Introduction: The majority of the European population live in urban areas (UAs). Policy making in urban areas is complex and the use of summary and aggregate measures for public health are important tools. Disability-Adjusted Life Years (DALYs) are important for national and international comparison. However, DALYs have not been calculated at urban level. Alcohol is an important European urban public health problem. Therefore the aim of this study was to calculate urban level DALYs attributable to alcohol consumption in Europe(AA-DALYs) and years of life lost (AA-YLL). This work was one of the deliverables of the European Urban Health Indicator System Part II (EURO-URHIS 2), a European Commission funded project. Methodology Design: This is a cross sectional study with four components to be able to calculate comparable DALYs. The boundary study determined the denominator to ensure comparability and facilitate identification of the UAs to be included in the study. The systematic review and national level DALY calculations were used to develop the methodology for calculating AA-DALYs, including AA-YLL. The main methodology was to calculate AA-DALYs and AA-YLL were calculated for comparison between UAs, but also to measure the relationship between alcohol policy strength (measured using the Alcohol Policy Index) and harms to health. Results: It was possible to calculate urban level AA-DALY and AA-YLL for males and females and for different age groups in 20 different UAs. There was no association at either national (p=0.15) or urban level with AA-DALYs and AA-YLL and API score. Clustering of the countries by European region may have influenced the lack of association as well as the need for further refinements of the API to include enforcement. Mean male (female) AA-YLL was 12.75 (3.23) per 1000 population (p<0.0001). Mean male (female) AA-DALYs was 18.85 (3.88) per 1000 population (p<0.0001). There were significant differences between mean male and female AA-DALYs and AA-YLL which were not present when the protective indicators were removed from the calculation. The mean effect size between all ages and the 15-79 year age groups were significant for AA-DALYs and AA-YLLs (p<0.0001).Conclusions: Comparable AA-DALYs and AA-YLL can be calculated at urban level. National level DALYs mask the intra-national differences observed within cities. AA-DALYs and AA-YLL can be used as a summary measure to help policy makers determine the outcomes of their alcohol policy strategies in cities of Europe. Morbidity data availability undermines AA-DALY estimates, but AA-YLL estimates were based on robust data on causes of death at the urban level. Future work will replicate this method for more risk factors for YLL.

American Cancer Society(ACS) of Greater Boston in partnership with CVS Pharmaceuticals, Mobile Diagnostics and WHDH-TV developed Project:AWARE which offered breast cancer information and free mammograms for over two years in the Greater Boston area. This program was designed to reach low income and/or minority women. In this study the intended audience for Project:AWARE was studied in order to determine if the messages reached them. Forty Hispanic, forty Black and forty Caucasian women thirty-five years of age or older who live in Boston Housing Authority developments were interviewed. An interviewer, using a questionnaire, requested information about the participants' knowledge of breast cancer, knowledge of Project:Aware, and television viewing habits in order to determine if they had seen any part of this extensive television campaign and if it convinced them to get a mammogram. After two documentaries, over 1500 airings of Public Service Announcements(PSA's), ten locally produced programs and numerous ten-second calendar spots, ten-percent of the sample remembered seeing a Project:AWARE message on television while a similar number remembered seeing a poster about Project:AWARE. Only one women reported that seeing information about Project:AWARE convinced her to get a mammogram. Further testing will have to be done by health care professionals in order to insure that health information campaigns are reaching all segments of society. Large audiences for television programs are no indication that everyone in a community is receiving the message. Additional funds will have to be found in order to insure that messages are placed when and where they will be seen by low income and/or minority women of all ethnic backgrounds in order to insure that they have the same opportunities for good health care as other segments of society.

Thesis (Ph. D.)--University of Connecticut, 1999. / Abstract (2 leaves) bound with copy. Includes bibliographical references (leaves 328-355).

