Politics, Practical Logic, and Primary Health Care in Rural Haiti

During the 1980s, an ambitious project for health development restructured medical services throughout rural Haiti. The "Rural Health Delivery System" (RHDS) pursued several goals of primary health care, including dispensary-based maternal and child health services and the provision of low–cost drugs. Based on fieldwork in a single village, this article examines how local residents pushed the project in unpredictable and ironic directions. People did not regard dispensary services—which were planned and financed by international health agencies—as essentially foreign elements in the local health–care system. They rather engaged with the dispensary according to long–standing local strategies for prestige and economic advance. Despite the dramatically new shape of biomedicine introduced by the RHDS, the dispensary remained for most people a recognizable arena to gain access to state resources or to contest state control over their lives. The "success" of clinic services, and the "failure" of the project to distribute essential drugs arose more from people's practical routes to symbolic and material power than from the formal plans of health planners or state bureaucrats. This practice-based analysis provides another dimension to both the liberal and neo-Marxist critiques of international health development, [primary health care, community participation, planned development, Haiti]     

Exploring core competencies for mental health and addictions work within a Family Health Team setting

Approximately 200 Family Health Teams (FHTs) have been implemented in Ontario to improve access to primary healthcare, including mental health and addiction. The objectives of this project were to examine, through a focus group and qualitative methodology with three FHTs, the profile of patients'' mental health and addiction-related needs and to identify the implications for the development of core competencies in these innovative organisations. A spectrum of needs and service trajectories was identified, as well as the importance of a wide range of clinical skills and knowledge. The results indicate that ‘core’ competencies for mental health work in the context of an FHT go well beyond those required for an embedded mental health ‘programme’ or specialised mental health counsellors, but rather they relate to the core and discipline-specific competencies of members of the entire team. In addition to specific knowledge and skills, competencies include common attitudes and values relating to teamwork, good communication and collaboration. Challenges were noted with regard to working with some community service providers, especially addiction services. Implications for core competencies at the individual and organisational level were identified.     

Linking Human and Ecosystem Health: The Benefits of Community Involvement in Conservation Groups

This study explored the health, well-being, and social capital benefits gained by community members who are involved in the management of land for conservation in six rural communities across Victoria. A total of 102 people participated in the study (64 males; 38 females) comprising 51 members of a community-based land management group and 51 controls matched by age and gender. Mixed methods were employed, including the use of an adapted version of Buckner’s (1988) Community Cohesion Scale. The results indicate that involvement in the management of land for conservation may contribute to both the health and well-being of members, and to the social capital of the local community. The members of the land management groups rated their general health higher, reported visiting the doctor less often, felt safer in the local community, and utilized the skills that they have acquired in their lifetime more frequently than the control participants. Male members reported the highest level of general health, and the greatest satisfaction with daily activities. Members also reported a greater sense of belonging to the local community and a greater willingness to work toward improving their community than their control counterparts. Of equal importance is evidence that involvement in voluntary conservation work constitutes a means of building social capital in rural communities which may help reduce some of the negative aspects of rural life.     

Understanding Land Use, Livelihoods, and Health Transitions among Tibetan Nomads: A Case from Gangga Township, Dingri County, Tibetan Autonomous Region of China

Tibetan nomads in the Tibetan Autonomous Region of China have experienced profound transitions in recent decades with important implications for land use, livelihoods, and health development. The change from being traditional nomads to agropastoralists engaged in permanent agriculture, a sedentary village life (known as “sedentarization”), has been associated with a remarkable change in diet and lifestyle, decline in spatial mobility, increase in food production, and emerging infectious and noncommunicable diseases. The overarching response of the government has been to emphasize infrastructure and technological solutions. The local adaptation strategies of Tibetan nomads through maintaining balanced mobile herding, reindeer husbandry, as well as off-farm labor and trade could address both the cause of environmental degradation and improve the well-being of local people. Drawing on transdisciplinary, preliminary field work in Gangga Township of Dingri County in the foothills of Mt. Everest, we identify pertinent linkages between land use and health, and spatial and temporal mismatch of livelihoods and health care services, in the transition to sedentary village life. We suggest emerging imperatives in Ecohealth to help restore Tibetan livelihoods in transition to a sedentary lifestyle.     

