In Bahia, Brazil, the decades following emancipation saw the rise of reformers who sought to reshape the citizenry by educating Bahian women in methods for raising "better babies." The idealized ...Brazilian would be better equipped to contribute to the labor and organizational needs of a modern nation. Backed by many physicians, politicians, and intellectuals, the resulting welfare programs for mothers and children mirrored complex debates about Brazilian nationality. Examining the local and national contours of this movement, Progressive Mothers, Better Babies investigates families, medical institutions, state-building, and social stratification to trace the resulting policies, which gathered momentum in the aftermath of abolition (1888) and the declaration of the First Republic (1889), culminating during the administration of President Getúlio Vargas (1930–1945). Exploring the cultural discourses on race, gender, and poverty that permeated medical knowledge and the public health system for almost a century, Okezi T. Otovo draws on extensive archival research to reconstruct the implications for Bahia, where family patronage politics governed poor women's labor as the mothers who were the focus of medical interventions were often the nannies and nursemaids of society's wealthier families. The book reveals key transition points as the state of Bahia transformed from being a place where poor families could expect few social services to becoming the home of numerous programs targeting the poorest mothers and their children. Negotiating crucial questions of identity, this history sheds new light on larger debates about Brazil's past and future.
Objective: Describe objectively the global gaps in policy, data gathering capacity, and resources to develop and implement services to support child mental health.
Methods: Report on the World ...health Organization (WHO) child and adolescent mental health resources Atlas project. The Atlas project utilized key informants and was supplemented by studies that focused on policy. This report also draws on current epidemiological studies to provide a context for understanding the magnitude of the clinical problem.
Results: Current global epidemiological data consistently reports that up to 20% of children and adolescents suffer from a disabling mental illness; that suicide is the third leading cause of death among adolescents; and that up to 50% of all adult mental disorders have their onset in adolescence. While epidemiological data appears relatively uniform globally, the same is not true for policy and resources for care. The gaps in resources for child mental health can be categorized as follows: economic, manpower, training, services and policy. Key findings from the Atlas project include: lack of program development in low income countries; lack of any policy in low income countries and absent specific comprehensive policy in both low and high income countries; lack of data gathering capacity including that for country‐level epidemiology and services outcomes; failure to provide social services in low income countries; lack of a continuum of care; and universal barriers to access. Further, the Atlas findings underscored the need for a critical analysis of the ‘burden of disease’ as it relates to the context of child and adolescent mental disorders, and the importance of defining the degree of ‘impairment’ of specific disorders in different cultures.
Conclusions: The recent finding of substantial gaps in resources for child mental health underscores the need for enhanced data gathering, refinement of the economic argument for care, and need for innovative training approaches.
Objectives
To describe reasons for unmet need for mental health care among blacks, identify factors associated with causes of unmet need, examine racism as a context of unmet need, and construct ways ...to improve service use.
Data Sources
Data from the 2011‐2015 National Survey on Drug Use and Health were pooled to create an analytic sample of black adults with unmet mental health need (N = 1237). Qualitative data came from focus groups (N = 30) recruited through purposive sampling.
Study Design
Using sequential mixed methods, reasons for unmet need were regressed on sociodemographic, economic, and health characteristics of respondents. Findings were further explored in focus groups.
Principal Findings
Higher education was associated with greater odds of reporting stigma and minimization of symptoms as reasons for unmet need. The fear of discrimination based on race and on mental illness was exacerbated among college‐educated blacks. Racism causes mistrust in mental health service systems. Participants expressed the importance of anti‐racism education and community‐driven practice in reducing unmet need.
Conclusion
Mental health systems should confront racism and engage the historical and contemporary racial contexts within which black people experience mental health problems. Critical self‐reflection at the individual level and racial equity analysis at the organizational level are critical.
This study provides the most
comprehensive and detailed analysis available on factors
behind the decline in maternal mortality in Malaysia and Sri
Lanka in the past 50 to 60 years and the magnitude ...of health
system expenditures on maternal health. The main findings
are that a modest investment in maternal health services,
combined with other poverty reduction measures leads to a
fairly rapid decline in the maternal mortality ratio (MMR),
defined as the number of maternal deaths per 100,000 live
births. The strategies of Malaysia and Sri Lanka changed
over time, from an initial emphasis on expanding the
provision of services, especially in underserved areas, to
increasing utilization and, finally, to emphasizing the
improvement of quality. Removing financial barriers to
maternal care for clients was an important step in both
countries. Professional midwives constitute the backbone of
maternal care in Malaysia and Sri Lanka. The MMR reduction
in developing countries is feasible with modest public
expenditures when appropriate policies are adopted, focused
wisely, and adapted incrementally in response to
environmental conditions and systems capacity.
China's health system performance Liu, Yuanli, Dr; Rao, Keqin, MD; Wu, Jing, MD ...
The Lancet (British edition),
2008-Nov-29, Letnik:
372, Številka:
9653
Journal Article
Recenzirano
Summary We created a comprehensive set of health-system performance measurements for China nationally and regionally, with health-system coverage and catastrophic medical spending as major ...indicators. With respect to performance of health-care delivery, China has done well in provision of maternal and child health services, but poorly in addressing non-communicable diseases. For example, coverage of hospital delivery increased from 20% in 1993 to 62% in 2003 for women living in rural areas. However, effective coverage of hypertension treatment was only 12% for patients living in urban areas and 7% for those in rural areas in 2004. With respect to performance of health-care financing, 14% of urban and 16% of rural households incurred catastrophic medical expenditure in 2003. Furthermore, 15% of urban and 22% of rural residents had affordability difficulties when accessing health care. Although health-system coverage improved for both urban and rural areas from 1993 to 2003, affordability difficulties had worsened in rural areas. Additionally, substantial inter-regional and intra-regional inequalities in health-system coverage and health-care affordability measures exist. People with low income not only receive lower health-system coverage than those with high income, but also have an increased probability of either not seeking health care when ill or undergoing catastrophic medical spending. China's current health-system reform efforts need to be assessed for their effect on performance indicators, for which substantial data gaps exist.