Na transição do regime autoritário para o Estado democrático de direito, consagrado na Constituição de 1988, o federalismo brasileiro passou a descentralizar as políticas públicas, atribuindo aos Estados, aos Municípios e ao Distrito Federal a sua co-gestão. No campo da saúde, uma característica inovadora nesse período foi a criação do Sistema Único de Saúde (SUS) e o desenvolvimento de processos participativos de gestão e controle das políticas. Este trabalho analisa o caso da Política Nacional de Saúde Bucal (PNSB) que, aprovada pelos conselhos nacionais de saúde, de secretarias estaduais e municipais de saúde, passou a integrar o Plano Nacional de Saúde (2004). O estudo aborda a implementação de Programas de Saúde Bucal, autonomia decisória municipal frente à PNSB, os mecanismos de coordenação da PNSB e suas características de alocação de recursos nos 39 municípios da Região Metropolitana de São Paulo (RMSP). Foram utilizados dados secundários, disponíveis em bancos de dados de acesso público, no período de 2006 a 2009, concentrando-se a análise no indicador Primeira Consulta Odontológica Programática (PCOP) no SUS, empregado para avaliar o acesso à assistência odontológica. As características do acesso bem como a adesão à PNSB foram analisadas buscando-se verificar possíveis associações com o porte do orçamento municipal, aferido pelas receitas disponíveis, PIB per capita, despesa total com saúde e filiação partidária do prefeito. Constatou-se que em 21 municípios houve tendência de diminuição nos valores do PCOP. Em 18 municípios houve tendência de alta no PCOP. Em 11 municípios a média do PCOP registrou valores acima do registrado para o estado de São Paulo (10,43 por cento ) de 2006 a 2009. Em relação à implementação das Políticas de Saúde Bucal, constatou-se ausência de correlação entre o acesso aos serviços de Saúde Bucal e PIB per capita, Receita Disponível per capita e Despesa Total com Saúde. Quanto à adesão à PNSB, 10 cidades não o fizeram. Não houve correlação entre adesão à PNSB e riqueza municipal e capacidade de gasto dos municípios. A adesão à PNSB ocorreu na totalidade dos municípios (sete) em que o prefeito era filiado ao Partido dos Trabalhadores, o mesmo do Presidente da República, em 2004. Além do fato de os municípios terem suas prioridades para as políticas públicas, deve-se considerar que, previamente ao surgimento da PNSB, tinham suas próprias definições para intervenção nessa área. Em tais situações, implementar a PNSB implica reorientações que podem colidir com suas possibilidades e suas agendas. O fato de a PNSB ser financiada com base em incentivos financeiros específicos para essa modalidade assistencial, transferidos da União, e também dos Estados, para os Municípios poderia exercer influência como indutor da adesão à PNSB, porém o cálculo dos governos municipais não levou só esta variável em consideração. Além disso, mesmo quando não há colisão de diretrizes e os incentivos federais não geram dilemas quanto ao que fazer, reorientações em práticas sociais requerem tempo e recursos até que seus efeitos sejam sentidos. Neste estudo constatou-se que na RMSP, sob os critérios adotados, a PNSB encontrou constrangimentos expressivos para se implantar e consolidar, com os incentivos federais não sendo suficientes para alterar a situação vigente na região / In the transition from authoritarian rule to the democratic State of law, as enshrined in the Constitution of 1988, the Brazilian federalism began to decentralize the public policies, attributing to the States, municipalities and the Federal District its comanagement. In the field of health, an innovative feature in this period was the creation of the Unified Health System (SUS) and the development of participatory processes for the management and control of the policies. This paper analyzes the case of a National Policy of Oral Health (PNSB) that was approved by national councils of health, state and municipal health secretariats, was included in the National Plan for Health (2004). The study deals with the implementation of programs for Oral Health, decision-making autonomy municipal front of PNSB, the mechanisms for the coordination of PNSB and their characteristics to the allocation of resources in the 39 municipalities in the Metropolitan Region of São Paulo. We used secondary data, available in data banks of public access, in the period from 2006 to 2009, concentrating the analysis in the indicator \"First Dental Assessment Program\" (PCOP) on the SUS, used to evaluate access to dental care. The characteristics of the access as well as the membership of the PNSB were analyzed in an attempt to verify possible