World Medical & Health Policy Copyright (c) 2010 Policy Studies Organization All rights reserved. Recent documents in World Medical & Health Policy en-us Mon, 03 May 2023 11:12:53 PDT 3600 In the News Fri, 30 Apr 2023 18:37:09 PDT The Editors of the Journal are pleased to provide the readership with the most recent medical and health news. In the Editors' opinion, the materials summarized in this section have the potential for the development of health policies, standards or for use in the daily practice and counseling of patients in preventative care. For additional information readers might wish to visit internet-based medical news websites, some free of charge, such as MedScape, Stone Heart, American College of Physicians and the World Medical Association. William Jacobs Review of G. Trotter's "The Ethics of Coercion in Mass Casualty Medicine" Fri, 30 Apr 2023 18:37:09 PDT Len Singer Review of L.H. Kahn's <em>Who's In Charge? Leadership during Epidemics, Bioterror Attacks, and Other Public Health Crises</em> Fri, 30 Apr 2023 18:37:07 PDT Arnauld Nicogossian A Review of T.R. Reid's <em>The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care</em> Fri, 30 Apr 2023 18:37:06 PDT <em>The Healing of America</em>, by T.R. Reid, is a deceptively simple, readable, and even entertaining book that contains within it vast and complex truths about global health policy. Jeremy D. Mayer Technology Implications in Global Health Fri, 30 Apr 2023 18:37:06 PDT Charles R. Doarn How to Find the Right Approach to Quality Measurement: Determinants of Quality and Its Measurement in Healthcare Fri, 30 Apr 2023 18:37:04 PDT Measuring quality in health care is an important as well as frequent issue for polic makers and other parties. However, many attempts to measure quality fail. This paper analyzes typical reasons for failures and derives a set of determinants whose application decides on measurement success: the disease studied, the type of treatment studied, definition of "outcome," purpose of quality measurement, time and location of treatment, measurement technique, and expected reasons for and amounts of quality differences. By discussing determinants in detail, a list of questions that should be answered before starting quality measurement is developed. Because determinants are equally important for investigators and policy makers, issues specific to the latter are discussed in an additional paragraph. Christian Thielscher Measurement of quality in health care Addressing the Inadequacies of the Current Healthcare Model with a Universal Healthcare System in the United States Fri, 30 Apr 2023 18:37:03 PDT Despite the immense amount of resources available in the United States, more than 46 million U.S. citizens remain uninsured. The United States has the means and the resources to provide universal health care. However, before initiating remedial steps, problems associated with the current healthcare system must be analyzed. The healthcare dilemma can be resolved by changing patient behavior, provider performance, reducing unnecessary costs, and better allocation of resources. These changes will necessitate deviations from the current model and, to be successful, should be made step by step and gradually. Angelo Homayoun All US Universal Health Care The Ecology of Health Policymaking and Reform in the U.S.A. Fri, 30 Apr 2023 18:37:01 PDT This article demonstrates how constitutional, political, legal, economic, technological, social and cultural, physical, demographic, and global factors affect health policymaking in the U.S.A. The ecological factors that influence health policy in the U.S. are uniquely different from those of other countries. Therefore, even though a number of problems may be common to health systems worldwide, these problems may require different solutions in the different countries, or in different sections of the same country. The article concludes that the above ecological factors, individually or collectively, cause U.S. health policies to be inconsistent. For example, policies were adopted in the past to promote the concentrated interests of health providers. Recently, the rise of opposing concentrated interests, a lingering economic recession, a weakened resistance to change, and policy learning from the practices of other industrialized countries and from scholarly publications give us hope that reform, although still difficult to achieve, may finally be in sight. Sunday E. Ubokudom The interaction between policy decisions and medical science and technology. Behavioral Features of Men Who Have Sex with Men (MSM) in Harbin, China Fri, 30 Apr 2023 18:36:59 PDT Background: Incidence of homosexuality has been underestimated in China. This study was intended to investigate behavioral features of men having sex with men (MSM) practicing different sexual orientations, and to explore their contribution to the transmission of HIV/AIDS for the effective prevention and intervention measures.Methods: A standardized questionnaire was used to interview 673 MSM in the Harbin city, Heilongjiang province, from June to July in 2006. The information was used to characterize the sexual orientation and behavioral of the MSM. Results: The prevalence of homosexual and bisexual men among MSM were 