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Persistent Child Malnutrition in Dhaka: Integrating Political Considerations and Multisectoral Interventions for Solutions Moving Forward 达卡持续存在的儿童营养不良问题:整合政治考虑因素和多部门干预措施,寻找向前迈进的解决方案
Pub Date : 2024-06-02 DOI: 10.52214/cujgh.v14i1.12398
Shafkat Meraj, Shaheem Nuraj
One of the world’s most densely populated cities in the World, Dhaka continues to grapple with its persisting challenge of child malnutrition. While food shortages, food insecurity, and inadequate feeding practices contribute to child malnutrition, various social and economic determinants, including maternal education, family household income, and geographic residence further exacerbate the problem. While existing interventions like the Health Sector Support Project and National Nutrition Programme have made strides in reducing short-term and long-term child malnutrition, challenges such as insufficient coverage hamper its overall scope and effectiveness. In order to address issues hampering funding capacity and the breadth and quality of nutrition-related services, it is necessary to understand the factors affecting them, including political commitment toward child nutrition, policy alignment, program design and implementation, monitoring and evaluation, and intervention strategies and service delivery. Moving forward, comprehensive strategies taking into account political prioritization, multisectoral coordination, and targeted primary intervention strategies are crucial for tackling child malnutrition effectively in LMICs and cities like Dhaka and beyond.
作为世界上人口最稠密的城市之一,达卡仍在努力应对儿童营养不良这一长期挑战。虽然粮食短缺、粮食不安全和喂养不当是造成儿童营养不良的原因,但各种社会和经济决定因素,包括产妇教育、家庭收入和居住地,也进一步加剧了这一问题。虽然卫生部门支助项目和国家营养计划等现有干预措施在减少短期和长期儿童营养不良方面取得了长足进步,但覆盖面不足等挑战阻碍了其整体范围和有效性。为了解决阻碍供资能力以及营养相关服务的广度和质量的问题,有必要了解影响这些问题的因素,包括对儿童营养的政治承诺、政策调整、计划设计和实施、监测和评估以及干预策略和服务提供。展望未来,考虑到政治优先次序、多部门协调和有针对性的初级干预战略的综合战略对于在低收入、中等收入国家和地区以及达卡等城市有效解决儿童营养不良问题至关重要。
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引用次数: 0
Attitudes and Behaviors Around Preventative Measures Against Malaria During Pregnancy in The Luwero District of Uganda 乌干达卢韦罗地区对孕期疟疾预防措施的态度和行为
Pub Date : 2024-06-02 DOI: 10.52214/cujgh.v14i1.12404
Alyssa Robb, Michelle Cathorall
Background: In Uganda, the rate of malaria in pregnancy ranges from 8.9-50% depending on the level of transmission within the region. It is estimated that malaria may contribute to 8-14% of low birth weight, 3-8% of infant mortality, and 3-15% of maternal anemia. There is limited information on the attitudes and behaviors of pregnant women related to malaria prevention-health impacts for the child, including infant and maternal death.  Methods: A cross-sectional study was conducted in June of 2023. A structured interview was used to collect data on demographics, attitudes, and preventative behaviors related to malaria during pregnancy. Interviews conducted in participants’ homes took approximately 50 minutes. Descriptive statistics were run for demographic data. Chi-squared test and Pearson Product Moment Correlation with a significance level set at p < 0.05 were conducted to test relationships between variables of interest.  Results: Data were collected from 63 women with a mean age of 37. All women had at least one pregnancy resulting in a live birth. Almost one-third of women (31.7%, n = 20) reported getting malaria during their most recent pregnancy. Most respondents (82%, n = 52) received prenatal care and 87.3% (n = 55) used at least one prevention measure against malaria during their last pregnancy. For the participants that reported not protecting themselves (12.7%, n = 8) it was found to be statistically significant in preventing malaria (χ2 = 9.744, p = .008). Bed net use was found significant in preventing malaria during pregnancy (χ2 = 7.113, p = .029) and SP/Fansidar (χ2 = 46.534, p = < .001) during their most recent pregnancy. Receiving prenatal care was found to be significant (χ2 = 24.186, p = <.001). Education level was also found to be significant in to whether women received prenatal care (χ2 = 14.634, p = .023) and in the attitudes that pregnant women should receive malaria treatment during pregnancy (χ2 = 17.084, p = .009).  Conclusion: This study sheds light on the attitudes and behaviors surrounding preventative measures against malaria during pregnancy among a sample of women in rural Uganda. The study emphasizes the need for targeted health campaigns to promote bed net use, addressing barriers to IPTp implementation, and advocacy for improved policy change and antenatal care attendance. Improving access to prenatal care services, particularly in rural communities, is needed to keep women and children healthy.  Implications for Practice: Recognizing the challenges related to policy implementation, there is a pressing need to advocate for policies that support effective prevention strategies during pregnancy. Advocacy efforts should be directed towards improved policy implementation and encouraging regular antenatal care visits.  