associations with the size of the municipal budget, as measured by the revenue available, per capita GDP, total expenditure on health and party affiliation of the prefect. They found that in 21 cities there was a tendency of decrease in the values of the PCOP. In 18 municipalities there was a tendency for high in PCOP. In 11 municipalities to average the PCOP recorded values above that recorded for the state of São Paulo (10.43 per cent ) from 2006 to 2009. With respect to the implementation of the Policies of Oral Health, it was found absence of correlation between access to the services of Oral Health and GDP per capita, Recipe Available per capita and Total Expenditure on Health. As to the membership of the PNSB, 10 cities did not. There was no correlation between membership of the PNSB and wealth municipal and capacity of expense of municipalities. The membership of the PNSB occurred in all of the municipalities (seven) in which the mayor was affiliated to the Workers\' Party, the same as that of President of the Republic, in 2004. In addition to the fact that the municipalities have their priorities for public policies, it must be considered that, before the onset of PNSB, had their own definitions for intervention in this area. In such situations, to implement the PNSB implies reorganizations that may conflict with their possibilities and their agendas. The fact of the PNSB be funded on the basis of specific financial incentives for this modality assistencial, transferred from the Union, and also the States, to the Municipalities could have an influence as inducer of membership of the PNSB, however the calculation of municipal governments did not take only this variable into account. In addition, even when there is a collision of guidelines and the federal incentives do not generate dilemmas regarding what to do, shifts in social practices require time and resources to which its effects are felt. In this study it was found that, in the Metropolitan Region, the PNSB found constraints expressive to deploy and consolidate, with the federal incentives are not sufficient to change the situation prevailing in the region

Na transição do regime autoritário para o Estado democrático de direito, consagrado na Constituição de 1988, o federalismo brasileiro passou a descentralizar as políticas públicas, atribuindo aos Estados, aos Municípios e ao Distrito Federal a sua co-gestão. No campo da saúde, uma característica inovadora nesse período foi a criação do Sistema Único de Saúde (SUS) e o desenvolvimento de processos participativos de gestão e controle das políticas. Este trabalho analisa o caso da Política Nacional de Saúde Bucal (PNSB) que, aprovada pelos conselhos nacionais de saúde, de secretarias estaduais e municipais de saúde, passou a integrar o Plano Nacional de Saúde (2004). O estudo aborda a implementação de Programas de Saúde Bucal, autonomia decisória municipal frente à PNSB, os mecanismos de coordenação da PNSB e suas características de alocação de recursos nos 39 municípios da Região Metropolitana de São Paulo (RMSP). Foram utilizados dados secundários, disponíveis em bancos de dados de acesso público, no período de 2006 a 2009, concentrando-se a análise no indicador Primeira Consulta Odontológica Programática (PCOP) no SUS, empregado para avaliar o acesso à assistência odontológica. As características do acesso bem como a adesão à PNSB foram analisadas buscando-se verificar possíveis associações com o porte do orçamento municipal, aferido pelas receitas disponíveis, PIB per capita, despesa total com saúde e filiação partidária do prefeito. Constatou-se que em 21 municípios houve tendência de diminuição nos valores do PCOP. Em 18 municípios houve tendência de alta no PCOP. Em 11 municípios a média do PCOP registrou valores acima do registrado para o estado de São Paulo (10,43 por cento ) de 2006 a 2009. Em relação à implementação das Políticas de Saúde Bucal, constatou-se ausência de correlação entre o acesso aos serviços de Saúde Bucal e PIB per capita, Receita Disponível per capita e Despesa Total com Saúde. Quanto à adesão à PNSB, 10 cidades não o fizeram. Não houve correlação entre adesão à PNSB e riqueza municipal e capacidade de gasto dos municípios. A adesão à PNSB ocorreu na totalidade dos municípios (sete) em que o prefeito era filiado ao Partido dos Trabalhadores, o mesmo do Presidente da República, em 2004. Além do fato de os municípios terem suas prioridades para as políticas públicas, deve-se considerar que, previamente ao surgimento da PNSB, tinham suas próprias definições para intervenção nessa área. Em tais situações, implementar a PNSB implica reorientações que podem colidir