WHO Report: Social determinants approaches to public health: from concept to practice

From the April 2011 World Health Organization report

The health of a population is measured by the level of health and how this health is distributed within the population. The WHO publication from early 2010, entitled Equity, social determinants and public health programmes analysed from the perspective of thirteen priority public health conditions their social determinants and explored possible entry points for addressing the avoidable and unfair inequities at the levels of socioeconomic context, exposure, vulnerability, health-care outcome and social consequences. However, the analysis needs to go beyond concepts to explore how the social determinants of health and equity can be addressed in the real world.

This publication takes the discussion on social determinants of health and health equity to a practical level of how programmes have actually addressed the challenges faced during implementation. Social determinants approaches to public health: from concept to practice is a joint publication of the Department of Ethics, Equity, Trade and Human Rights (ETH), Special Programme for Research and Training in Tropical Diseases (TDR), Special Programme of Research, Development and Research Training in Human Reproduction (HRP), and Alliance for Health Policy and Systems Research (AHPSR).

The case studies presented in this volume cover public health programme implementation in widely varied settings, ranging from menstrual regulation in Bangladesh and suicide prevention in Canada to malaria control in Tanzania and prevention of chronic noncommunicable diseases in Vanuatu.

Related articles

• On Priority-Setting, Public Reason, and the Social Determinants of Health (medhumanities.org)
• Have I Got a Story for You: A Call for Public Health Storytelling (scienceblogs.com)

Bringing Health Information to the Community Blog Goes National!

From a May 2011 Cornflower posting by Jacqueline Leskovec

The Bringing Health Information to the Community blog (fondly referred to as the BHIC blog) was developed by the NN/LM MidContinental Region (NN/LM MCR) about four years ago as a way to provide information to staff at community based organizations and public health departments, clinics, and others outside of libraries that the MCR staff encountered in their outreach efforts. It was also created as a tool to be used by NN/LM MCR members to share information with people within their institutions and communities.

With the new NLM contract, the BHIC blog has moved over to become a national blog, and staff at four other RMLs (including the GMR!) will be contributing writers. The new URL is http://nnlm.gov/bhic/.

If you want to receive a daily digest of the BHIC blog postings, just email Siobhan Champ-Blackwell, at siobhan at creighton.edu, and you will be added to a distribution LISTSERV. The distribution list sends out only one email a day. You can subscribe directly to the blog and get an email each time a posting is made (4-5 emails a day). An RSS feed is also available.

According to Siobhan, “We are excited that the BHIC blog is recognized as a national resource, and we are looking forward to the growth that will occur through the participation of the other RMLs”. The GMR is proud to be a contributor to this great resource.

Less Educated People Age Faster, DNA Study

Image via Wikipedia

From a 11 May 2011 Medical News Today article

People who leave education with fewer academic qualifications may grow old faster, according to a DNA study that compared groups of people who spent different lengths of time in education and found the ones who spent the least time had shorter telomeres or “caps” on the ends of their DNA, a sign of premature aging in cells….

…BHF’s Associate Medical Director, Professor Jeremy Pearson, said the study reinforces the need to tackle social inequalities to combat ill health:

“It’s not acceptable that where you live or how much you earn — or lesser academic attainment — should put you at greater risk of ill health,” he said in a statement.

Andrew Steptoe, BHF Professor of Psychology at UCL, and colleagues, wrote about their findings in a paper published recently in the journal Brain, Behavior, and Immunity.

They were concerned that while there is evidence that low socioeconomic status is linked to faster biological aging, attempts to tie it telomere length have yielded inconsistent results.

Telomeres are short repetitive sequences of DNA that “cap” the ends of chromosomes and stop them degrading and fusing with their neighbours: imagine the tips on the ends of shoelaces that stop them fraying. Telomeres get consumed in cell division, and are replenished by an enzyme called telomerase, but there is a limit to how many times this can happen, and they gradually get shorter, limiting the number of times cells can divide, and in turn, lifespan….