背景:在乌干达,妊娠期疟疾发病率为 8.9%-50%,这取决于该地区的传播水平。据估计,疟疾可能导致 8-14% 的新生儿体重不足、3-8% 的婴儿死亡和 3-15% 的产妇贫血。关于孕妇在预防疟疾方面的态度和行为--对儿童健康的影响,包括婴儿和产妇死亡--的信息十分有限。 研究方法2023 年 6 月进行了一项横断面研究。采用结构化访谈法收集有关人口统计学、态度和孕期疟疾预防行为的数据。访谈在参与者家中进行,耗时约 50 分钟。对人口统计学数据进行了描述性统计。对相关变量之间的关系进行了卡方检验(Chi-squared test)和皮尔森乘积矩相关检验(Pearson Product Moment Correlation),显著性水平设定为 p <0.05。 结果共收集了 63 名妇女的数据,她们的平均年龄为 37 岁。所有妇女至少有一次怀孕,并最终诞下活产。近三分之一的妇女(31.7%,n = 20)表示在最近一次怀孕期间患过疟疾。大多数受访者(82%,n = 52)接受了产前护理,87.3%(n = 55)的受访者在最近一次怀孕期间至少采取了一种预防疟疾的措施。对于报告未采取自我保护措施的受访者(12.7%,n = 8),发现这对预防疟疾有显著的统计学意义(χ2 = 9.744,p = .008)。在最近一次怀孕期间,使用蚊帐对预防孕期疟疾(χ2 = 7.113,p = .029)和 SP/Fansidar (χ2 = 46.534,p = < .001)有显著效果。接受产前护理具有显著性(χ2 = 24.186,p = <.001)。教育水平对妇女是否接受产前护理(χ2 = 14.634,p = .023)和对孕妇在怀孕期间应接受疟疾治疗的态度(χ2 = 17.084,p = .009)也有显著影响。 结论本研究揭示了乌干达农村妇女对孕期疟疾预防措施的态度和行为。该研究强调,有必要开展有针对性的健康宣传活动,以推广蚊帐的使用,消除实施 IPTp 的障碍,并倡导改善政策变化和产前护理就诊率。为了保证妇女和儿童的健康,需要改善产前保健服务的可及性,尤其是在农村社区。 对实践的启示:认识到与政策实施相关的挑战,迫切需要倡导支持孕期有效预防策略的政策。宣传工作应着眼于改善政策实施和鼓励定期产前检查。
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引用次数: 0
One Health: The Future of Ecosystem Health and Where to Start 一个健康:生态系统健康的未来与起点
Pub Date : 2024-06-02 DOI: 10.52214/cujgh.v14i1.12311
Alyssa Persano
Highly relevant to our current and future global state is the need for ecosystem conservation. Rewilding, the process of introducing wildlife to degraded areas, is one such method of conservation. Rewilding is primarily applied from an ecological point of view and largely fails to consider the public health and systemic implications of habitat restoration. As such, a new conservation paradigm is warranted. One Health is a global health approach that considers the complex interplay between humans, animals, and their shared environment. While One Health examines the social, political, and economic context of degraded areas to prioritize systemic advancement and disease prevention in conjunction with conservation, the large scope and transdisciplinary nature of One Health make it challenging to implement. Rewilding efforts conducted by the Conservation Landscape Institute (CLI) in South Africa’s Eastern Cape is an ideal candidate for a One Health approach. With stable funding, infrastructure, and institutional support, CLI is prime for a transition to a One Health framework that can serve as a model for One Health implementation worldwide. As concerns about systemic inequality, disease prevalence, and ecosystem degradation increase, it is necessary to take advantage of the opportunity provided at CLI to establish the new global health paradigm that is One Health.