com suas possibilidades e suas agendas. O fato de a PNSB ser financiada com base em incentivos financeiros específicos para essa modalidade assistencial, transferidos da União, e também dos Estados, para os Municípios poderia exercer influência como indutor da adesão à PNSB, porém o cálculo dos governos municipais não levou só esta variável em consideração. Além disso, mesmo quando não há colisão de diretrizes e os incentivos federais não geram dilemas quanto ao que fazer, reorientações em práticas sociais requerem tempo e recursos até que seus efeitos sejam sentidos. Neste estudo constatou-se que na RMSP, sob os critérios adotados, a PNSB encontrou constrangimentos expressivos para se implantar e consolidar, com os incentivos federais não sendo suficientes para alterar a situação vigente na região / In the transition from authoritarian rule to the democratic State of law, as enshrined in the Constitution of 1988, the Brazilian federalism began to decentralize the public policies, attributing to the States, municipalities and the Federal District its comanagement. In the field of health, an innovative feature in this period was the creation of the Unified Health System (SUS) and the development of participatory processes for the management and control of the policies. This paper analyzes the case of a National Policy of Oral Health (PNSB) that was approved by national councils of health, state and municipal health secretariats, was included in the National Plan for Health (2004). The study deals with the implementation of programs for Oral Health, decision-making autonomy municipal front of PNSB, the mechanisms for the coordination of PNSB and their characteristics to the allocation of resources in the 39 municipalities in the Metropolitan Region of São Paulo. We used secondary data, available in data banks of public access, in the period from 2006 to 2009, concentrating the analysis in the indicator \"First Dental Assessment Program\" (PCOP) on the SUS, used to evaluate access to dental care. The characteristics of the access as well as the membership of the PNSB were analyzed in an attempt to verify possible associations with the size of the municipal budget, as measured by the revenue available, per capita GDP, total expenditure on health and party affiliation of the prefect. They found that in 21 cities there was a tendency of decrease in the values of the PCOP. In 18 municipalities there was a tendency for high in PCOP. In 11 municipalities to average the PCOP recorded values above that recorded for the state of São Paulo (10.43 per cent ) from 2006 to 2009. With respect to the implementation of the Policies of Oral Health, it was found absence of correlation between access to the services of Oral Health and GDP per capita, Recipe Available per capita and Total Expenditure on Health. As to the membership of the PNSB, 10 cities did not. There was no correlation between membership of the PNSB and wealth municipal and capacity of expense of municipalities. The membership of the PNSB occurred in all of the municipalities (seven) in which the mayor was affiliated to the Workers\' Party, the same as that of President of the Republic, in 2004. In addition to the fact that the municipalities have their priorities for public policies, it must be considered that, before the onset of PNSB, had their own definitions for intervention in this area. In such situations, to implement the PNSB implies reorganizations that may conflict with their possibilities and their agendas. The fact of the PNSB be funded on the basis of specific financial incentives for this modality assistencial, transferred from the Union, and also the States, to the Municipalities could have an influence as inducer of membership of the PNSB, however the calculation of municipal governments did not take only this variable into account. In addition, even when there is a collision of guidelines and the federal incentives do not generate dilemmas regarding what to do, shifts in social practices require time and resources to which its effects are felt. In this study it was found that, in the Metropolitan Region, the PNSB found constraints expressive to deploy and consolidate, with the federal incentives are not sufficient to change the situation prevailing in the region

