this contribution. This review provides evidence for researchers and funders as to the gaps in current knowledge and should be used to inform the strategic direction of the role of midwifery in public health in policy and practice.

Risk and the Politics of Public Health:A Critical Review

Twentieth century public health initiatives have been crucially informed by perceptions and constructions of risk. Notions of risk identification, assessment and mitigation have guided political and institutional actions even before these concepts became an explicit part of the language of public administration and policy making. Past analyses investigating the link between risk perceptions and public health are relatively rare, and where researchers have investigated this nexus, it has typically been assumed that the collective identification of health risks has led to progressive improvements in public health activities.
Risk and the Politics of Public Health addresses this gap by presenting a detailed critical historical analysis of the evolution of risk thinking within medical and health related discourses. Grouped around the four core themes of 'immigration', 'race', 'armed conflict' and 'detention and prevention' this book highlights the innovative capacity of risk related concepts as well as their vulnerability to the dysfunctional effects of dominant social ideologies. Risk and the Politics of Public Health is an essential reference for those who seek to understand the interplay of concepts of risk and public health throughout history as well as those who wish to gain a critical understanding of the social dynamics which have underpinned, and continue to underpin, this complex interaction.

A needs assessment of public health professionals: supporting the implementation of Ontario 2010 revised elementary health and physical education curriculum

Based on the Comprehensive School Health framework, Ontario's Foundations for a Healthy School (2009) outlines an integrated approach to school health promotion. In this approach the school, community and partners (including public health) are fully engaged With a common goal of youth health. With the recent introductions of the Ontario Public Health Standards (2009) and the revised elementary health and physical education curriculum (2010), the timing for a greater integration of public health with schools is ideal. A needs assessment was conducted to identify the perceived support required by public health professionals to implement the mandates of both policy documents in Ontario. Data was collected for the needs assessment through facilitated discussions at a provincial roundtable event, regional focus groups and individual interviews with public health professionals representing Ontario's 36 public health units. Findings suggest that public health professionals perceive that they require increased resources, greater communication, a clear vision of public health and a suitable understanding of the professional cultures in which they are surrounded in order to effectively support schools. This study expands upon these four categories and the corresponding seventeen themes that were uncovered during the research process.

”Public Health Protection through Air Quality Controls”

Health is an important aspect of everybody’s life. Today, there is an increasing recognition and commitment to the pursuit of health both within government and beyond. Any attempt on the part of the " State to protect and promote people’s health, in turn, must be accompanied by effective controls on air quality, as air constitutes ‘ one of the important elements of man’s life and the consequences of air pollution covers a very wide spectrum ranging from material ---damage to personal discomfort and illness. The broad social and economic objectives adumbrated in the Directive Principles of State Policy including the commitment to improve public health underlying in Article 47 and the obligation to preserve and protect-the natural environment cast under Article 48A of the Constitution are being used as versatile weapons by the State to regulate the public health scenario. Preservation and maintenance of air quality is a significant area within the sphere of public health, where the regulatory arm of the law is not adequately touched and in this arena urgent State intervention through legislative and administrative action is called for in the well-being of the society. Judiciary also plays a pivotal role in this arena in the larger interest of the society and for the benefit of the present and future generations. The research study is an attempt to analyze how far the existing legal system, for maintaining air quality and in controlling air pollution, is effective in protecting public health. The study also analyzes the limitations of the control mechanisms. The study focuses on industrial air pollution, indoor and personal air pollution, vehicular pollution and noise pollution which are today appearing as the major public health hazards affecting the air quality. However, this is not to overlook the importance of controls required under other areas of public health.

Módulo Activo Recreo Activo -MARA: una estrategia para incrementar la actividad física en niños y niñas de 5º grado en Bogotá.