与我们当前和未来全球状况高度相关的是生态系统保护的必要性。野化,即在退化地区引入野生动物的过程,就是这样一种保护方法。野化主要是从生态学的角度出发,在很大程度上没有考虑栖息地恢复对公共健康和系统的影响。因此,需要一种新的保护范式。一体健康 "是一种全球健康方法,它考虑了人类、动物及其共同环境之间复杂的相互作用。虽然 "一体健康 "研究了退化地区的社会、政治和经济背景,以便在保护的同时优先考虑系统性进步和疾病预防,但 "一体健康 "的大范围和跨学科性质使其在实施过程中面临挑战。南非东开普省保护景观研究所(CLI)开展的野化工作是 "一体健康 "方法的理想候选者。该研究所拥有稳定的资金、基础设施和机构支持,是向 "一体健康 "框架过渡的最佳时机,可作为全球实施 "一体健康 "的典范。随着人们对系统性不平等、疾病流行和生态系统退化的关注与日俱增,有必要利用 CLI 提供的机会,建立 "一体健康 "这一新的全球健康模式。
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引用次数: 0
Preliminary analysis of the disability landscape on Roatán, Honduras 对洪都拉斯罗阿坦岛残疾状况的初步分析
Pub Date : 2024-06-02 DOI: 10.52214/cujgh.v14i1.11978
Julia Lin, Catherine Purnell, Shanzeh Sheikh, Hishi Ulak, Kallie Vallecillo, Dennis Clements
Understanding the needs of persons with disabilities (PWDs) is vital to improving targeted healthcare and resources. The project seeks to assess the prevalence of disabilities, resources used, and care and treatment needs for PWDs on Roatán, Honduras. There is little to no prior research about disabilities on the island of Roatán, and few disability studies available in the country of Honduras. We surveyed 581 community members on the island of Roatán over a period of 6 weeks, on questions surrounding the disability status of themselves and their family members, and resources used by PWDs. Interviews were conducted with physicians, promotoras (community health promoters), and staff at the local Rehabilitation Clinic to assess the social experiences and resource needs of PWDs on the island. Of the 613 subjects obtained from our surveys, 258 (42%) had one or more disabilities. The most common disabilities were vision impairment, mobility impairment, and diabetes. 44.98% reported that the PWD did not visit any medical care facility to receive treatment. We found that there was a lack of disability-specific resources on Roatán, and no consistent definition of disability among community members and healthcare providers. Barriers to care include discrimination; caretaker burden; lack of medications, assistive devices, and specialists; and transportation. Our research highlights the need for more education on disabilities within communities, as well as increasing the amount and depth of disability-specific resources accessible on the island. This study was conducted at the request of Clinica Esperanza to determine how it could better support PWDs on Roatán, and the potential benefit of developing a day home for PWDs.
了解残疾人(PWDs)的需求对于改善有针对性的医疗保健和资源至关重要。该项目旨在评估洪都拉斯罗阿坦岛残疾人的残疾发生率、使用的资源以及护理和治疗需求。此前几乎没有关于罗阿坦岛残疾问题的研究,洪都拉斯国内也鲜有关于残疾问题的研究。我们对罗阿坦岛上的 581 名社区成员进行了为期 6 周的调查,内容涉及他们本人及其家庭成员的残疾状况,以及残疾人使用的资源。我们还对医生、社区健康宣传员和当地康复诊所的工作人员进行了访谈,以评估岛上残疾人的社会经历和资源需求。在我们调查的 613 名受访者中,有 258 人(42%)患有一种或多种残疾。最常见的残疾是视力障碍、行动障碍和糖尿病。44.98% 的受访者表示没有到任何医疗机构接受治疗。我们发现,罗阿坦缺乏专门针对残疾的资源,社区成员和医疗服务提供者对残疾的定义也不一致。医疗障碍包括歧视、看护负担、缺乏药物、辅助设备和专家以及交通。我们的研究强调,需要在社区内开展更多有关残疾的教育,并增加岛上可获得的残疾专用资源的数量和深度。这项研究是应 "埃斯佩兰萨诊所 "的要求进行的,目的是确定该诊所如何才能更好地为罗阿坦岛的残疾人提供支持,以及发展残疾人日间之家的潜在益处。
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引用次数: 0
The COVID-19 Pandemic and the Health of Incarcerated People COVID-19 大流行与被监禁者的健康
Pub Date : 2024-02-27 DOI: 10.52214/cujgh.v13i2.10683
Sebastian Acevedo, Pamela Valera
COVID-19 has upended the daily operations of the criminal justice system. Correctional COVID-19 policies have altered how incarcerated people navigate legal proceedings, receive visitors, procure healthcare services, and maintain mental well-being and physical health. Although some of these changes have been positive (e.g., increased access to tablets, and de-incarceration policies), other strategies have exposed societal inequities that fail to meet the needs of people who are incarcerated. Lockdown orders may have unintended consequences for incarcerated people, particularly among those with mental disorders. This commentary examines the barriers and facilitators of healthcare access in our correctional system that has been made more acute due to COVID-19.
