International Journal of Health Services最新文献

This article analyzes the relationship between various forms of intimate partner violence (IPV) and unmet need for family planning (FP) in South Asia. The data were obtained from the latest wave of the Demographic and Health Survey in Afghanistan, India, Maldives, Nepal, and Pakistan. Binary logistic regression analyses show mixed results, with a significant association between at least one type of IPV and unmet need for FP in all countries under study, except Maldives. There were also contrasting findings on the IPV-unmet need nexus, with a positive sign in some but negative sign in others. Women who experienced physical violence were associated with a higher odds of having an unmet need in Pakistan, but the opposite was true in Afghanistan and Nepal. The odds of having an unmet need were higher among Indian women who experienced IPV (sexual and emotional). In Afghanistan, women who experienced IPV (physical and emotional) have lower odds of having an unmet need. However, the interaction analysis of IPV (physical and sexual) and partners' controlling behavior showed a positive association with unmet need. Policymakers need to develop policies and strategies to prevent IPV and reduce unmet need for FP, in line with the Sustainable Development Goals.

The Vira Vida program promotes the health of adolescents and young adults, ages 16 to 24, who have been sexually exploited. It has served more than 3000 individuals in 18 Brazilian states. The objective of this research was to estimate the costs of Vira Vida and compare them with the costs of detention policies for juveniles under 18. This program cost study considers two periods: 2008 to 2012 (Cycle 1) and 2013 to 2014 (Cycle 2). The System S perspective and time horizon for one year were adopted. Direct costs incurred by the National Council of Industry Social Services, which coordinates Vira Vida, and by the Regional Departments (RD), responsible for the direct execution of Vira Vida, were analyzed. The cost of detention measures for adolescents and youngsters under the age of 18 was obtained from the literature. The annual cost per student enrolled in Vira Vida varied between US$ 3754.93 and US$27,244.48, depending on the cycle and the state. Most of the costs of the program were lower than those reported for detention measures for adolescents in Brazilian states. Evidence indicates that health promotion interventions targeting sexually exploited children and adolescents can help their recovery; on the other hand, studies indicate that detention measures do not help adolescents recover.

On May 12, 2022, Senator Bernie Sanders held a hearing in the U.S. Senate Budget Committee on Medicare for All legislation. These were the first such hearings in the U.S. Senate. In testimony presented to the Budget Committee, I argued that the achievement of Medicare for All was a medical and moral imperative. I explored the problem of uninsurance, noting that 30 million Americans remain uninsured at a cost of more than 30,000 deaths annually. I contended that improving the quality of coverage was equally crucial, describing how some 41 million Americans remain underinsured at a grave cost to their health and financial wellbeing. Finally, I examined the economics of Medicare for All reform, and showed how the reduction of the enormous administrative waste in American healthcare could save hundreds of billions of dollars a year. Medicare for All, I concluded, is the one health reform that could expand and improve coverage for all while simultaneously controlling costs.

Academic interest in the social determinants of health has grown substantially in the past quarter century. In the past decade this academic engagement has been followed by greater public engagement with the conditions where we live, work, and play and how they affect our health. This moment of greater engagement with social determinants presents an opportunity for us to think about the determination of health more broadly, to look to a future beyond the social determinants. This would mean recognizing the full set of determinants of health across the lifecourse, spanning levels of influence, and including medical determinants to cure disease as much as we include the social forces that can prevent, or can cause that disease to begin with. Such a conception would have us see the determination of health as our central concern, and within that to recognize that health is produced throughout the lifecourse, by forces proximal and distal. The scholarship and practice of health can then usefully array itself around a conceptual framing that encompasses the full range of determinants of health.

Since 1996, we have been working to have Canadian governmental authorities implement health-promoting public policy that would improve the quality and equitable distribution of the social determinants of health, with rather little to show for our efforts. In this commentary, we identify seven emerging themes that can help explain our failures and point the way forward.

