The Roots of Global Health Inequity

2017 ◽  
Author(s):  
Joia S. Mukherjee
Keyword(s):  
Health Care ◽  
World War Ii ◽  
Primary Health Care ◽  
Economic Policies ◽  
World War ◽  
The Public ◽  
The World Bank ◽  
Primary Health ◽  
The Cold War ◽  
The Impact

This chapter outlines the historical roots of health inequities. It focuses on the African continent, where life expectancy is the shortest and health systems are weakest. The chapter describes the impoverishment of countries by colonial powers, the development of the global human rights framework in the post-World War II era, the impact of the Cold War on African liberation struggles, and the challenges faced by newly liberated African governments to deliver health care through the public sector. The influence of the World Bank and the International Monetary Fund’s neoliberal economic policies is also discussed. The chapter highlights the shift from the aspiration of “health for all” voiced at the Alma Ata Conference on Primary Health Care in 1978, to the more narrowly defined “selective primary health care.” Finally, the chapter explains the challenges inherent in financing health in impoverished countries and how user fees became standard practice.

Editor's Introduction

2012 ◽  
Author(s):  
Dan Stone
Keyword(s):  
World War Ii ◽  
Cold War ◽  
Public Sphere ◽  
World History ◽  
Postwar Period ◽  
World War ◽  
The Public ◽  
The Public Sphere ◽  
The Cold War ◽  
The Impact

It is tempting to tell the story of Europe in the twentieth century in two halves: the first, a sorry, bleak tale of poverty, war, and genocide; and the second, a happy narrative of stability and the triumph of boring normality over dangerous activism and exuberant politics. When one examines the ‘return of memories’ which could not be articulated in the public sphere during the Cold War, one can see that the years since 1989 are intimately connected to World War II and its aftermath. In many ways, we are only now living through the postwar period. The impact of World War II, the largest and bloodiest conflict in world history, did not end in 1945. This book modifies the emphasis usually placed on the Cold War as the main historical framework for understanding the postwar period. It questions the extent to which 1945 was really a ‘zero hour’ and examines various facets of postwar life – from high politics to economics to tourism and consumerism.

scholarly journals Cohort study of ageing from Bagé (SIGa-Bagé), Brazil: profile and methodology

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elaine Thumé ◽  
Marciane Kessler ◽  
Karla P. Machado ◽  
Bruno P. Nunes ◽  
Pamela M. Volz ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cohort Study ◽  
Primary Health Care ◽  
Rio Grande ◽  
Cognitive Testing ◽  
Rio Grande Do Sul ◽  
Primary Health ◽  
The Impact

Abstract Background The Bagé Cohort Study of Ageing is a population-based cohort study that has recently completed the first follow-up of a representative sample of older adults from Bagé, a city with more than 100,000 inhabitants located in the state of Rio Grande do Sul, Brazil. This is one of the first longitudinal studies to assess the impact of primary health care coverage on health conditions and inequalities. Our aim is to investigate the prevalence, incidence and trends of risk factors, health behaviours, social relationships, non-communicable diseases, geriatric diseases and disorders, hospitalisation, self-perceived health, and all-cause and specific-cause mortality. In addition, we aim to evaluate socioeconomic and health inequalities and the impact of primary health care on the outcomes under study. Methods/design The study covers participants aged 60 or over, selected by probabilistic (representative) sampling of the urban area of the city of Bagé, which is covered by Primary Health Care Services. The baseline examination included 1593 older adults and was conducted from July 2008 to November 2008. After eight to nine years (2016/2017), the first follow-up was conducted from September 2016 to August 2017. All participants underwent an extensive core assessment programme including structured interviews, questionnaires, cognitive testing (baseline and follow-up), physical examinations and anthropometric measurements (follow-up). Results Of the original participants, 1395 (87.6%) were located for follow-up: 757 elderly individuals (47.5%) were re-interviewed, but losses in data transfer occurred for 22. The remaining 638 (40.1%) had died. In addition, we had 81 (5.1%) refusals and 117 (7.3%) losses. Among the 1373 older adults who were followed down, there was a higher proportion of female interviewees (p=0.042) and a higher proportion of male deaths (p=0.001) in 2016/2017. There were no differences in losses and refusals according to gender (p=0.102). There was a difference in average age between the interviewees (68.8 years; SD ±6.5) and non-interviewees (73.2 years; SD ±9.0) (p<0.001). Data are available at the Department of Social Medicine in Federal University of Pelotas, Rio Grande do Sul, Brazil, for any collaboration.