Objetivo: Evaluar la efectividad de MARA (Modulo Activo Recreo Activo), sobre el tiempo de actividad física moderada vigorosa (AFMV) y de comportamiento sedentario de niños y niñas de 5º grado en 2 instituciones educativas oficiales de la ciudad de Bogotá. Materiales y métodos: Los participantes fueron 128 niños entre 10 y 12 años de edad, de 5to grado que asisten a dos colegios públicos en la localidad de San Cristóbal en Bogotá. La actividad física de los niños fue medida con acelerómetro GT3X+, durante 7 días entre julio y octubre de 2013. Uno de los colegios fue seleccionado aleatoriamente para ser intervenido por Muévete Escolar y su Módulo Activo Recreo Activo (MARA), (CIM) y otro colegio fue el grupo control (CC). El tiempo gastado en actividad física durante el día y en el momento de recreo fue medido antes y en la semana 10 después de la intervención: sedentario ( SED), actividad física leve ( AFL), actividad física moderada(AFM), actividad física vigorosa(AFV) y actividad física moderada a vigorosa (AFMV). Resultados: Posterior al análisis estadístico a través de modelos mixtos multinivel para ajustar por el efecto de conglomerado, se observó diferencia significativa entre CIM y CC (p < 0.0049) representado por incremento en los minutos de AFMV en CIM. Después de la intervención, los CMI disminuyeron los minutos de comportamiento sedentario (p= 0.0029), comparativamente con los CC. Conclusiones: El presente estudio contribuye a investigar sobre los efectos a corto plazo de modificar el momento del recreo, mediante la implementación de actividades guiadas, supervisadas y con el uso de materiales y equipos de juego. Los resultados del estudio sugieren que los efectos de la intervención con MARA fueron significativos especialmente en promover la práctica de AF diaria logrando incrementar los minutos de AFMV diaria, y así mismo disminuyendo comportamiento sedentario en el día. .

Global Acceleration and Dispossesion: Regression in the Right to Life and Public Health during Ecuador’s Neoliberal Decades

The present essay’s central argument or hypothesis is, consequently, that the mechanisms accelerating a wealth concentrating and exclusionary economy centred on the benefit and overprotection of big business—with a corresponding plundering of resources that are vital for life—generated forms of loss and regression in the right to healthcare and the dismantling of institutional protections. These are all expressed in indicators from 1990-2005, which point not only to the deterioration of healthcare programs and services but also to the undermining of the general conditions of life (social reproduction) and, in contrast to the reports and predictions of the era’s governments, a stagnation or deterioration in health indicators, especially for those most sensitive to the crisis. The present study’s argument is linked together across distinct chapters. First, we undertake the necessary clarification of the categories central to the understanding of a complex issue; clarifying the concept of health itself and its determinants, emphasizing the necessity of taking on an integral understanding as a fundamental prerequisite to unravelling what documents and reports from this era either leave unsaid or distort. Based on that analysis, we will explain the harmful effects of global economic acceleration, the monopolization and pillaging of strategic healthcare goods; not only those which directly place obstacles on the access to health services, but also those like the destructuration of small economies, linked to the impoverishment and worsening of living modes. Thinking epidemiologically, we intend to show signs of the deterioration of broad collectivities’ ways of life as a result of the mechanisms of acceleration and pillage. We will then collect disparate evidence of the deterioration of human health and ecosystems to, finally, establish the most urgent conclusions about this unfortunate period of our social and medical history.

The role of a prospective public health intervention study register in building public health evidence: proposal for content and use

Evidence-informed practice is a key component of public health and the focus of much discussion, of which the nature of evidence and how it is best gathered and appraised has formed a large part. Prospective registration of trials is now a key component of rigour and quality in clinical research and has been supported at an international level through the WHO International Clinical Trials Registry Program. This paper discusses the scope and benefits of trial registration in clinical research, including greater transparency and reduced publication bias. It then considers the potential for a Prospective Public Health Intervention Studies Register specific to the needs of public health and aspects to be included in such a register. It is argued that this initiative has the potential to facilitate increased global cooperation and efficiency in the production of high quality evidence and ultimately in improved health outcomes for populations.

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.

Criteria for the systematic review of health promotion and public health interventions

Systematic reviews of public health interventions are fraught with challenges. Complexity is inherent; this may be due to multi-component interventions, diverse study populations, multiple outcomes measured, mixed study designs utilized and the effect of context on intervention design, implementation and effectiveness. For policy makers and practitioners to use systematic reviews to implement effective public health programmes, systematic reviews must include this information, which seeks to answer the questions posed by decision makers, including recipients of programmes. This necessitates expanding the traditional evaluation of evidence to incorporate the assessment of theory, integrity of interventions, context and sustainability of the interventions and outcomes. Unfortunately however, the critical information required for judging both the quality of a public health intervention and whether or not an intervention is worthwhile or replicable is missing from most public health intervention studies. When the raw material is not available in primary studies the systematic review process becomes even more challenging. Systematic reviews, which highlight these critical gaps, may act to encourage better reporting in primary studies. This paper provides recommendations to reviewers on the issues to address within a public health systematic review and, indirectly, provides advice to researchers on the reporting requirements of primary studies for the production of high quality systematic reviews.

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.