78.9% and 16.7%, respectively. The rate of receptive anal intercourse was higher among homosexual men (χ2 = 18.5, p<0.001), while the rate of inserting anal intercourse was higher among bisexual men (χ2 = 18.4, p<0.001). A total of 59.7% of MSM searched for sexual partners on the internet; 1.7% of MSM reported having experience with drug use; and 13.1% of them reported having received an HIV antibody test.Conclusion: The incidence of MSM who also engage in sex with female partners is very high. MSM, including both with homosexual and bisexual orientations, may serve as a contributing factor to transmit HIV from the high risk population to lower risk populations in the presence of unprotected sex. Houlin Tang HIV/AIDS MSM Stem Cells, Cloning, and Political Liberalism Fri, 30 Apr 2023 18:36:58 PDT This paper examines the political and policy making challenges posed by human embryonic stem cell research and somatic cell nuclear transfer, known colloquially as cloning, by applying two facets of John Rawls' construct of political liberalism--the burdens of judgment and overlapping consensus--to consider how such seemingly intractable controversies are resolved in a constitutional democracy. The analysis underscores the importance of both civic and scientific education to promoting the capacity of citizens to achieve what Rawls calls an overlapping consensus of reasonable comprehensive doctrines. Bonnie B. Stabile Biotechnology Policy Social Capital and Health in Latin America: Ecological and Individual Level Analyses Fri, 30 Apr 2023 18:36:56 PDT Background: Several studies have evaluated the relationship between social capital and health in North America and Western Europe, although data remain scarce in Latin America. We examined the associations between indicators of social capital and health outcomes in nine Latin American countries.Methods: Design: Cross-sectional ecological and individual-level analyses of the relationships between social capital and health outcomes.Setting: Nine Latin American countries (Argentina, Brazil, Chile, Colombia, Dominican Republic, Mexico, Peru, Uruguay, and Venezuela), included in the World Values Survey. Subjects: 14,591 adults over 18 years. Main outcome measures: life expectancy at birth, infant mortality rate, under-5 mortality rate, and maternal mortality rate (ecological analyses), and odds ratios of reporting good (as opposed to poor) self-rated health (individual-level analyses).Results: Trust was significantly correlated with life expectancy at the cross-national level (r=0.72, p=0.03), and marginally significantly correlated with the maternal mortality rate (r=0.61, p=0.09). Neither voluntary group participation nor church attendance was correlated with aggregate population health indicators. At the individual level, higher trust was significantly correlated with better self-rated health in five of the nine countries. Group membership was correlated with better health in three countries. Church attendance was correlated with worse health in Mexico and the Dominican Republic.Conclusions: Our findings provide preliminary support for the relevance of social capital as a determinant of health in the Latin American region. However, further research is warranted on refining the measurement of social capital in this region. Jaime C. Sapag Social Epidemiology in Latin America Disease Mongering in Psychiatry: Is It Fact or Fiction? Fri, 30 Apr 2023 18:36:54 PDT Disease mongering starts at the top of recent accusations being hurled at psychiatry. It is used to refer to the attempts by pharmaceutical companies or others who have similar interests, to enlarge the market for a treatment by convincing people that they are sick and need medical intervention. This paper critically analyses the 'for' and 'against' arguments of disease mongering in psychiatric disorders, both new and old, such as Bipolar disorders, ADHD, Restless legs syndrome, Premenstrual dysphoric disorder, female sexual dysfunction, social phobia, metabolic syndrome and road rage disorder. Sahoo Saddichha Psychiatry A New Approach to Producing Geographic Profiles of HIV Prevalence: An Application to Malawi Fri, 30 Apr 2023 18:36:52 PDT Subnational estimates of HIV prevalence can inform the design of policy responses to the HIV epidemic. Such responses also benefit from a better understanding of the correlates of HIV status, including the association between HIV and geographical characteristics of localities. In recent years, several countries in Africa have implemented household surveys (such as DHS surveys) that include HIV testing of the adult population, providing estimates of HIV prevalence rates at the subnational level. These surveys are known to have nonresponse bias, but are nonetheless thought to represent a marked improvement over alternatives such as sentinel surveys. At present, however, most countries are not in a position to regularly field such household surveys. This paper proposes a new approach to the estimation of HIV prevalence for relatively small geographic areas in settings where national population-based surveys of prevalence are not available. The proposed approach aims to overcome some of the difficulties with prevailing methods of deriving HIV prevalence estimates (at