…After adjusting for possible confounding factors, such as age, gender, various health indicators such as smoking and cholesterol, and lifestyle indicators such as exercise, they found that lower educational attainment was linked to shorter telomere length, while household income was not, and neither was employment grade.

In fact, the link between “telomere length and education remained significant after adjusting for current socioeconomic circumstances,” they wrote.

They also found that in men, the highest telomerase activity (the enzyme that repairs the telomeres) was in the lowest education group.

The researchers concluded that low socioeconomic status defined in terms of education but not current socioeconomic circumstances is linked to shorter telomeres.

This supports the idea that faster aging is not just a result of current economic circumstances or social status in a person’s life, but of long-term effects that start early in life, such as education.

The researchers also suggest that people with higher levels of education are probably better equipped with life skills like problem-solving that help them deal with the stresses of life, and this reduces the biological stress on their bodies, the so-called “allostatic load.

“Educational attainment but not measures of current socioeconomic circumstances are associated with leukocyte telomere length in healthy older men and women.”
Andrew Steptoe, Mark Hamer, Lee Butcher, Jue Lin, Lena Brydon, Mika Kivimäki, Michael Marmot, Elizabeth Blackburn, Jorge D. Erusalimsky.
Brain, Behavior, and Immunity, In Press, Uncorrected Proof, Available online 23 April 2011.
DOI:10.1016/j.bbi.2011.04.010

[For suggestions on how to get this article for free or at low cost, click here]

Related articles

• Telomere Nobelist: Selling a ‘biological age’ test (newscientist.com)
• Risk of accelerated aging seen in PTSD patients with childhood trauma (eurekalert.org)
• Study finds link between chronic depression and accelerated immune cell aging (eurekalert.org)

Research On The Multiple Dimensions Of Video Game Effects

From an 11 May 2011 Medical News Today article

Douglas Gentile is painfully aware of how research on the effects of video games on kids is often oversimplified to say that games are either “good” or “bad.” The associate professor of psychology at Iowa State University has had his own research typecast on the “bad” side with studies on violent video game’s effects and video game addiction, even though he’s also done studies demonstrating the benefits of games.

A new article by Gentile appearing in the journal Child Development Perspectives argues that existing video game literature can’t be classified in black and white terms.

[The abstract of the journal article may be found here.

For suggestions on how to get the full text of the article for free or at low cost, click here]

Instead, there’s a vast grey area when considering the multiple dimensions of video game effects on children and adolescents.

Gentile writes that there are at least five dimensions on which video games can affect players simultaneously – amount of play, content of play, game context, structure of the game, and the mechanics of game play. …

Click here to read the rest of the article

Related articles

• Careful with Violent Video Games (brain4biz.wordpress.com)
• Can focus on Video Games and Visual Effects enhance STEM education efficiency? (computinged.wordpress.com)
• Video games effective treatment for stroke patients: study (eurekalert.org)
• Video Memory Game Shown to Boost Kids’ Brain Power (news.yahoo.com)
• Training Via Video Game Shown to Boost Kids’ Brain Power (nlm.nih.gov)

What’s The Use Of Health Economic Evaluations?

From the 10 May 2011 Medical News Today article

The production of health economic evaluations of pharmaceuticals is a multibillion dollar industry globally. Nevertheless, little is known about uptake by medical decision makers.

Dr. Sandra Erntoft has investigated whether there are differences in use across decision makers and to what extent these patterns can be explained by contextual factors?

The review – “Pharmaceutical priority setting and the use of health economic evaluations – A systematic literature review”, published in Value In Health identifies differences in the use between decision makers and contexts. Health Economic evaluations are not only used in order to inform decisions, but also serves the purpose of rationalize decisions, structuring the priority setting process or requesting additional budgets. Factors that seem to support an increased use of health economic evaluations are a general awareness and acceptance of limited health care resources, demands for an explicit priority setting process, the lack of budgetary responsibilities and the presence of health economic skills.