Scotland has the highest rates of child obesity in Europe with more than 1 in every 4 children aged between 2 and 15 being overweight or obese in 2008. The need to curb the nation’s unhealthy eating habits through Scottish public health policy has been acknowledged, although there remains a shortage of policy addressing the eating habits of infants and young children as they develop in the context of family life. This is matched by a shortage of empirical research which uses nationally representative longitudinal data on Scottish children, to look at how diets of children under five develop within the home. This doctoral research seeks to explain how children’s nutritional trajectories develop from birth through infancy and into early childhood in contemporary Scotland within the context of maternal resources, maternal use of nutrition advice, and family meal habits. Theoretical concepts pertaining to social constructionism and the symbolic meaning of meal rituals, as well as theories of risk and responsibilisation, human capital and health behaviours, and discussions about agency and structure, frame the research questions and the interpretation of results. The research draws on the first three annual sweeps of the Growing Up in Scotland nationally representative, longitudinal survey of families and young children. The analysis is based on multivariate proportional hazards regression and logistic regression models. The empirical analysis shows that maternal education is a consistently superior predictor of children’s nutritional outcomes, when compared to maternal occupational classification and household income, and that children of more educated mothers have healthier diets throughout infancy and childhood. This points to the utility of human capital theories which stress the importance of education, rather than income, and also reflects on the need for policy to recognise the structural nature of nutritional inequalities. More educated mothers are also more likely to be proactive in using healthy eating advice, resonating with theories of risk awareness and medicalised childhoods. Surprisingly, mothers from disadvantaged backgrounds are more likely to use advice from health professionals, possibly as a result of health professionals actively targeting their support to more ‘at risk’ families. Yet these mothers are also more apprehensive about the interference of health professionals in aspects of childrearing. Relevant policy reflections pointed to the need to identify how support for mothers from more disadvantaged backgrounds can be provided in formats which help to overcome the culture of mistrust towards health professionals prevalent among disadvantaged parents. Nevertheless, positive associations between infant diet and maternal use of breastfeeding advice from health professionals are found, in line with theories of power-knowledge, lending support to information-based policy initiatives as a tool for improving infant nutrition. The analysis also indicates that children who are breastfed, and children who are weaned later have healthier diets in their toddler years, which contributes to the proposal of a theoretical typology explaining how young children’s nutritional trajectories evolve from the pre-partum period through infancy and childhood. Finally, the analysis suggests that communal patterns of eating play an important role in children’s dietary quality, attesting to the importance of the meal ritual as a vehicle for socialising children into developing particular tastes for food. Thus, there seems to be room for policy initiatives which address not only what children eat, but how young children and families eat in the context of everyday family life.

The following thesis presents an analysis of power and control in the English National Health Service. Notably, it focuses upon power and control over knowledge; over defining what is 'valid' knowledge; over the production of that valid knowledge; and over how, what, when and where that knowledge is used in everyday clinical practice. The issue reaches to the heart of professional conception and definition and hence, control over professions themselves. The thesis attempts to demonstrate the relationship between the different professional groups in the NHS, through the analysis of national, regional and local documents, and interviews with managers, doctors, nurses, dietitians and physiotherapists in three case studies, the thesis shows the complex pattern of relations and behaviour at play. Particular attention is paid to Michael Power's notion of audit and the 'Audit Explosion', which provides a framework for the thesis, and to the work of Michel Foucault, especially his ideas about power, control and panopticism. These are used as a useful metaphor to understand and explain NBS research and audit in relation to the NHS professions. The thesis ends with a cross-case analysis which draws together the rich variety of data and concludes with an analysis of the wider sociological implications ofthe thesis.