Impact of community participation in primary health care: what is the evidence?

2015 ◽  
Vol 21 (1) ◽  
pp. 2 ◽  
Author(s):  
Jessamy Bath ◽  
John Wakerman
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Outcomes ◽  
Community Participation ◽  
Service Providers ◽  
Developmental Process ◽  
Service Access ◽  
Primary Health ◽  
Intermediate Outcomes ◽  
The Impact

Community participation is a foundational principle of primary health care, with widely reputed benefits including improved health outcomes, equity, service access, relevance, acceptability, quality and responsiveness. Despite considerable rhetoric surrounding community participation, evidence of the tangible impact of community participation is unclear. A comprehensive literature review was conducted to locate and evaluate evidence of the impact of community participation in primary health care on health outcomes. The findings reveal a small but substantial body of evidence that community participation is associated with improved health outcomes. There is a limited body of evidence that community participation is associated with intermediate outcomes such as service access, utilisation, quality and responsiveness that ultimately contribute to health outcomes. Policy makers should strengthen policy and funding support for participatory mechanisms in primary health care, an important component of which is ongoing support for Aboriginal Community Controlled Health Services as exemplars of community participation in Australia. Primary health-care organisations and service providers are encouraged to consider participatory mechanisms where participation is an engaged and developmental process and people are actively involved in determining priorities and implementing solutions.

The Use of and Attitude Towards Telehealth in Rural Communities

2007 ◽  
Vol 13 (3) ◽  
pp. 29 ◽  
Author(s):  
Emily Mauldon
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Routine Practice ◽  
Care Providers ◽  
Urban Hospital ◽  
Primary Health ◽  
The Impact ◽  
Rural Patients

This paper reports on the attitudes of a sample of health care providers towards the use of telehealth to support rural patients and integrate rural primary health and urban hospital care. Telehealth and other information technologies hold the promise of improving the quality of care for people in rural and remote areas and for supporting rural primary health care providers. While seemingly beneficial for rural patients, study participants believed that telehealth remains underused and poorly integrated into their practice. In general, participants thought that telehealth is potentially beneficial but places constraints on their activities, and few actually used it. Published literature usually reports either on the success of telehealth pilot projects or initiatives that are well resourced and do not reflect the constraints of routine practice, or has an international focus limiting its relevance to the Australian context. Because of the paucity of systematic and generalisable research into the effects of the routine use of telehealth to support rural patients, it is unclear why health care professionals choose to provide such services or the costs and benefits they incur in doing so. Research and policy initiatives continue to be needed to identify the impact of telehealth within the context of Australian primary health care and to develop strategies to support its use.

scholarly journals Promoting cross-jurisdictional primary health care research: developing a set of common indicators across 12 community-based primary health care teams in Canada

2018 ◽  
Vol 20 ◽  
Author(s):  
Sabrina T. Wong ◽  
Julia M. Langton ◽  
Alan Katz ◽  
Martin Fortin ◽  
Marshall Godwin ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Working Group ◽  
Scale Up ◽  
Data Sources ◽  
Knowledge Generation ◽  
Community Based ◽  
Primary Health ◽  
The Impact

AbstractAimTo describe the process by which the 12 community-based primary health care (CBPHC) research teams worked together and fostered cross-jurisdictional collaboration, including collection of common indicators with the goal of using the same measures and data sources.BackgroundA pan-Canadian mechanism for common measurement of the impact of primary care innovations across Canada is lacking. The Canadian Institutes for Health Research and its partners funded 12 teams to conduct research and collaborate on development of a set of commonly collected indicators.MethodsA working group representing the 12 teams was established. They undertook an iterative process to consider existing primary care indicators identified from the literature and by stakeholders. Indicators were agreed upon with the intention of addressing three objectives across the 12 teams: (1) describing the impact of improving access to CBPHC; (2) examining the impact of alternative models of chronic disease prevention and management in CBPHC; and (3) describing the structures and context that influence the implementation, delivery, cost, and potential for scale-up of CBPHC innovations.FindingsNineteen common indicators within the core dimensions of primary care were identified: access, comprehensiveness, coordination, effectiveness, and equity. We also agreed to collect data on health care costs and utilization within each team. Data sources include surveys, health administrative data, interviews, focus groups, and case studies. Collaboration across these teams sets the foundation for a unique opportunity for new knowledge generation, over and above any knowledge developed by any one team. Keys to success are each team’s willingness to engage and commitment to working across teams, funding to support this collaboration, and distributed leadership across the working group. Reaching consensus on collection of common indicators is challenging but achievable.