COVID-19 颠覆了刑事司法系统的日常运作。COVID-19 的惩教政策改变了被监禁者在法律诉讼、接待来访者、获得医疗保健服务以及保持精神和身体健康方面的方式。虽然其中一些变化是积极的(例如,增加了使用平板电脑的机会,以及非监禁政策),但其他策略暴露了社会的不平等,无法满足被监禁者的需求。封锁令可能会对被监禁者造成意想不到的后果,尤其是对那些精神失常的人。这篇评论探讨了在我们的惩教系统中,由于 COVID-19 而变得更加尖锐的医疗保健获取的障碍和促进因素。
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引用次数: 0
Healthcare Capacity Building in Northwest Syria: Challenges, Successes, and Lessons Learned 叙利亚西北部的医疗保健能力建设:挑战、成功和经验教训
Pub Date : 2024-02-27 DOI: 10.52214/cujgh.v13i2.11738
Fahad Ahmed, Basem Zouhair Shaher, Nazih Mohammad Saeed Al Tueni, Fares Mohammad Amin Alshadidi, Natasha Mussa, Nimetcan Mehmet, S. Mollahaliloğlu
The conflict in Syria has caused significant loss of life and widespread displacement. Northwest Syria (NWS) has been heavily impacted, leading to challenges in providing healthcare services. Attacks on healthcare workers and facilities have worsened the situation. Healthcare students and professionals have been specifically targeted, disrupting their education and resulting in migration and a shortage of skilled healthcare workers. To address these challenges, local and international organizations and institutions have supported long-term projects to improve healthcare facilities and provide a trained healthcare workforce. Collaborations with multiple stakeholders have been established to ensure comprehensive and effective training opportunities, enabling healthcare workers to better serve the population's healthcare needs. A range of undergraduate, postgraduate, and research programs have been developed to enhance healthcare capacity building. These programs aim to strengthen the knowledge and skills of healthcare professionals in NWS. Efforts have been made to strengthen the health system and build the capacity of policy makers in utilizing evidence-based knowledge for informed policy decisions. Global and regional partnerships, along with adequate funding, have played a significant role in the successful enhancement of capacity building activities at all levels. Building healthcare and health research capacity in underdeveloped and conflict-affected parts of NWS presents numerous challenges. Underdeveloped infrastructure, inadequate teaching and service delivery tools, gender disparities, and the sustainability of funding create obstacles to effective capacity building. The political context, coupled with security concerns further complicate efforts. The accreditation of education, and the brain drain of skilled healthcare professionals, add to the difficulties in strengthening the healthcare system in NWS. Addressing these challenges requires comprehensive and collaborative approaches that prioritize stability, security, gender equity, sustainable funding, and improved coordination and resources for education and service delivery. The lessons learned from capacity-building efforts in the Syrian conflict have broader implications for other regions facing similar challenges.