No Brasil, pesquisas sobre a situação nutricional apontam para a redução da prevalência de desnutrição no país, mas se observa o aumento da prevalência de sobrepeso e de obesidade. Apesar do diagnóstico nutricional positivo, alguns problemas estruturais permanecem, como a elevada concentração de renda, os altos níveis de analfabetismo funcional, a discriminação social e racial e a prevalência de Insegurança Alimentar e Nutricional (INSAN). Está em curso um processo de legitimação e de exigibilidade do Direito Humano a Alimentação Adequada, no Brasil. A própria constituição federal e a Lei Orgânica de SAN (LOSAN), sancionada em 2006, integram um conjunto de regras de ordenamento jurídico do país que, em tese, garantiria uma alimentação saudável e adequada a todos os brasileiros, em consonância com as Diretrizes Voluntárias da FAO e com os tratados internacionais de direitos humanos, aos quais o Brasil é signatário. O objetivo geral do presente estudo é analisar a Política de Segurança Alimentar e Nutricional (PNSAN) em construção no Brasil, discutindo o seu arranjo institucional e a alocação de recursos. A metodologia da pesquisa foi baseada na análise de dados secundários, de documentos oficiais, e na legislação pertinente envolvendo o período de 2003 ao final do ano de 2008. A análise teve como suporte teórico os ensinamentos da Economia Institucional e de Finanças Públicas. Entre os principais resultados destaca-se a conclusão de que a Política de Segurança Alimentar e Nutricional brasileira está constituída. Com as Leis que a embasam tornou-se uma política de Estado e não mais de um Governo, entretanto, um dos tripés de sua &#8220;institucionalidade&#8221;, a Câmara Interministerial criada em 2007, peça-chave no processo de articulação da PNSAN, por sua natureza intersetorial, é, sem dúvida, o órgão mais precário do SISAN. Apesar dessa falha institucional, a política tem recebido apoio econômico substantivo, contudo os recursos estão concentrados em um único programa, importante, mas não estruturante. Programas que garantam o emprego e a produção, passando por qualificação, educação e assistência técnica são inequivocamente essenciais para a garantia do Direito Humano a Alimentação Adequada a todos os brasileiros e portanto deveriam receber maiores quantidades de recursos orçamentários. / In Brazil, research on the nutritional situation shows the reduction of the prevalence of malnutrition in the country, but reveals the increased prevalence of overweight and obesity. Although the positive nutritional diagnosis, structural problems remain, such as high income concentration, high levels of functional illiteracy, social and racial discrimination and the prevalence of Food and Nutrition Insecurity. There is an ongoing process of legitimation and enforceability of the Human Right to Adequate Food in Brazil. The federal constitution and the Food and Nutritional Security Law, published in 2006, incorporate a set of rules that, in theory, ensure a healthy and adequate diet to all Brazilians, in line with the FAO Voluntary Guidelines and the international human rights treaties to which Brazil is signatory. The general objective of this study is to analyze the Food and Nutritional Security Policy under construction in Brazil, discussing its institutional arrangement and allocation of resources. The methodology of the research was based on the analysis of secondary data, from official documents, and legislation involving the period of 2003 to 2008. The theoretical analysis was based on the teachings of Institutional Economics and Public Finance. Among the main results there is a conclusion that the Brazilian Food and Nutritional Security Policy is established, with Laws that makes it as a State Policy rather than a government. However, one of the tripods of its \"institutions\", the \"Câmara terministerial\" established in 2007, a key element in the articulation of this Policy, is without doubt the most precarious element of the Food and Nutritional Policy system. Despite this institutional failure, the policy has received substantial economic support, however the resources are concentrated in a single program, an important one, but not structural. Programs made to ensure employment and production, through skills, education and technical assistance are clearly essential to ensure the human right to adequate food to all Brazilians and therefore should receive higher amounts of budgetary resources.

No description available.

The 2001 destruction of the World Trade Center and the subsequent anthrax attacks highlighted the inability of an antiquated public health system in the United States to respond effectively to emergencies. Little documentation exists to define how public health agencies can improve performance. The overarching research question was the extent to which drills and exercises improve performance in public health emergencies. Adult learning theory and deliberate practice theory were explored in this context. The research data were from 50 state public health departments, which were required to report performance information to the U.S. Centers for Disease Control and Prevention. The data were examined using Poisson analysis and logistic regression. Results indicated that drills and exercises had no statistically significant impact on public health performance for the 3 performance measures examined; of all predictors, what explained the most variance in reaching performance targets was the number of real emergencies to which a health department had responded in the past. Performing drills and exercises did not predict the likelihood of reaching performance targets. These findings have implications for positive social change for Congressional leaders and other government representatives. Such public servants could use this information to guide their efforts to redirect public health emergency preparedness funds away from drills and exercises and toward other fundamental public health activities. These more focused efforts could facilitate the improvement of public health laboratory capacity, the training of field epidemiologists, and the advancements in technology for enhanced reporting and surveillance.