Inupiat Health and Proposed Alaskan Oil Development: Results of the First Integrated Health Impact Assessment/Environmental Impact Statement for Proposed Oil Development on Alaska’s North Slope

We report on the first Health Impact Assessment (HIA) for proposed oil and gas development in Alaska’s North Slope region. Public health is not generally analyzed in the Environmental Impact Statement (EIS) process in the U.S. We conducted an HIA for proposed oil development within the National Petroleum Reserve - Alaska in response to growing concerns among North Slope Inupiat communities regarding the potential impacts of regional industrial expansion on their health and culture. We employed a qualitative HIA methodology, involving a combination of stakeholder input, literature review, and qualitative analysis, through which we identified potential health effects. The possible health outcomes identified include increases in diabetes and related metabolic conditions as a result of dietary change; rising rates of substance abuse, domestic violence, and suicide; increased injury rates; more frequent asthma exacerbations; and increased exposure to organic pollutant, including carcinogens and endocrine disruptors. There are also potential benefits, including funding for infrastructure and health care; increased employment and income; and continued funding of existing infrastructure. Based on these findings, we recommend a series of public health mitigation measures. This project represents the first formal effort to include a systematic assessment of public health within the U.S. EIS process. The inclusion of public health concerns within an EIS may offer an important and underutilized avenue through which to argue for environmental management strategies that focus on public health, and may offer communities a stronger voice in the EIS process. An erratum to this article can be found at     

Understanding the Development and Perception of Global Health for More Effective Student Education

The concept of “global health” that led to the establishment of the World Health Organization in the 1940s is still promoting a global health movement 70 years later. Today’s global health acts first as a guiding principle for our effort to improve people’s health across the globe. Furthermore, global health has become a branch of science, “global health science,” supporting institutionalized education. Lastly, as a discipline, global health should focus on medical and health issues that: 1) are determined primarily by factors with a cross-cultural, cross-national, cross-regional, or global scope; 2) are local but have global significance if not appropriately managed; and 3) can only be efficiently managed through international or global efforts. Therefore, effective global health education must train students 1) to understand global health status; 2) to investigate both global and local health issues with a global perspective; and 3) to devise interventions to deal with these issues.     

同一个世界 同一个健康

随着工业化和城镇化水平的持续提高,人类的生活方式发生了翻天覆地的变化,在传统因素依然制约人类健康的同时,食源性疾病与营养结构不合理、畜禽养殖方式转变与宠物快速发展带来人与动物关系深刻变化、生态环境与居住环境变化等非传统因素,对人类健康的制约凸显。面对这些人类健康的新挑战,我们必须因应时代变化,在大力发展医疗卫生事业的同时,树立营养健康、动物健康、环境健康三位一体的现代健康新理念。努力提高营养健康水平,以宠物健康为新的关注点高度重视动物健康,以人居、社区环境为重点营造健康生态环境,建立起现代健康新模式。     

美国区域卫生信息化及有效使用电子健康档案的启示

通过介绍美国区域卫生信息化发展、有效使用EHR计划、区域卫生信息化组织等，探讨推进区域卫生信息化和电子健康档案应用过程中的问题和挑战，包括公共医学术语和技术标准、电子健康档案及区域卫生信息化潜在经济效益、电子健康档案应用保障机制、区域卫生信息化水平评价及区域卫生信息化组织可持续运营等，以提供借鉴。     

An Integrated Framework for Risk Management and Population Health

The traditional medical model of health and health policy development has focused on individuals and the role of medical care in preventing and treating disease and injury. Recent attention to health inequities and social determinants of health has raised the profile of population heath and evidence-based strategies for improving the health of whole populations. At the same time, risk science has emerged as an important new discipline for the assessment and management of risks to health. This article reviews historical developments in the fields of risk management and population health and proposes a joint population health risk management framework that integrates the key elements of both fields. Applying this integrated approach to managing population health risks will facilitate the development of evidence-based health policy. It will encourage a more systematic and comprehensive evaluation of population health issues and promote the use of a broader suite of interventions to reduce health risks and enhance population health status.     