scholarly journals Melhores práticas de enfermagem na saúde da pessoa idosa

2020 ◽  
Vol 14 ◽  
Author(s):  
Maria Alice De Freitas ◽  
Angela Maria Alvarez
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Best Practices ◽  
Methodological Approach ◽  
Family Health ◽  
The Elderly ◽  
Structured Interview ◽  
Primary Health ◽  
La Red ◽  
The Impact

Objetivo: compreender, dentro das melhores práticas, as experiências de busca por conhecimento e utilização da experiência profissional dos enfermeiros no cuidado da pessoa idosa na Atenção Primária à Saúde. Método: trata-se de um estudo qualitativo, descritivo e exploratório, com 30 enfermeiros atuantes nas Estratégias Saúde da Família. Utilizou-se um instrumento de entrevista semiestruturado. Analisaram-se os dados pela técnica de Análise de Conteúdo na modalidade Análise Temática. Resultados: revelaram-se a busca por conhecimento com outros profissionais e o acesso à rede de internet como fontes de conhecimento. Evidenciou-se a necessidade do estabelecimento de uma rotina de estudos sistematizada e agenda de educação permanente sob a temática do envelhecimento. Conclusão: conclui-se que o estudo confirma que os enfermeiros realizam ações que carecem de notoriedade e que estão preocupados com o impacto de suas ações para o usuário idoso, mas, para que as melhores práticas sejam completamente estabelecidas,  se faz necessária a imersão científica e metodológica dos profissionais e da gestão, além da busca por conhecimento e valorização da experiência, que já coexistem. Descritores: Idoso; Enfermagem; Conhecimento, Atenção Primária à Saúde; Saúde da Pessoa Idosa; Dinâmica Populacional.AbstractObjective: to understand, within the best practices, the experiences of searching for knowledge and using nurses' professional experience in the care of the elderly in Primary Health Care. Method: this is a qualitative, descriptive and exploratory study, with 30 nurses working in the Family Health Strategies. A semi-structured interview instrument was used. Data was analyzed using the Content Analysis technique in the Thematic Analysis modality. Results: the search for knowledge with other professionals and access to the internet network as sources of knowledge were revealed. The need to establish a systematic study routine and a permanent education agenda under the theme of aging became evident. Conclusion: it is concluded that the study confirms that nurses perform actions that lack notoriety and that they are concerned with the impact of their actions for the elderly user, but, for the best practices to be completely established, scientific immersion is necessary and methodological approach of professionals and management, in addition to the search for knowledge and appreciation of experience, which already coexist. Descriptors: Elderly; Nursing; Knowledge; Primary Health Care; Elderly health; Population Dynamics.ResumenObjetivo: comprender, dentro de las mejores prácticas, las experiencias de búsqueda de conocimiento y el uso de la experiencia profesional de los enfermeros en el cuidado de ancianos en Atención Primaria de Salud. Método: estudio cualitativo, descriptivo y exploratorio con 30 enfermeros activos en las Estrategias de Salud Familiar. Se utilizó un instrumento de entrevista semiestructurada. Los datos se analizaron utilizando la técnica de Análisis de Contenido en la modalidad de Análisis Temático. Resultados: se reveló la búsqueda de conocimiento con otros profesionales y el acceso a la red de Internet como fuentes de conocimiento. La necesidad de establecer una rutina de estudio sistemática y una agenda de educación permanente bajo el tema del envejecimiento se hizo evidente. Conclusión: se concluye que el estudio confirma que los enfermeros realizan acciones que carecen de notoriedad y que están preocupados por el impacto de sus acciones para el usuario mayor, pero, para que las mejores prácticas se establezcan por completo, es necesaria la inmersión científica y enfoque metodológico de profesionales y directivos, además de la búsqueda de conocimiento y valoración de la experiencia, que ya coexisten. Descriptores: Anciano; Enfermería; Conocimiento; Atencíon Primária de la Salud; Saúde do Idoso; Dinámica Poblacional.

scholarly journals The impact of COVID-19 on primary health care and antibiotic prescribing in rural China: qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tingting Zhang ◽  
Xingrong Shen ◽  
Rong Liu ◽  
Linhai Zhao ◽  
Debin Wang ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Primary Health Care ◽  
Rural Areas ◽  
Rural China ◽  
Antibiotic Prescribing ◽  
Epidemic Control ◽  
Primary Health ◽  
Tract Infections ◽  
The Impact