England's National Health Service (NHS) is in the process of major reform as old institutional structures based around an internal "market" are being replaced with integrated care systems. The changes represent a significant shift in ethos away from commercialisation to collaboration between health providers. But the way that these policies unfold will depend on the context within which they are implemented, and three decades of neoliberal reforms have left their mark on the structure of the health system. This paper shows how a powerful, politically-connected financialised private sector has evolved alongside a weakened public system, depleted further by the pandemic. While the share of overall public health spending reaching the private sector has not increased greatly over the past decade, private financial investors are strongly embedded in some segments of health delivery, particularly mental health services where shareholder returns are boosted by financial engineering. The boundaries between private and public are increasingly blurred with the NHS treating private patients and self-payment for health services is increasingly normalised. Rather than traditional privatisation, the health system is facing a more subtle and pernicious erosion of public services across different dimensions which seems likely to continue despite the new reforms.

This article examines the distribution patterns of primary health care centers (PHCC) in the 30 Local Government Areas (LGAs) of Osun State, Nigeria, using secondary data. The study focused on the problem of inequality and inadequacy in the distribution pattern of PHCCs among the population. The provision of PHCCs in the state was analyzed using three criteria: among the three senatorial districts; among the 30 LGAs; and on the basis of population per PHCC. Findings revealed that although PHCCs were almost equally distributed among senatorial districts, disparities exist in distribution patterns among the LGAs and within each senatorial district and in terms of population ratio per PHCC in the state. Sixty percent (60%) of the LGAs had fewer than 26 PHCCs, which is the expected average number of PHCCs in the state. The inequalities observed in the study favored rural areas against urban areas. The study further revealed inadequacies in the provision of PHCCs in terms of the population ratio per PHCCs. The study concluded that to achieve the Sustainable Development Goals (SDGs) by 2030-and to contain the COVID-19 pandemic-there is a need for government intervention in the provision of PHCCs in Osun State for equal and adequate distribution.

The concept of the social determinants of health has become increasingly accepted and mainstream in anglophone public health over the past three decades. Moreover, it has been widely adopted into diverse geographic, sociocultural, and linguistic contexts. By recognizing the role of social conditions in influencing health inequalities, the concept challenges narrow behavioral and reductive biological understandings of health. Despite this, scholars and activists have critiqued the concept of the social determinants of health for being incomplete and even misrepresenting the true nature of health inequities. Arguably, these critiques have been most thoroughly developed among those working in the Latin American social medicine and collective health traditions who formulated the "social determination of health" paradigm and the concept of interculturality decades prior to the advent of the social determinants of health. We draw on Jaime Breilh's main works, with a focus on the recently published book, Critical Epidemiology and the People's Health, to (1) provide a broad overview of the social determination of health paradigm and its approach to interculturality and (2) clarify how these ideas and the broader collective health movement challenge assumptions within the social determinants of health concept.

The National Health Service was established in the United Kingdom in 1948 as a universal, comprehensive service free at the point of delivery, which is publicly provided, funded, and accountable. Market incrementalism in England has eroded this system over three decades. The recently enacted Health and Care Act will erode it further. This article first explains briefly how legislation and policy initiatives in 1990, 2003, and 2012 furthered development of the market and private provision of health services, and then describes the main structural changes in the new Act and their implications. England is now moving decisively toward a marketized, two-tier, mixed-funding system with several similarities to the United States.

This study provides an insight into medical journalism practice by examining how news media have framed who is responsible for causing and solving the growing problem of medical disputes in Mainland China. We identified responsibility-attribution information presented in 490 news articles about medical disputes published in the People's Daily, Health News, and Southern Metropolis Daily between 2012 and 2017. Our data reveal that, mentions of personal causes have significantly outnumbered those of societal causes. Specifically, health workers were discussed most often as being responsible for the occurrence of medical disputes. In terms of how to solve the problem, the media were focusing heavily on societal-level efforts, while post-event solutions were addressed more frequently than preventative actions. City press was less likely to discuss societal causes and solution suggestions compared with party press and professional newspapers. In the conclusion, we discussed the potential consequences of such framing patterns, and how media professionals can be meaningfully engaged in the future reporting on public health problems.