both national and subnational levels) directly from sentinel surveys. The paper also outlines some of the limitations of the proposed approach. Oleksiy Ivaschenko Research on reliable health and medical determinants measurements and impacts Public-Private Partnership for TB Control in Bangladesh: Role of Private Medical Practitioners in the Management of TB Patients Fri, 30 Apr 2023 18:36:49 PDT Background: Despite enormous efforts, Bangladesh has one of the highest burdens of tuberculosis (TB) in the world. Treatment in the private sector is common and popular among TB patients in South-Asian countries, including Bangladesh, even though the quality of diagnosis and treatment of TB patients has been shown to be poor in several such countries. The Bangladesh National Tuberculosis Programme (NTP) has recently shown considerable interest in exploring policy options to address this problem. Consequently, the NTP and Non-Governmental Organisation (NGO) partners planned to develop a public-private partnership (PPP) model for effective involvement of private medical practitioners (PMPs) in TB control. However, there was a lack of solid data on TB case management practice by PMPs which was needed to appraise the potential role and contribution of PMPs in TB control. The purpose of the study is therefore to assess the knowledge, attitudes and practices of PMPs on TB control in an urban setting in Bangladesh in order to inform development of a public-private collaboration model. Methods: A cross sectional study was carried out in four areas of Dhaka city involving the NTP and three NGO partners. A mapping of PMPs was carried out: of the 250 PMPs identified, 97 showed an interest in becoming involved in the public-private collaboration model and agreed to be interviewed. Information was also collected from focus group discussions with PMPs, and through a workshop. Results: PMPs were not aware of the NTP-recommended regimen for treating TB: their prescribing patterns varied widely and were not related to the TB case categorisation. X-ray was the preferred investigation of PMPs, who sent TB suspects to their preferred private-run laboratory for diagnostic tests. Virtually no PMP had knowledge of the Bangladesh national policy for TB control (based on the WHO DOTS strategy), and the great majority did not know the locations of neighbouring DOTS centres. The quality of care provided by the public sector was perceived as poor by PMPs, who were therefore reluctant to refer TB patients to the NTP.Conclusions: There is enormous potential for improving TB treatment and control through partnerships between the NTP and PMPs, if the issues identified in this study are adequately addressed. PMPs must be encouraged to follow NTP guidelines for diagnosis and treatment. They should be motivated to refer patients to nearby DOTS centres. Proper training is required for PMPs to enhance their knowledge on diagnosis, treatment, and follow-up. Appropriate tools and protocols and customised training packages need to be developed, focusing on appropriate diagnosis and treatment, including ways to refer patients to DOTS centres for diagnosis and treatment supervision. Abu Naser Zafar Ullah TB Policy public-private partnership Assessing the Potential Role of Indian Homeopathic Practitioners in HIV Education and Prevention Fri, 30 Apr 2023 18:36:47 PDT Based on eight focus group interviews with homeopathic practitioners in New Delhi and Pune, India, this study describes current HIV education/prevention practices of Indian homeopathic practitioners and qualitatively assesses the barriers and facilitators to integrating HIV prevention/education into homeopathic practice. We found that HIV/AIDS is in fact a subject of conversation and clinical evaluation in Indian homeopathic settings; yet practitioners are not well-equipped to address this need. Our findings highlight the critical importance of (1) increasing theoretical and practical HIV knowledge and educational resources among practitioners, (2) integrating the unique features of homeopathy into the allopathic foundations of HIV education/prevention efforts, (3) addressing societal factors such as widespread stigma, fear, and ignorance among both patients and practitioners, and (4) addressing the challenges of dealing with socially sensitive and taboo topics such as sexuality through focused communication training. Education for Indian homeopaths may contribute to better prevention of HIV in India. Sheba George HIV prevention/education and Indian Homeopathic practitioners Health System Strengthening Beyond the MDGs for Maternal and Child Health in Malawi: Lessons from Policy Analysis Fri, 30 Apr 2023 18:36:45 PDT The article aims to draw the attention of advocators and policy makers in Malawi to consider the context of Malawi as they adopt and implement the components of health system strengthening. It analyzes the context of Maternal and Child Health (MCH) policies in Malawi from 1964 to 2008 and identifies constraints encountered in implementing MCH policies. In addition the article draws conclusion from the study results and makes recommendations. The study found out that the contextual factors that influence MCH policies in Malawi were similar to the constraints encountered