叙利亚冲突已造成重大人员伤亡和大范围流离失所。叙利亚西北部(NWS)受到严重影响,导致医疗服务的提供面临挑战。对医疗工作者和医疗设施的袭击使局势进一步恶化。医护学生和专业人员成为特别袭击目标,扰乱了他们的学业,导致移民和熟练医护人员短缺。为了应对这些挑战,当地和国际组织及机构支持了一些长期项目,以改善医疗保健设施并提供一支训练有素的医疗保健队伍。与多个利益攸关方建立了合作关系,以确保提供全面、有效的培训机会,使医护人员能够更好地满足民众的医疗保健需求。为加强医疗保健能力建设,还制定了一系列本科生、研究生和研究计划。这些计划旨在加强西北地区医疗保健专业人员的知识和技能。我们努力加强卫生系统,培养决策者利用循证知识做出明智决策的能力。全球和地区伙伴关系以及充足的资金在成功加强各级能力建设活动方面发挥了重要作用。在西北部欠发达地区和受冲突影响地区建设医疗保健和卫生研究能力面临诸多挑战。不发达的基础设施、不足的教学和服务工具、性别差异以及资金的可持续性,都对有效的能力建设造成了障碍。政治环境和安全问题使工作进一步复杂化。教育认证和熟练医疗保健专业人员的人才流失增加了加强西北地区医疗保健系统的困难。要应对这些挑战,就必须采取全面的协作方法,优先考虑稳定、安全、性别平等、可持续供资以及改善教育和服务提供方面的协调和资源。从叙利亚冲突中的能力建设工作中汲取的经验教训对面临类似挑战的其他地区具有更广泛的影响。
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引用次数: 0
Examining the Impact of Living in an Asylum on the Mental Health of Middle Eastern Refugees 研究避难所生活对中东难民心理健康的影响
Pub Date : 2024-02-27 DOI: 10.52214/cujgh.v13i2.11727
Maariyah Kharal
Refugee aid is seldom a topic of American political conversations despite rising global refugee populations (American Immigration Council, 2020). Refugees who have fled or been forced out of their native country seek asylum, or protection from persecution, in a host country (U.S. Citizenship and Immigration Services, 2015). Thus, an asylum country is one in which refugees can live without fear of persecution or deportation to their native country, while they apply for permanent residence or resettlement (U.S. Citizenship and Immigration Services, 2015). Many Middle Eastern nations including Syria, Libya, Yemen, and Palestine are currently experiencing war and subsequently, hundreds of thousands of individuals from these nations have been forced to seek asylum elsewhere (International Institute for Strategic Studies, 2022). Adjusting to asylum countries may affect mental health, which is an individual’s state of psychological wellness (Centers for Disease Control and Prevention, 2023; United Nations High Commissioner for Refugees, 2022). Thus, this paper will examine how relocation to an asylum country impacts the mental health of Middle Eastern refugees.
尽管全球难民人口不断增加,但难民援助却很少成为美国政治对话的话题(美国移民委员会,2020 年)。逃离或被迫离开祖国的难民在收容国寻求庇护,或免受迫害的保护(美国公民及移民服务局,2015 年)。因此,庇护国是难民在申请永久居留或重新安置时,可以在其中生活而不必担心受到迫害或被驱逐回祖国的国家(美国公民与移民服务局,2015 年)。包括叙利亚、利比亚、也门和巴勒斯坦在内的许多中东国家目前都在经历战争,因此,来自这些国家的数十万人被迫到其他地方寻求庇护(国际战略研究所,2022 年)。适应庇护国可能会影响心理健康,即个人的心理健康状态(美国疾病控制和预防中心,2023 年;联合国难民事务高级专员,2022 年)。因此,本文将探讨迁往庇护国如何影响中东难民的心理健康。
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引用次数: 0
The Silent Suffering: Obstetric Fistula in Ethiopia 无声的痛苦:埃塞俄比亚的产科瘘
Pub Date : 2024-02-27 DOI: 10.52214/cujgh.v13i2.11986
Emma Germano
Obstetric fistula is a maternal morbidity that accounts for 6% of all maternal deaths worldwide. This condition occurs most commonly in areas of sub-Saharan Africa and rural south Asia where access to medical care and maternal education is not readily available. During prolonged or obstructed labor, a fistula can form connecting the rectum or urinary tract with the vagina. The condition is more common in young mothers who are pressured by their community, culture, or partner to have children early. This has severe and devastating potentially lifelong consequences. Women living with obstetric fistula experience chronic incontinence and associated odors, social and psychological isolation, and severe pain. Despite the condition being preventable and treatable with surgery, there is still a high prevalence in low-income countries. Although the incidences of obstetric fistula are difficult to document due to the lack of medical reporting, this analysis will focus on the effects of the disease in Ethiopia, one of the poorest countries in the world.
产科瘘管病是一种孕产妇疾病,占全球孕产妇死亡总数的 6%。这种疾病最常发生在撒哈拉以南非洲和南亚农村地区,因为这些地区不容易获得医疗保健和孕产妇教育。在产程延长或难产时,直肠或泌尿道与阴道之间会形成瘘管。这种情况在受到社区、文化或伴侣压力而过早生育的年轻母亲中更为常见。这种情况会造成严重的破坏性后果,甚至可能影响终生。患有产科瘘管病的妇女会长期大小便失禁并伴有异味,在社会和心理上被孤立,并承受剧烈疼痛。尽管这种疾病可以通过手术预防和治疗,但在低收入国家的发病率仍然很高。尽管由于缺乏医疗报告,产科瘘管病的发病率难以记录,但本分析报告将重点关注该疾病在埃塞俄比亚--世界上最贫穷的国家之一--的影响。
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引用次数: 0
Opioids and Covid-19: Perfect Storm, or Perfect Opportunity? 阿片类药物和Covid-19:完美风暴还是完美机会?
