If we want more evidence-based practice, we need more practice-based evidence.*
Table of Contents
This first chapter in Part 5 sets the stage for an understanding of the delivery of community and population health services, including personal medical care, by presenting first the broader national policy and global context of health services. Our objective is to clarify how community and population health services are influenced by national and international contexts and resources.
Chapter 18 introduces the global underpinnings of community and population health services. The emphasis is on the historical, philosophical, political and economic context of community and population health relative to national and international health policies. The chapter begins with a discussion of the constitutional authority and responsibilities of the federal government in regard to the nation's health. A detailed description of official health agencies in the United States follows, contributing to an understanding of the purpose and function of each of these agencies. The remainder of the chapter acquaints you with professional health organizations, health foundations, and various international health organizations including the World Health Organization (WHO).
Bush Signs FY 2003 Supplemental Budget, Including Funds for Smallpox Vaccine Program. April 17, 2003
Baltimore Sun Profiles HHS Secretary Thompson. Apr. 16, 2003
Isolated Bangladeshi Area Proves an Ideal Lab.(The New York Times, March 23, 2003) - Matlab, Bangladesh has been the location of many studies that have contributed to public health knowledge and serves as the basis of inexpensive, simple solutions to problems within the developing world.
WHO Targets Health, Poverty(Washington Times, June 22, 1999) World Health Organization Director Gro Harlem Brundtland promoted a worldwide effort to reduce poverty in developing nations and improve global health. According to Brundtland, four key issues the WHO will confront in the coming decade are (1) lowering mortality from disease, (2) establishing systems to identify health threats, (3) creating more effective health systems, and (4) increasing the knowledge basis and research efforts. She noted that "infectious diseases are a neglected concern within the social and economic development sector," with about $800 million provided by WHO partners in 1990 to aid developing nations' control efforts--or less than 2 percent of overall donated funds. A WHO report released last week identified six diseases--AIDS, malaria, tuberculosis, measles, diarrheal diseases, and respiratory diseases--as the cause of every second death among young working adults and children throughout the world.
For more information http://www.globalhealthcouncil.org/conference-99/conf-index.html.
World Health Organization Launches New Directions for Health Into the 21st Century- Global. (WHO Press Release, May 26, 1999) -The World Health Organization (WHO) today unveils new directions for health into the 21st century that could save millions of lives and have a major impact on global well-being and poverty reduction within a decade. The main aim is to increase healthy life expectancy for all - while ensuring a better deal for the world's poorest people. http://www.who.int/whr/1999/en/press_release.htm
World Health Assembly Paves Way for Framework Convention on Tobacco Control- (WHO Press release, May 1999). The World Health Assembly (WHA), the governing body of the World Health Organization (WHO), (yesterday) paved the way for multilateral negotiations to begin on a set of rules and regulations that will govern the global rise and spread of tobacco and tobacco products in the next century. The 191-member WHA unanimously backed a resolution calling for work to begin on the Framework Convention on Tobacco Control (FCTC) - a new legal instrument that will address issues as diverse as tobacco advertising and promotion, agricultural diversification, smuggling, taxes and subsidies. WHO hopes to reframe the tobacco issues in a such a way as to show that far from, and in addition to, being a debilitating personal habit, tobacco contributes to a public health disaster exacerbated by tobacco industry practices that seek new markets and newer victims for a product that addicts before it kills. TFI officials say they hope their work will contribute to increased popular understanding and demands for comprehensive government regulation of tobacco... For the full press release, go to:
http://www.who.int/inf-pr-1999/en/pr99-wha14.html . The full text of the WHO Executive Board resolution (EB103.R11) is available at the following link: http://www.who.org/gb/eb103/eer11.pdf
Liberia: Unicef Provides Latrines to Camp(UNICEF, Feb. 24, 1999). UNICEF and British charity Concern World-Wide have built 56 latrines for the Siaka Stevens Stadium in Freetown, which hosts some 50,000 internally displaced people following the rebel incursion in January 1999. The latrines have been handed over to the Freetown health authorities. Contact: UNICEF Liberia, fax: +231-226136, mailto:firstname.lastname@example.org. Star Radio: Liberian Daily News Bulletin, 24 February 1999, http://www.africanews.org/west/liberia/stories/19990224_feat2.html
Afganistan: Disease Outbreak.(WHO, Feb. 24, 1999). A disease outbreak, thought to be plague or cholera, in Darwaz, Badakhshan, near the Tajik border in Afghanistan, is killing dozens of people a day. Some 6,300 cases and 135 deaths have been reported so far. The World Health Organization (WHO) has sent emergency medical supplies and special team to the area to help local health authorities deal with the outbreak. WHO Outbreak News, 24 February 1999, http://www.who.int/emc/outbreak_news/n1999/feb/n24feb1999.html
UN Seeks End to Avoidable Blindness.GENEVA (AP, Feb. 19, 1999) - The United Nations pledged Thursday to eliminate avoidable blindness by the year 2020. Cataracts, curable by surgery and accounting for almost half the world's blindness, are a prime target of the World Health Organization's "Vision 2020: The Right to Sight" initiative. Some 20 million people are blind from the condition. The plan identifies four other conditions, including trachoma and childhood blindness, as priorities. WHO will work with independent development organizations to redouble efforts against blindness, concentrating on disease prevention, training and transferring technology to developing countries.
