This thesis presents a detailed analysis of illness related costs of human salmonellosis In England and Wales, estimated at £263 million (minimum), including intangible costs, in 1988, and explores potential benefits of preventive activities aimed at the poultry industry. To explore trends In reported infection and the factors which may influence those trends, salmonella reporting between 1960 and 1989 was examined. Trends in foodborne Illness were associated with increased reporting of salmonella infection. The factors which contributed to this increase included Intrinsic factors such as the microbiological quality of food, and extrinsic factors such as ambient temperature which may amplify intrinsic effects. Evidence that poultry products were important vehicles of human Illness was supported by trends in infections in animals and poultry, and food consumption patterns. Thus a significant decrease in human infection would result from reduction in poultry contamination. The findings of a unique and detailed survey of 1,482 human salmonella cases, presented in this thesis, indicated tangible costs of illness of £996,350 to £1,091,131. Over a third (E392,822 - £426,887) were costs related to investigation and treatment of cases and over half (E507,555 -E559,401) was production loss associated with sickness related absence from work. The remaining costs Identified represented important costs to affected Individuals and their families. Additional intangible costs of £1.57 million to £5.07 million were ascribed to value of lives lost and to pain and suffering estimates. Extrapolation of costs, utilizing an index of severity developed for this study and categorisation of cases by level of treatment demanded, indicated national, tangible, costs of £231 million to £331 million; additional intangible costs were £32 million to £119 million). The cost-effectiveness of limiting these totals was explored by two approaches. Cost reduction by changes in cases management (eg. reducing faecal specimens tested and time off work) indicated small potential savings. However, substantial benefits were indicated by cost-benefit analysis of preventive activities including irradiation of poultry carcasses and use of competitive exclusion methods in poultry rearing.

The 'sun-rise' industry of private health care, especially private hospitals, in Thailand throws many questions to the health policy forum. Will the growth of the private health sector reduce public health expenditure, or will it increase total expenditure on health? The focus of this study is on equity in health and health care: in a country where private expenditure dominates total health expenditure and the government lets the private health sector flourish, in this scenario, are the poor or the underprivileged the victims of this limited privatisation policy? The main research objective was to assess the equity of coverage of public and private health in an urban area in order to identify policies of promotion and regulation which would lead to an equitable and efficient health service system. The study used Phitsanulok municipal area as a model to develop policy recommendations for other urban areas. There were three main methods of data collection: general household survey, health diary plus household health interview and a one-day bed census of patients in public and private hospitals in the municipality. The first two methods employed multi-stage random sampling with clusters of 12 and 3 households, respectively, as smallest sampling units and these neighbourhood households were divided into three groups to represent each season in a year. The main findings were that inequalities in health existed among different household income, education and occupational groups, including these attributes of the education and occupational groups adjusted according to the household head. Unequal accessibility to health care seemed to affect both reported rates of illness within the past two weeks and hospitalisation during the past 12 months. Inequity of health care financing was obvious in that the underprivileged (the poor, the uninsured and underinsured) paid out of pocket as a percentage of their household income higher sums than the privileged groups. The private health sector (private clinics and private hospitals) was the major provider of health care to urban dwellers for both outpatient and inpatient services. Users of public facilities were the lower income groups and civil servants, while users of the private health sector were the higher income groups, the higher occupational groups and the younger age groups. Inpatients of private hospitals were more likely to be covered by health benefit schemes (civil servant benefit, private insurance, etc.) than inpatients of public hospitals. Information on the utilisation and financing pattern of private health services reconfirmed inequity of health care financing. It is obvious that the Thai health care system needs changes to reduce inequity in health and health care. Universal coverage is a way towards more equitable health care financing. While Thai citizens (in urban areas) have enjoyed a wide choice of health utilisation, a public competition model could be applied to the public health sector to make public services more competitive and more efficient.

No description available.

No description available.

No description available.

No description available.

No description available.

The study is initially concerned with the origins and development of different approaches to nutrition science in Britain during the first three decades of the twentieth century. The contrasting approaches are shown to embody alternative "styles of thought" in the sense used by Karl Mannheim. An account of the work of the Advisory Committee on Nutrition of the Ministry of Health (founded 1931) is then given. The conflicts which occured during the deliberations of the Committee are interpreted as conflicts between those who advanced the contrasting "styles of thought." The focus of attention then shifts to the foundation and development of the Nutrition Society (1941). The disputes which occured in the Nutrition Society during its early years are shown to be largely concerned with alternative notions of the application of nutritional knowledge. Developments in the Society after the war, it is suggested, must be understood against the background of the post -war reaction against the "social relations of science movement ". The foundation of the first Nutrition Degree in 1953 at the Nutrition Department at Queen Elizabeth College of the University of London, is then considered. A hypothesis is presented which suggests an explanation of certain important features of the professional ideology of nutrition which has been associated with the College.

No description available.

The health of children is very important in Kenya, given that more than half of its population is under twenty years of age. Despite continued efforts, Kenya has not achieved the Universal Child Immunisation (UCI) target of full immunisation for 75 per cent of all children. It is argued here that two of the factors contributing to this situation are the lack of information and of effective media of communication.