Dr. Sandra Erntoft, Research Director of the Swedish Institute for Health Economics says “When these preconditions are not in place, it is difficult for a decision maker to use health economic evaluations directly in medical decision making. In order to increase the use these cultural and institutional barriers need to be removed.”

Related articles

• FDA could analyze public health consequences of its decisions better (medicalxpress.com)

Improving Health Care Decisions By Putting Research Into Practice

From a 12 May 2011 Medical News Today article

Adding research-centred approaches into the day-to-day life of the doctor’s clinic strengthens clinical decisions, according to a new report by the European Medical Research Councils. The “Implementation of Medical Research in Clinical Practice” report launched at the European School of Management and Technology in Berlin, Germany.

The report examines the quality of clinical research, and how using research in clinical practice can improve treatment. An important theme is tightening the relationship between doctors, patients and researchers, such as involving GPs in clinical trials to get a better idea of how treatments work in a wider range of patients, beyond the controlled environment of a hospital.

“Medical care has improved greatly in the last 50 years, underpinned by progress in clinical research,” said Professor Liselotte Højgaard, chair of the European Medical Research Councils, part of the European Science Foundation (ESF). “But we cannot be complacent. We want new findings to be introduced into clinical practice as speedily and efficiently as possible, so that evidence-based medicine is used in each and every patient treatment.”…

…
Greater international collaboration between countries could help with systematically reviewing treatments, through shared databases on protocols, data, and health technology assessments. The report recommends actively using evidence-based clinical practice guidelines, as well as promoting rigorous reporting for clinical studies. Health technology assessment reports and clinical guidelines are strongly advised for hospitals and primary care facilities, as well as for administrative processes including financing of treatment and technologies. ….

Click here to read the rest of the news article

Related articles

• Do Doctors Resist Reform? The Case of Evidence-Based Medical Practice (larrycuban.wordpress.com)
• IOM recommends standards to achieve reliable clinical practice guidelines (eurekalert.org)

Doctors call embedding a severe type of self-harm

From a May 10, 2011 Reuters Health News article by Kerry Grens

NEW YORK (Reuters Health) – In a new study this week, doctors describe a form of self-injury among teenagers called self-embedding, which involves inserting objects into the skin or muscle.

The researchers say embedding is on the spectrum of self-harming behaviors, but a much more severe form that appears to be linked to thoughts of suicide and major psychiatric disorders.

“There’s clearly a more severe intent to hurt themselves than cutting,” said Dr. William Shiels, a radiologist at Nationwide Children’s Hospital in Columbus, Ohio and one of the authors of the study.

“Inserting a 16 cm paperclip – not just to do that on one arm, but both arms – the intent that’s required to cause that much self harm is significant,” he said.

Self-injury, which is often in the form or cutting or burning, is a fairly common behavior, with estimates ranging between 4 and 30 percent of youth who have hurt themselves in some way.

The pain involved in self-harm is thought to provide a sense of psychological relief, and is generally not considered part of a suicide attempt.

Click here to read the rest of the article

Related resources and articles

• Cutting (Teen Health/Nemours Foundation)
  Article written for teens with information and advice
• Self-harm videos a worrying trend (healthzone.ca)
• Cutting: Deliberate Self-Harm Syndrome (Medpedia)
• A new study on self-injury behavior encourages quick and targeted intervention (eurekalert.org)
• How can we tackle the rise in self-harm? (Irish Times, May 2011)
  

  “The solution, she says, is a multiple-intervention approach similar to the very successful German model, which has reduced self-harm and suicide in Nuremberg by 24 per cent over two years and has now been rolled out across that country.

  The Nuremberg Alliance Against Depression was a two year pilot intervention programme performed at four levels: training of family doctors and support through different methods; a public relations depression awareness campaign; cooperation with community facilitators (teachers, priests, local media, etc.); and support for self-help activities as well as for high-risk groups. The programme has been extended throughout Germany and in other European countries through the European Alliance Against Depression.”