Abstract Background In China, the primary health care (PHC) system has been designated responsible for control and prevention of COVID-19, but not treatment. Suspected COVID-19 cases presenting to PHC facilities must be transferred to specialist fever clinics. This study aims to understand the impact of COVID-19 on PHC delivery and on antibiotic prescribing at a community level in rural areas of central China. Methods Qualitative semi-structured interviews were conducted with 18 PHC practitioners and seven patients recruited from two township health centres and nine village clinics in two rural residential areas of Anhui province. Interviews were transcribed verbatim and analysed thematically. Results PHC practitioners reported a major shift in their work away from seeing and treating patients (due to government-mandated referral to specialist Covid clinics) to focus on the key public health roles of tracing, screening and educating in rural areas. The additional work, risk, and financial pressure that PHC practitioners faced, placed considerable strain on them, particularly those working in village clinics. Face to face PHC provision was reduced and there was no substitution with consultations by phone or app, which practitioners attributed to the fact that most of their patients were elderly and not willing or able to switch. Practitioners saw COVID-19 as outside of their area of expertise and very different to the non-COVID-19 respiratory tract infections that they frequently treated pre-pandemic. They reported that antibiotic prescribing was reduced overall because far fewer patients were attending rural PHC facilities, but otherwise their antibiotic prescribing practices remained unchanged. Conclusions The COVID-19 pandemic had considerable impact on PHC in rural China. Practitioners took on substantial additional workload as part of epidemic control and fewer patients were seen in PHC. The reduction in patients seen and treated in PHC led to a reduction in antibiotic prescribing, although clinical practice remains unchanged. Since COVID-19 epidemic control work has been designated as a long-term task in China, rural PHC clinics now face the challenge of how to balance their principal clinical and increased public health roles and, in the case of the village clinics, remain financially viable.

The Impact of Primary Health Care on Tuberculosis: A Quasi-Experimental Study Based on a Nationwide Cohort of 7.3 Million Brazilians

2021 ◽  
Author(s):  
Gabriela dos Santos de Jesus ◽  
Julia Moreira Pescarini ◽  
Andréa Silva ◽  
Ana Wieczorek Torrens ◽  
Elzo Pereira Pinto Júnior ◽  
...  
Keyword(s):  
Health Care ◽  
Experimental Study ◽  
Primary Health Care ◽  
Primary Health ◽  
Quasi Experimental ◽  
The Impact

scholarly journals Detection of mental disorders with the Patient Health Questionnaire in primary care settings in Nigeria

2010 ◽  
Vol 2 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Olawale O. Ogunsemi ◽  
Francis A. Oluwole ◽  
Festus Abasiubong ◽  
Adebayo R. Erinfolami ◽  
Olufemi E. Amoran ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Disorders ◽  
Patient Health Questionnaire ◽  
Health Questionnaire ◽  
Primary Care Settings ◽  
Primary Health ◽  
Patient Health ◽  
The Impact

Mental disorders lead to difficulties in social, occupational and marital relations. Failure to detect mental disorder denies patients potentially effective treatment. This study aimed to assess the prevalence and nature of mental disorders at the primary care settings and the recognition of these disorders by the attending physicians. Over a period of eight weeks, consecutive and consenting patients who attended three randomly selected primary health care facilities in Sagamu Local Government Area of Ogun state were recruited and administered a questionnaire that included a socio-demographic section and Patient Health Questionnaire (PHQ). A total of 412 subjects took part in the study. Subject age ranged from 18-90 years with a mean age of 52.50±21.08 years. One hundred and seventy-six (42.7%) of the subjects were males. A total of 120 (29.1%) of the subjects had depressive disorder, 100 (24.3%) had anxiety disorder, 196 (47.6%) somatoform disorder and 104 (25.2%) met the criteria for an alcohol related problem. The PHC physicians were only able to diagnose disorders relating to mental health in 52 (12.6%) of the subjects. Health and work situations accounted for more than three-quarters of the causes of stress experienced by the subjects. We conclude that there is a high prevalence of mental disorders among patients seen in primary care settings and that a significant proportion of them are not recognized by the primary care physicians. Stress relating to health, work and financial problems is common among primary health care attendees. Physicians in primary health care should be alert to the possibility and the impact of undetected psychiatric morbidity.

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