This review examines the literature on adolescents' and providers' views on access and use of Sexual and Reproductive Health (SRH) information and services. The SRH services referred to in this study ...were predominantly family planning services, STI treatment including HIV testing and counselling services. The study design was a systematic review of empirical studies. Twenty-five databases were searched using a well-defined search strategy and Boolean operators. A total of 45 studies were included in the review, and the findings were reported thematically under four emerging themes. The review showed that adolescents and sexual health service providers had differing views on barriers and enablers to adolescent access to SRH services and often had contradictory views on key markers of youth-friendly services, service preferences, barriers and enablers of service use. While service providers perceived physical and financial barriers as fundamental, adolescents identified barriers emanating from providers' attitude as the key hindrance to their access and use of services. The review also revealed that the unprofessional attitudes of some service providers limit adolescents' access to SRH services. These findings serve as evidence to policy actors at all levels to consider attitudinal qualities of service providers when planning and designing sexual health services for adolescents.
Cette revue examine la documentation sur les opinions des adolescents et des prestataires de services sur l'accès et l'utilisation des informations sur la santé sexuelle et de la reproduction (SSR). Les services de santé sexuelle et de reproduction mentionnés dans cette étude étaient principalement les services de la planification familiale, du traitement des IST, y compris le dépistage du VIH et les services de conseil. La conception de l'étude consistait en un compte-rendu systématique d'études empiriques. Vingtcinq bases de données ont été explorées à l'aide d'une stratégie de recherche bien définie et d'opérateurs booléens. Au total, 45 études ont été incluses dans le compte-rendu et les résultats ont été présentés de manière thématique sous quatre thèmes émergents. Le compte-rendu a montré que les adolescents et les prestataires de services de santé sexuelle avaient des opinions divergentes sur les obstacles et les facilitateurs à l'accès des adolescents aux services de santé sexuelle et de la reproduction et qu'ils avaient souvent des opinions contradictoires sur les indicateurs clés des services adaptés aux jeunes, les préférences de service, les obstacles et les facilitateurs de l'utilisation des services. Alors que les fournisseurs de services considéraient les obstacles physiques et financiers comme fondamentaux, les adolescents ont identifié les obstacles résultant de leur attitude comme étant le principal obstacle à leur accès et à leur utilisation des services. Le rapport a également révélé que l'attitude non professionnelle de certains prestataires de services limitait l'accès des adolescents aux services de SSR. Ces résultats servent de preuves aux acteurs politiques à tous les niveaux pour prendre en compte les qualités d'attitude des fournisseurs de services lors de la planification et de la conception des services de santé sexuelle pour les adolescents.
Health ministries around the world face a new challenge: to assess the risks and respond to the opportunities of the increasing openness in health services under the World Trade Organization's (WTO) ...General Agreement on Trade in Services (GATS). International Trade in Health Services and the GATS addresses this challenge head-on by providing analytical tools to policymakers in health and trade ministries alike who are involved in the liberalization agenda and, specifically, in the GATS negotiations. This book informs and assists policymakers in formulating trade policy and negotiating internationally. There is ongoing and animated international debate about the impact of GATS on public services in general and health in particular. In response, the book offers different perspectives from more than 15 leading experts. Some of the authors stress opportunities linked to trade in health services, others focus more on the risks. The book offers:Detailed legal analysis of the impact of the agreement on health policy An overview of trade commitments in health-related services New empirical evidence from nine country studies A simple 10-step explanation on how to deal with GATS negotiations.International Trade in Health Services and the GATS is a must-have resource for policymakers and other practitioners working in the trade and health sectors.
Integrated care models may improve health care for children and young people (CYP) with ongoing conditions.
To assess the effects of integrated care on child health, health service use, health care ...quality, school absenteeism, and costs for CYP with ongoing conditions.
Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library databases (1996-2018).
Inclusion criteria consisted of (1) randomized controlled trials, (2) evaluating an integrated care intervention, (3) for CYP (0-18 years) with an ongoing health condition, and (4) including at least 1 health-related outcome.
Descriptive data were synthesized. Data for quality of life (QoL) and emergency department (ED) visits allowed meta-analyses to explore the effects of integrated care compared to usual care.
Twenty-three trials were identified, describing 18 interventions. Compared with usual care, integrated care reported greater cost savings (3/4 studies). Meta-analyses found that integrated care improved QoL over usual care (standard mean difference = 0.24; 95% confidence interval = 0.03-0.44;
= .02), but no significant difference was found between groups for ED visits (odds ratio = 0.88; 95% confidence interval = 0.57-1.37;
= .57).
Included studies had variable quality of intervention, trial design, and reporting. Randomized controlled trials only were included, but valuable data from other study designs may exist.
Integrated care for CYP with ongoing conditions may deliver improved QoL and cost savings. The effects of integrated care on outcomes including ED visits is unclear.
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