World unites to halt death and injury on roads

Decade of Action for Road Safety 2011-2020 set to save millions of lives

The  WHO Global Plan for The Decade of Action for Road Safety 2011-2020 includes links to programs, publications, events, and more by a voluntary consultative process of partners. These partners include governments, international agencies, the private sector, and others.

[The editor was in a road accident back in her Peace Corps Liberia West Africa days, truck overturned and rolled over several times down a rather steep embankment. Very fortunately neither the driver, my colleague, or myself was seriously injured. However, my right leg ended up outside the vehicle, and underneath the truck. Nothing was broken, but I had 35 or so stitches in my leg because of shattered glass… Accident happened late at night on dirt road, driver had swerved to avoid oncoming car which was speeding in the center of the road…No ambulances up country…luckily a bus stopped…passengers got out, helped us in bus..and they turned around and drove back to town…to the hospital..t was the second time that night that this bus had stopped at an accident scene and transported people to the local hospital]

The Decade of Action link includes social media options (as Facebook and Twitter), advocacy and press materials, and highlighted publications.

From the World Health Organization (WHO) press release

6 MAY 2011 | GENEVA – On 11 May, dozens of countries around the world kick off the first global Decade of Action for Road Safety 2011-2020. From New Zealand to Mexico and the Russian Federation to South Africa, governments are committing to take new steps to save lives on their roads. The Decade seeks to prevent road traffic deaths and injuries which experts project will take the lives of 1.9 million people annually by 2020.

To mark the launch of the Decade, governments in countries such as Australia, Cambodia, Ethiopia, Indonesia, Kuwait, Malaysia, Mexico, Niger, Nigeria, the Philippines, Slovenia, Sri Lanka, Uzbekistan and Viet Nam will host high-profile events and release national plans to improve safety and services for victims. A number of landmark national monuments will be illuminated with the road safety “tag”, the new symbol for the Decade. These include Times Square in New York City; Christ the Redeemer statue in Rio de Janeiro; Trafalgar Square in London; and the Jet d’Eau in Geneva, among others.

Curbing a growing health and development problem

“Today countries and communities are taking action vital to saving lives on our streets and highways” said WHO Director-General Dr Margaret Chan. “Road traffic crashes are a growing health and development concern affecting all nations, and the Decade offers a framework for an intensified response.”

Road traffic injuries have become the leading killer of young people aged 15–29 years. Almost 1.3 million people die each year on the world’s roads, making this the ninth leading cause of death globally. In addition to these deaths, road crashes cause between 20 million and 50 million non-fatal injuries every year. In many countries, emergency care and other support services for road traffic victims are inadequate. These avoidable injuries overload already stretched health services.

Global plan to improve the safety of roads and vehicles

“None of us should have to bear the grief and devastation caused by a road traffic crash” said Dr Etienne Krug, WHO Director of the Department of Violence and Injury Prevention and Disability. “The steps outlined in the Global Plan for the Decade are immediately doable, and will do much to spare the suffering of so many.”

The Global Plan outlines steps towards improving the safety of roads and vehicles; enhancing emergency services; and building up road safety management generally. It also calls for increased legislation and enforcement on using helmets, seat-belts and child restraints and avoiding drinking and driving and speeding. Today only 15% of countries have comprehensive laws which address all of these factors.

Pedestrians, cyclists, and motorcyclists collectively represent almost half of those killed on the world’s roads….

Click here to read the rest of the press release

Related Post

Vaccine for Road Safety

I stumbled upon this infomercial from BBC World while looking for something to entertain me over dinner:

 

Related articles

• Vietnam joins the world to halt death and injury on the roads (redantliberationarmy.wordpress.com)
• A vaccine for road safety  waronthemotorist.wordpress.com)
• Group backs road safety Decade (lv.com)
• PM helps launch road safety campaign (number10.gov.uk)
• Call for global road safety action (autonetinsurance.co.uk)
• Stay Safe! (motorhomenews.wordpress.com)
• Road safety decade in Bangladesh – BBC News (news.google.com)