全球健康史项目亚洲模块——亚洲古代人群健康、疾病和生活方式的大数据

“全球健康史项目”探导新石器时期以来人类的疾病史,以前所未有的大数据研究方式回顾近代人类的历史,来衡量人类的生活质量和人类在充满挑战的生活条件下的适应能力。我们于2018年5月启动了全球健康史项目亚洲模块,将这个起源于美洲和欧洲的宏伟的项目扩展到亚洲。在全球健康史项目中纳入亚洲数据,不仅可以从进化的角度丰富近代人类演化历史上的第一手骨骼和口腔健康状况,还可以为健康政策制定的视野提供历史性的深度。     

Laypeople's Health Concerns and Health Beliefs in Regard to Risk Perception of Mobile Communication

The consensus scientific view is that there is an absence of convincing scientific evidence for health risks of exposures to electromagnetic fields (EMF) at levels below those recommended in international guidelines. Nevertheless, some citizens are worried about EMF emitted by mobile communication and its consequences for health. The present study explored, by means of a mail survey, health concerns and the prevalence of health beliefs related to EMF in the general population. A random sample (n = 765, response rate 41%) of the German-speaking population in Switzerland was asked to assess various health beliefs. Results suggest that health concerns are widespread but lower than health concerns in regard to other hazards. About two-thirds of the respondents believed that some people suffer from electromagnetic hypersensitivity (EHS). Health beliefs items were analyzed using the Mokken scale. This scale was related to respondents' health concerns and showed that health beliefs differed in regard to sociodemographic variables. For example, analyses showed that females, younger respondents, and respondents who believed that some people are affected by EHS endorsed significantly more health beliefs than males, older respondents, and non-EHS respondents. Results indicate that it is important for policy-makers to develop a clear understanding of the possible effects of health beliefs on health concerns and risk perception. These findings may provide guidance for the further development of information materials and strategies.     

Improving Health in Ucayali,Peru: A Multisector and Multilevel Analysis

We review the key determinants of health in Ucayali, Peru, identified by researchers, and, according to these, propose a set of tools to improve health in this area. Women and indigenous peoples are recognized as two vulnerable groups in the region that face greater health risks, and these are the main focus of the development of tools for health improvement. Also, the growing economic integration in the region facilitates the spread of infectious disease, thus requiring several levels of intervention. The tools discussed to improve health in Ucayali cross several scales and sectors. They include improved natural resource management, education and empowerment of women, integration of traditional and biomedical care, improved health information management, and community mobilization for health. Overall, our conclusions reinforce the limitations of the biomedical approach, which focuses on the treatment of specific pathologies in improving health. Health-system development requires the cooperation of many sectors and many actors across several spatial scales.     

The Framing of Teenage Health Care: Organizations,Culture, and Control

Adolescent health is one of the most polemical healthissues that has swept the United States in recentyears. This study is about documenting the process ofa project on teenage sex, drug, and alcohol abuse ina small rural California town. It illustrates adynamic set of concerns that impinge on health issues:development and underdevelopment, experts and laypeople, young and old, in a context of thetransformation of a rural economy to a prison-basedindustry. It is also about covert forms of control,pacification, burnout, and teenagers caught in thecrossfire between bureaucratic institutions andcontradictory messages about adolescent health as theycorrespond to changing conditions betweeninstitutional power holders.     

Introducing Indonesian Medical Students to Rainforest Conservation and Community Health in the Field: A Practicum Experience in East Kalimantan

This article describes a practicum experience developed between a conservation organization (The Nature Conservancy) and a medical school (The Faculty of Medicine at Mulawarman University in East Kalimantan). Through this practicum, groups of medical students from Mulawarman have assisted with baseline and follow-up community evaluations in remote villages along the Kelay River, Berau District. These evaluations were done in conjunction with the Kelay Conservation Health Program, a program designed to improve health and healthcare for local people, mostly former hunter–gatherers, in an area of rainforest that the conservation organization seeks to protect. Besides gaining experience in community health assessment, through this practicum medical students also gained field experience and knowledge in rural and remote area health and healthcare in Indonesia and had an opportunity to explore linkages between conservation and health. At the conclusion of their time with the program, participating students also presented individual problem-based reports on relevant topics to students and faculty at the Medical School and to the District Health Department. This partnership between a conservation agency and a medical school in a developing country is unusual, but has been very well received by all stakeholders involved. Because of this, Mulawarman is now planning to make Kelay into a formal training site for its students. This experience may serve as a model for other groups interested in promoting ecosystem health education to future health professionals in the developing world.     