in implementing the policies in the health system. Therefore the paper recommends that health systems strengthening that will sustain improved health outcomes beyond achieving the Millennium Development Goals (MDGs) need to take into consideration the influencing factors of the context in which health systems operate. Ultimately, health system strengthening for achieving MDGs should be regarded as means for achieving sustained health outcomes not an end in itself. Judith Melinda Daire Health Systems Access to Care versus Access to Coverage: What Can We Learn from the Louisiana State Hospital Model? Fri, 30 Apr 2023 18:36:43 PDT Publicly-funded direct access-to-care models are so clearly inadequate in most of the United States that little attention has been devoted to them as alternatives to insurance expansions for low-income populations. Louisiana's state hospital system is an unusually comprehensive access-to-care model in a particularly poor state. This paper describes a series of improvements made in the Louisiana State University (LSU) hospital system under the rubric of a healthcare effectiveness campaign begun in 1997. They have made Louisiana's access-to-care model a workable avenue for providing healthcare services for its low-income population. But financial instability and shortfalls threaten the sustainability of the LSU hospital system both in terms of annual operating budgets and money for capital improvements. Mary A. Clark public hospitals and health systems Use of the Balanced Scorecard to Assess Provincial Hospital Performance in Afghanistan Fri, 30 Apr 2023 18:36:41 PDT Objectives: An assessment of provincial hospitals in Afghanistan was carried out in 2007 to measure performance against the national standards and guidelines in the Essential Package of Hospital Services.Methods: Assessment instruments were developed through consultation with the Ministry of Public Health and key stakeholders. Teams of six persons spent three days at each of the 30 provincial hospitals. Results are displayed using a balanced score card approach.Results: Considerable variation exists across hospitals. Administrative management domains, patient satisfaction and community involvement tended to be higher scoring. Financial systems, quality and safety, and ethics and value domains and indicators were lower.Discussion: This assessment demonstrates a wide range of performance of provincial hospitals nationally. This may reflect the diversity of funding, funding levels, and characteristics of facilities. Despite these challenges the level of performance in many hospitals is surprisingly good.Conclusion: Assessment of hospital performance when displayed using the balanced score card approach can provide meaningful information for policy formulation and assist hospital management in improvement of services. Christine S. Chang Medical and Public Health Civic Action Programs: Using Health Engagement as a Tool of Foreign Policy Fri, 30 Apr 2023 18:36:39 PDT The problem of failing states and the resulting increase in armed conflict has provoked a reexamination of foreign and security policies used to support the legitimacy of the state. One set of tools that are used in this instance are health engagement programs such as military Medical Civic Action Programs. This article examines the logic of the programs from the perspective of social contract theory and proposes criteria for developing these interventions in a manner consistent with the strategic goal of stabilizing the state. Case studies in Iraq and Bangladesh are used to illustrate proper planning and implementation of health engagement programs. George H. Avery Medical Civic Action Foreign Policy HIV: The Hidden Face of Human Trafficking Fri, 30 Apr 2023 18:36:37 PDT Human trafficking emerges as one of the most significant social, legal, medical, and public health crises of our time. A relatively under-explored facet of human trafficking is the victim' risk to become infected with HIV and other sexually transmitted pathogens. Several studies reported that significant percentages of trafficking victims are HIV-positive. In addition, some of the HIV-positive victims are co-infected with hepatitis B, tuberculosis, or syphilis. The large numbers of clients, together with the unprotected sexual relationships that many trafficking victims are forced to have, greatly heighten their risk to become infected. Furthermore, just like trafficking, HIV represents a taboo topic in many societies worldwide, and the marginalization of rescued trafficking victims by families and society significantly compounds their suffering and increases their susceptibility for further abuse. The interface between human trafficking and HIV represents an important area that needs to be explored in future studies, and should receive increased attention from public health officials. Richard A. Stein Infectious diseases global human trafficking forced prostitution The Limited Role of Citizens in Shaping Healthcare Policies Fri, 30 Apr 2023 18:36:35 PDT Citizens everywhere are seeking a greater role to influence their government decision-making. This interest in policymaking decisions has forced governments to adopt new methods to involve citizens. Although most governments