Public policy plays a key role in improving population health and in the control of diseases, including non-communicable diseases. However, an evidence-based approach to formulating healthy public ...policy has been difficult to implement, partly on account of barriers that hinder integrated work between researchers and policy-makers. This paper describes a "policy effectiveness-feasibility loop" (PEFL) that brings together epidemiological modelling, local situation analysis and option appraisal to foster collaboration between researchers and policy-makers. Epidemiological modelling explores the determinants of trends in disease and the potential health benefits of modifying them. Situation analysis investigates the current conceptualization of policy, the level of policy awareness and commitment among key stakeholders, and what actually happens in practice, thereby helping to identify policy gaps. Option appraisal integrates epidemiological modelling and situation analysis to investigate the feasibility, costs and likely health benefits of various policy options. The authors illustrate how PEFL was used in a project to inform public policy for the prevention of cardiovascular diseases and diabetes in four parts of the eastern Mediterranean. They conclude that PEFL may offer a useful framework for researchers and policy-makers to successfully work together to generate evidence-based policy, and they encourage further evaluation of this approach.
Background: This paper examines one EC-funded multinational project (RESCAP-MED), with a focus on research capacity building (RCB) concerning non-communicable diseases (NCDs) in the Mediterranean ...Middle East and North Africa. By the project's end (2015), the entire region was engulfed in crisis.
Objective: Designed before this crisis developed in 2011, the primary purpose of RESCAP-MED was to foster methodological skills needed to conduct multi-disciplinary research on NCDs and their social determinants. RESCAP-MED also sought to consolidate regional networks for future collaboration, and to boost existing regional policy engagement in the region on the NCD challenge. This analysis examines the scope and sustainability of RCB conducted in a context of intensifying political turmoil.
Methods: RESCAP-MED linked two sets of activities. The first was a framework for training early- and mid-career researchers through discipline-based and writing workshops, plus short fellowships for sustained mentoring. The second integrated public-facing activities designed to raise the profile of the NCD burden in the region, and its implications for policymakers at national level. Key to this were two conferences to showcase regional research on NCDs, and the development of an e-learning resource (NETPH).
Results: Seven discipline-based workshops (with 113 participants) and 6 workshops to develop writing skills (84 participants) were held, with 18 fellowship visits. The 2 symposia in Istanbul and Beirut attracted 280 participants. Yet the developing political crisis tagged each activity with a series of logistical challenges, none of which was initially envisaged. The immediacy of the crisis inevitably deflected from policy attention to the challenges of NCDs.
Conclusions: This programme to strengthen research capacity for one priority area of global public health took place as a narrow window of political opportunity was closing. The key lessons concern issues of sustainability and the paramount importance of responsively shaping a context-driven RCB.
The objective of the study was to explore the cultural aspect of compliance, its underlying principles and how these cultural aspects can be used to improve patient centred care for diabetes in ...Cameroon.
We used participant observation to collect data from a rural and an urban health district of Cameroon from June 2001 to June 2003. Patients were studied in their natural settings through daily interactions with them. The analysis was inductive and a continuous process from the early stages of fieldwork.
The ethnography revealed a lack of basic knowledge about diabetes and diabetes risk factors amongst people with diabetes. The issue of compliance was identified as one of the main themes in the process of treating diabetes. Compliance emerged as part of the discourse of healthcare providers in clinics and filtered into the daily discourses of people with diabetes. The clinical encounters offered treatment packages that were socially inappropriate therefore rejected or modified for most of the time by people with diabetes. Compliance to biomedical therapy suffered a setback for four main reasons: dealing with competing regimes of treatment; coming to terms with biomedical treatment of diabetes; the cost of biomedical therapy; and the impact of AIDS on accepting weight loss as a lifestyle measure in prescription packages. People with diabetes had fears about and negative opinions of accepting certain prescriptions that they thought could interfere with their accustomed social image especially that which had to do with bridging their relationship with ancestors and losing weight in the era of HIV/AIDS.
The cultural pressures on patients are responsible for patients' partial acceptance of and adherence to prescriptions. Understanding the self-image of patients and their background cultures are vital ingredients to improve diabetes care in low-income countries of Sub-Sahara Africa like Cameroon.