Report on The Federal BudgetThe FY 1999 Omnibus Spending bill (H.R. 4328) was approved by Congress and signed by the President on October 21, 1998. Included in this bill were the amounts appropriated for programs at the Health Resources and Services Administration (HRSA, e.g., preventive medicine residencies), the Centers for Disease Control and Prevention (CDC), the Agency for Health Care Policy and Research (AHCPR), and the National Institutes of Health (NIH), among others. For more information, contact Suzy Leous, at email@example.com or 202-466-2044, ext. 106.
WHO Pinpoints Smoking as Huge Global Health Threat.COPENHAGEN (Reuters) - World Health Organization director-general Gro Harlem Brundtland t least 227 of them have died, health officials said Thursday. "The ratio is high, but it is still well below the international standard for an epidemic, which is 1%, or 100 deaths per 10,000 patients," Hardjotanogo said.
President's Committee on Health Care Quality Finished. (CNN 1998). A report critical of the US health-care system has been endorsed by and large by the President. It suggests a consumer bill of rights for the medical-care system.
Most Doctors Agree: French Health System Needs New Prescription. (Wall Street Journal April 25-26, 1996). A one-day walk out by French physicians was a flop with less that one quarter participating. The new reforms include caps on procedures and billing.
Why Canada's Single-Prayer Medicare is Worth Preserving (Globe and Mail June 10, 1996). Privatization is not the route Canadians want to follow. They do agree that the current system needs improvement but putting money into the hands of a few select doctors and insurance companies is not on the Canadian agenda.
World Climate: Experts Predict a Grim Future. (Sydney Morning Herald September 30, 1996). Australia will come under intense international pressure to reduce its greenhouse gas emissions after study says planet can't absorb any more.
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WEB PAGES AND INFORMATION SOURCES
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A summary of the World Bank Report, "Curbing the Epidemic – Governments and the Economics of tobacco control" was launched on May 18, 1999, by the WHO. The document marks a significant development in the co-operation and commitment of two major UN agencies to tobacco control worldwide. The report examines the economic consequences of tobacco and tobacco control and explains why raising tobacco taxes should play a key role in anti-tobacco strategies. The document is available on the ASH website at: http://www.globalink.org/tobacco/wb/
Global Progress Toward Laboratory Containment of Wild Polioviruses---July 2001-August 2002. Morbidity and Mortality Weekly Report 51(44). November 8, 2002, pp. 993-995. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5144a2.htm. Since the World Health Assembly launched the Global Poliomyelitis Eradication Initiative in 1998, the number of countries in which wild poliovirus is endemic has decreased from 125 to 10 in 2001. Three of the six World Health Organization (WHO) regions (Americas, European, and Western Pacific) have been certified as free of wild poliovirus transmission. The Global Commission for the Certification of the Eradication of Poliomyelitis will declare the world polio-free when all regions have documented the absence of wild poliovirus transmission for at least 3 consecutive years and when laboratories with wild poliovirus-containing materials have implemented appropriate containment conditions. This report describes preparations for laboratory containment and the creation of a global inventory of laboratories and institutions retaining wild poliovirus and summarizes global progress since July 2001. The data indicate that substantial progress has been made in identifying laboratories with wild poliovirus-containing materials and in conducting national wild poliovirus inventories.
1. Declaration of Alma-Ata, Summary. This box contains the essence of the influential declaration of the member states of WHO at the global health meeting in Alma-Ata, then still in the USSR. The emphasis on primary health care to reduce the inequities in health among and within populations is operationalized in the articles on participation and on the combination of health and social measures. Translate this understanding of health to your own community.
2. Immigrant health. Immigrant health is an important aspect of world and national community health services. Epidemiological investigations can provide information that may be used in the development of health planning for immigrants. Students preparing for careers in the health professions, and multicultural health services in particular, need to understand the culture of the community in question. Without an in-depth understanding of the community's culture, conflicts may develop which render health services, however well developed or intended, ineffective. Familiarize yourself with legislation regulating health care both locally and nationally or internationally. Identify immigrants to your communities, the health concerns of these populations, and the cultural implications for health.
3. Changing organizations. The review of official federal health agencies (see text) illustrates changes in the structure and function of these agencies over the years. Select either an executive department which offers health services or, a specific division within the Department of Health and Human Services. Write a report which documents the history and services of the department/division. What were the founding principles? How have these evolved or changed in response to new health care issues?
4. Community-based research. The National Heart, Lung, and Blood Institute, the National Cancer Institute and the National Institute for Dental Research have funded a number of community intervention studies. The Multiple Risk Factor Intervention Trial (MRFIT) and the Hypertension Detection and Follow-up Program (HDFP) are two examples. Select a NIH-funded community intervention study. Describe the research methods, sample, intervention and outcome of the study.
5. Working together. How did world and national health agencies cooperate in the eradication of smallpox? When did major initiatives to eradicate this disease begin? What agencies were involved? How were services delivered to individual communities? What kinds of barriers had to be overcome to achieve such cooperation?