Is 2020 the year when primatologists should cancel fieldwork? A reply

The aim of this article is to explore the impact of coronavirus disease (COVID-19) pandemic on primate-related conservation work. The withdrawal of primatologists and conservation staff from field research can lead to a number of detrimental effects not just on conservation but also on local communities in low- and middle-income countries. Inequalities in access to health and financial insecurities may be drivers for the illegal wildlife trade and the lack of tourism and research activity may allow poachers to work with greater ease. The paper also looks at how conservation organizations and research bodies should modify their field protocols by developing robust occupational health policies that will not only make field work safer but also support local staff as they are likely to face the greatest threats to their physical health, psychological health, and economic loss from COVID-19. By adopting a One Health approach that considers the complex interactions between human and primate health, researchers will be able to find new ways of working not only to protect primates but understand how they adapt to the COVID-19 pandemic.     

我国贫困地区医疗卫生服务体系建设探讨

健康扶贫是提高贫困地区人民群众的健康水平、实现健康中国的重要途径。构建和完善中国贫困地区的医疗服务体系,要重点加强医疗卫生机构标准化建设、公共卫生服务网络建设、远程医疗服务体系建设和中医药服务能力建设等方面,形成与当地经济发展和健康需求相适应的医疗卫生服务体系,保障贫困人群的健康,最终实现全民健康。     

Ecosystem Approach to Community Health Planning in Ghana

An ecosystem approach to community health seeks to investigate human health concerns from an ecological perspective. The goal is to improve the health of community members by instituting sustainable ecosystem management strategies that will preserve the health of both the ecosystem and its inhabitants. This article reports on a study in a rural community in Ghana that employed an ecosystem approach to community health planning. Adopting a participatory action research approach, a research team comprised of representatives from various local government departments collaborated with local residents to identify major community health problems, their underlying causes, and possible intervention strategies. The findings illustrate the usefulness of the ecosystem approach to mobilizing community-based interventions to addressing environmental determinants of human health.     

深圳市社区公共卫生服务包运行的成本结构分析

目的 了解深圳市社区公共卫生服务包运行成本的总体情况及财政投入的参考标准。方法 在人力成本、基本支持与保障成本测算的基础上,结合社康中心普查资料与统计年鉴,分析服务包运行中各要素成本及其占财政支出的比例。结果 完成服务包基本项目时,按每万服务人口计,服务包运行成本为64.67万元,其中人力成本占70%,此时服务包成本占同年财政一般性的比例约为1%。结论 深圳市有实力也有必要进一步加大对社区卫生服务的投入,特别是保证人员经费的投入。     

Health in exchange: teachers,doctors, and the strength of informal practices in Russia

This article explores teachers' and doctors' informal medical exchange practices in the context of the transforming health care system in post-Soviet Russia. Despite the advent of a medical marketplace, most Russians have low incomes and cannot buy the goods and services the market offers. Instead, they bypass the formal market mechanisms (such as obtaining cheaper medicine through personal connections) and official procedures (such as obtaining free or cheaper health care services despite the emergence of paid services) by using their social networks. This paper uses a network perspective to investigate how doctors' and teachers' mutual relations are formed and what resources form the basis of these informal exchange practices. Drawing on structured diary data and qualitative interviews with 20 teachers, in addition to interviews with eight doctors in St. Petersburg, the study goes beyond mere statistics on health care and attempts to depict from below the implications health and illness have for survival in contemporary Russia.     

Health risk assessment of nitrates in the groundwater of Beni Amir irrigated perimeter,Tadla plain,Morocco

Abstract

Shallow groundwater contaminated with nitrates may result in human health risks. Groundwater quality in the Beni Amir irrigation perimeter in Tadla plain, Morocco, is influenced by agriculture and farming-related activities. This study was carried out to assess the nitrate contamination of groundwater for drinking purposes by comparing it to Moroccan and WHO guidelines, and by estimating the potential human health effect of nitrates using the model recommended by the USEPA. The results showed that the nitrate content of groundwater fall between 0 and 82.08?mg L^?1 (mean 24.73?mg L^?1), with 38.10% of groundwater samples exceed the Moroccan and WHO limits for drinking. Groundwater nitrates mainly originated from intensive agricultural practices. The health effects of oral exposure to nitrate are higher than those of dermal exposure. For non-carcinogenic risks, 57.14% of samples showed hazard index (HI) values >1, indicating potential risks. The non-carcinogenic risk for infant and female are higher than that for females and males. The results of this study will offer a health risk reference for local residents and can help to propose suitable management ensuring safe drinking water.