This paper examines the changing reputation of one village in Himachal Pradesh, India, looking back over 30 years. This village has long had a singular identity and local notoriety for its ...association with jadu (‘witchcraft’). I argue that in this village today the idea of ‘witchcraft’ as a potent malignant force is losing its old persuasiveness, and with this change the village is also shedding its unwanted reputation. Against claims for ‘the modernity of witchcraft’ in various parts of the world, I argue that, in this case at least, witchcraft is construed as distinctly unmodern. The capacity of jadu to cause fear and, equally, its value as an explanatory idiom are, I suggest, being overwhelmed by social changes, the cumulative effect of which has been to reduce the previous insularity of this village and greatly widen the social networks of its members. I pose two main questions. Why should this village have held such a particular reputation? And why should it now be on the wane? Linked to the second question is the relationship between this decline and local understandings of ‘modernity’. In developing my argument around the specificity of an unusual village, I also consider the significance of ‘the village’ as both social entity and, formerly, one cornerstone of the anthropological project. Finally, I reflect on the methodological opportunities of long-term familiarity with a setting, exemplified in the iterative nature of learning ethnographically, as the children known initially in early fieldwork become the adult conversationalists of today, partners in interpreting their own village's past. In exploring their explanations for the decline in the salience of jadu, the pivotal impact of education and the pressures of ‘time’ created by the ‘speed’ of modernity are both salient.
The objective was to examine how the indigenous naming, indigenous self-diagnosis and management of diabetes evolved with awareness in order to develop a socially oriented theoretical model for its ...care.
The data was collected through a one-year extended participant observation in Bafut, a rural health district of Cameroon. The sample consisted of 72 participants in a rural health district of Cameroon (men and women) with type 2 diabetes. We used participant observation to collect data through focus group discussions, in depth interviews and fieldwork conversations. The method of analysis entailed a thick description, thematic analysis entailing constant comparison within and across FGD and across individual participants and content analysis.
The core concepts identified were the evolution of names for diabetes and the indigenous diagnostic and self-management procedures. Participants fell into one of two naming typologies: (a) Naming excluding any signs and symptoms of diabetes; (b) naming including signs and symptoms of diabetes. Participants fell into two typologies of diagnostic procedures: (a) those that use indigenous diagnostic procedures for monitoring and controlling diabetes outcomes and b) those that had initially used it only for diagnosis and continued to use them for self management. These typologies varied according to how participants' awareness evolved and the impact on self-diagnosis and management.
The evolution of names for diabetes was an important factor that influenced the subsequent self-diagnosis and management of diabetes in both traditional and modern biomedical settings.
Objectives
Current capacity of the Turkish health system is reviewed to evaluate and develop appropriate policies for cardiovascular diseases (CVD), diabetes mellitus (DM) and related risk factors.
...Methods
This paper qualitatively evaluates existing policies; interviews with key informants (KIs); and rapid appraisal fieldwork in clinical settings about CVD–DM through the framework of Walt and Gilson (Health Policy Plan 9:353–370,
1994
).
Results
Document review shows that prevention and control of CVD–DM were strongly addressed in Turkey, yet no document mentioned country-wide early detection or screening programs. KIs indicated over-fragmented management of CVD–DM by the Ministry of Health (MoH). Coordination among the MoH, organizational structure at provincial level and civil society organizations are poor where mutual trust is a significant problem according to KIs. Clinical setting findings point to a complete lack of a referral structure and a lack of follow-up, compounding the absence of functioning health information systems for patient records.
Conclusions
Primary care services for CVD–DM require urgent attention, focusing particularly on the training of staff in public facilities, the integration of patient data, referrals and follow-up across all levels of the health system.
Objectives
To explore how married women living in low-income formal and informal neighbourhoods in Aleppo, Syria, perceived the effects of neighbourhood on their health and well-being, and the ...relevance of these findings to future urban rebuilding policies post-conflict.
Methods
Semi-structured interviews were undertaken with eighteen married women living in informal or socioeconomically disadvantaged formal neighbourhoods in Aleppo in 2011, a year before the armed conflict caused massive destruction in all these neighbourhoods.