Pub Date : 2023-05-01 DOI: 10.52214/cujgh.v13i1.10687
A. Jain, Annika Dhingra, Aditya Sivakumar
The opioid epidemic in the United States has been made worse by the COVID-19 pandemic, due to increased stress and isolation, reduced access to addiction treatment services, and a disruption in the supply chain for conventional opioids, resulting in more dangerous and potent drugs entering the market. This has led to a spike in overdose deaths, particularly from fentanyl and other synthetic opioids. The availability of Naloxone, the opioid overdose reversal medication, has also been affected by the pandemic, with shortages in some areas due to supply chain disruptions. Access to buprenorphine and methadone, drugs used in opioid use disorder (OUD) therapy, has also been limited due to social distancing guidelines, however government policy has gradually adapted to loosen regulations surrounding their access.
由于压力和隔离加剧,获得成瘾治疗服务的机会减少,以及传统阿片类药物供应链中断,导致更多危险和强效药物进入市场,2019冠状病毒病大流行使美国的阿片类药物流行病变得更加严重。这导致过量死亡人数激增,尤其是芬太尼和其他合成阿片类药物。阿片类药物过量逆转药物纳洛酮的供应也受到大流行的影响,由于供应链中断,一些地区出现短缺。丁丙诺啡和美沙酮是阿片类药物使用障碍(OUD)治疗中使用的药物,由于社会距离准则,获得丁丙诺啡和美沙酮也受到限制,但政府的政策已逐渐调整,放宽了对其获取的监管。
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引用次数: 0
Changes for a Better Health and a Better Nation 为了更好的健康和更美好的国家而改变
Pub Date : 2023-05-01 DOI: 10.52214/cujgh.v13i1.10654
Samantha Strelzer
Since decentralization of Spanish government, questions have remained as to developing policy that effectively impacts both regional and national population. Spain has developed an efficient socialized healthcare program. Due to the decentralization process, however, certain regions of Spain have developed far more advanced policy mechanisms. In particular, Catalonia steps outside the traditional rolls of government oversight to forecast visionary policy and policy-making techniques. Amidst the tug of war between willingness and resistance to implement healthcare policies that have a dedicated impact on improving the population health and healthcare, Catalonia employs original thinking and innovation in policy using the Health in All Policies (HiAP) model to create comprehensive strategies. By integrating health into every policy put forth, Catalonia ensures decision-making that prioritizes citizen health first and foremost. When all shareholders are on the same plane, better conversations can be facilitated to better avoid potential issues. Health, as this policy paper explains, is aspect of life that interweaves all other socioeconomic factors. Policy changes must be introduced to improve communication and coordination amongst regions and on a national level, thereby introducing horizontal, collaborative partnerships. The accountability that exists as a main tenet of HiAP limits the presence of the free rider issue in government at all levels. This paper demonstrates the needed nuanced conversations that compel policy-makers to work together to further advance effective efficiency in socialized medicine.
自从西班牙政府权力下放以来,关于制定有效影响地区和国家人口的政策的问题仍然存在。西班牙制定了有效的社会化医疗保健方案。然而,由于权力下放的进程,西班牙的某些地区制定了更为先进的政策机制。特别是,加泰罗尼亚走出了传统的政府监督,预测有远见的政策和决策技术。在实施对改善人口健康和医疗保健有专门影响的医疗保健政策的意愿和抵制之间的拉锯战中,加泰罗尼亚采用原始思维和政策创新,利用所有政策中的健康(HiAP)模型制定全面战略。通过将卫生纳入所提出的每一项政策,加泰罗尼亚确保决策优先考虑公民健康。当所有股东都在同一飞机上时,可以促进更好的对话,以更好地避免潜在的问题。正如这份政策文件所解释的那样,健康是生活的一个方面,它与所有其他社会经济因素交织在一起。必须改变政策,以改善区域之间和国家一级的沟通和协调,从而建立横向的合作伙伴关系。作为HiAP的主要原则而存在的问责制限制了各级政府搭便车问题的存在。本文展示了需要进行细致入微的对话,迫使政策制定者共同努力,进一步提高社会化医疗的有效效率。
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引用次数: 0
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