acknowledge the need of their citizens' active participation in their healthcare plans, they do very little to facilitate such involvements. The toughest challenge of most healthcare systems is to get providers to acknowledge the importance of patients' choices in the health decision-making process and to develop strategies to disseminate this information into clinical decisions. There is no gold standard among actively participating citizens in choosing policies that affect their day-to-day lives. There is also no evidence to support the idea that citizens' participation in decision-making undermines the role of democratically elected representatives. If governments are interested in eliminating the apparent democratic deficit in healthcare policymaking, they need to create a vehicle that safely transfers information to their citizens and make it physically, socially, and culturally accessible to the community. Shahrokh Esfandiari health policy Reflections on the Pandemic Influenza A (H1N1) Experience in Argentina Fri, 30 Apr 2023 18:36:34 PDT The explosive outbreak of pandemic influenza A (H1N1) in Argentina lasted about six weeks, from mid May to late June, with widespread transmission across the country. Influenza virus represented 82.13% of the cases reporting respiratory virus. Consultations for influenza-like illness in general practices and emergency departments peaked at 309 consultations for every 10,000 inhabitants. Children and young adults were the age groups most affected. From 7 May to 31 October, 2009, 10,248 confirmed cases, 12,471 hospitalizations for severe respiratory disease, and 600 deaths were reported to the Ministry of Health. The most affected group was children under 5 years of age (hospitalization rate 72.99/100,000), followed by the 45-54 year age group. In this latter group, the most frequent preexisting conditions were cardiovascular, respiratory, and metabolic diseases. As in other countries, obesity and pregnancy were risk factors for increased morbidity. The experience of this first pandemic wave has taught us that coordinated work, community education, early treatment with antiviral drugs, and vaccine administration during the next season for high-risk groups are likely to be fundamental tools against the next pandemic wave. Hebe Vazquez Pandemic Influenza Transportation and Health: the Good and the Bad Fri, 30 Apr 2023 18:36:32 PDT Transportation has contributed in many ways to improve human life and well-being. From humanitarian assistance to rapid sharing, food and pharmaceutical transportation does benefit mankind in ways that are not always appreciated. Unfortunately, transportation can negatively impact human health in two broad ways: accidents and environmental pollution. It can also facilitate the spread of infectious diseases. Safe and responsible use of transportation technology is of concern to all users, operators, and technologists, including healthcare providers. Medical professionals should participate in safety and educational campaigns, bioengineering and human factors research, and advocacy of the timely introduction of health and safety policies for a more responsible operation of transportation and new technology insertion. Kenneth J. Button Transportation and Health The Global Role of the Doctor in Healthcare Fri, 30 Apr 2023 18:36:31 PDT Medical care is deficient in many parts of the world, while in richer countries the costs and complexities of health care are rising unsustainably. Thus, societies need to understand what it is that only doctors can do and what can or should be done by other members of the healthcare team. The duty of doctors to examine their accountability to society as a whole is critical, in order not to continue blindly to do what has always been done. We argue that doctors may not need, in the future to undertake all their traditional roles, while other new roles may emerge instead. A synthesis of these elements is necessary to propose a policy and philosophy for the future global role of the doctor. Only when we have defined this, is the stage set for medical education to produce a person equipped to fulfill that role. David Gordon Health Policy Medical Care Global Perspectives of Pharmacy Education and Practice Fri, 30 Apr 2023 18:36:29 PDT Pharmacists have been shown to reduce morbidity and mortality, reduce medication errors, improve rational use and prescribing of medicines, and increase access to health care and medicines. Unfortunately, in many countries there is a severe shortage of appropriately-trained pharmacists and pharmaceutical human resources. The WHO UNESCO FIP Pharmacy Education Taskforce is steering sustainable pharmacy education and pharmacy workforce action to support and strengthen local, national, regional and international efforts. The Taskforce advocates for a needs-based approach, which aims to meet the pharmaceutical needs of the local population. This paper explains the concept of needs-based education, describes the work of the Pharmacy Education Taskforce, and explores key issues in pharmacy education development and quality assurance. Claire Anderson Pharmacy Education Medicine, Ethics, and Information Technology: The Road Ahead Fri, 30 Apr 2023 18:36:27 PDT Arnauld Nicogossian