Results
Our findings suggest that the experience of neighbourhood social characteristics is even more critical to women’s sense of well-being than environmental conditions and physical infrastructure. Most prominent was the positive influence of social support on well-being.
Conclusions
The significance of this study lies, first, in its timing, before the widespread destruction of both formal and informal neighbourhoods in Aleppo and, second, and in its indication of the views of women who lived in marginalised communities on what neighbourhood characteristics mattered to them. Further research post-conflict needs to explore how decisions on urban rebuilding are made and their likely influence on health and well-being.
This article takes cultural understandings of industrial risk in a center of the global chemical industry as an opening that, perhaps unexpectedly, highlights nostalgia for a particular period in ...(West) Germany's postwar history. Based on fieldwork in Ludwigshafen, we reflect on memories among an older generation of residents that evoke the severity of industrial pollution from the city's vast chemical industry during the 1950s and 1960s. Although the pollution of that era is hardly mourned, it was portrayed as emblematic of a culturally defining era, an era valorized as one of enormous achievement in a more straightforward time. We draw on Tim Ingold's concept of “taskscapes” and his emphasis on skill and Tim Edensor's discussion of “excessive spaces” and “multiple absences” to explore the selectivity of the nostalgia of Ludwigshafen's older residents, in which the celebration of the rebuilding of the postwar chemical industry, and its dominant company BASF, simultaneously obscured problematic memories associated with the city's chemical industry in wartime.
This article takes cultural understandings of industrial risk in a center of the global chemical industry as an opening that, perhaps unexpectedly, highlights nostalgia for a particular period in ...(West) Germany's postwar history. Based on fieldwork in Ludwigshafen, we reflect on memories among an older generation of residents that evoke the severity of industrial pollution from the city's vast chemical industry during the 1950s and 1960s. Although the pollution of that era is hardly mourned, it was portrayed as emblematic of a culturally defining era, an era valorized as one of enormous achievement in a more straightforward time. We draw on Tim Ingold's concept of “taskscapes” and his emphasis on skill and Tim Edensor's discussion of “excessive spaces” and “multiple absences” to explore the selectivity of the nostalgia of Ludwigshafen's older residents, in which the celebration of the rebuilding of the postwar chemical industry, and its dominant company BASF, simultaneously obscured problematic memories associated with the city's chemical industry in wartime.
The aim of this study is to define the research capacity and training needs for professionals working on non-communicable diseases (NCDs) in the public health arena in Turkey.
This study was part of ...a comparative cross-national research capacity-building project taking place across Turkey and the Mediterranean Middle East (RESCAP-Med, funded by the EU). Identification of research capacity and training needs took place in three stages. The first stage involved mapping health institutions engaged in NCD research, based on a comprehensive literature review. The second stage entailed in-depth interviews with key informants (KIs) with an overview of research capacity in public health and the training needs of their staff. The third stage required interviewing junior researchers, identified by KIs in stage two, to evaluate their perceptions of their own training needs. The approach we have taken was based upon a method devised by Hennessy&Hicks. In total, 55 junior researchers identified by 10 KIs were invited to participate, of whom 46 researchers agreed to take part (84%). The specific disciplines in public health identified in advance by RESCAP-MED for training were: advanced epidemiology, health economics, environmental health, medical sociology-anthropology, and health policy.
The initial literature review showed considerable research on NCDs, but concentrated in a few areas of NCD research. The main problems listed by KIs were inadequate opportunities for specialization due to heavy teaching workloads, the lack of incentives to pursue research, a lack of financial resources even when interest existed, and insufficient institutional mechanisms for dialogue between policy makers and researchers over national research priorities. Among junior researchers, there was widespread competence in basic epidemiological skills, but an awareness of gaps in knowledge of more advanced epidemiological skills, and the opportunities to acquire these skills were lacking. Self-assessed competencies in each of the four other disciplines considered revealed greater training needs, especially regarding familiarity with the qualitative research skills for medical anthropology/sociology.
In Turkey there are considerable strengths to build upon. But a combination of institutional disincentives for research, and the lack of opportunities for the rising generation of researchers to acquire advanced training skills.
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