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Dissertations / Theses on the topic 'Public health'
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1
Santiago, Denise L. "Assessment of public health infrastructure to determine public health preparedness." Thesis, Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 2006. http://library.nps.navy.mil/uhtbin/hyperion/06Mar%5FSantiago.pdf.
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Thesis (M.A. in Security Studies (Homeland Security and Defense))--Naval Postgraduate School, March 2006.Thesis Advisor(s): Anke Richter. "March 2006." Includes bibliographical references (p. 75-81). Also available online.
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Bührer, Sabine. "Public Health im Wandel : eine vergleichende Bestandsaufnahme dreier Schools of Public Health /." Konstanz, 2004. http://www.public-health-edu.ch/new/Abstracts/BS_07.03.05.pdf.
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Emmelin, Maria. "Self-rated health in public health evaluation." Doctoral thesis, Umeå : Univ, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-226.
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Faust, Linda A. "AIDS Public health implications /." Instructions for remote access. Click here to access this electronic resource. Access available to Kutztown University faculty, staff, and students only, 1991. http://www.kutztown.edu/library/services/remote_access.asp.
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Thesis (M.P.A.)--Kutztown University of Pennsylvania, 1991.Source: Masters Abstracts International, Volume: 45-06, page: 2940. Abstract precedes thesis as [2] preliminary leaves. Typescript. Includes bibliographical references (leaves 94-100).
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Heimburg, Dina von. "Public health and health promotion: a salutogenic approach." Thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for sosialt arbeid og helsevitenskap, 2010. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-12094.
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Shah, Rebecca Sonul. "Global health inequality : Justice and public health ethics." Thesis, Keele University, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.535801.
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This thesis is motivated by the intuition that current extremes of global health inequality and deprivation constitute moral problems of the utmost importance. It aims to advance our understanding of how we should think about and be morally guided in our responses to global health inequality by engaging critically with literature and arguments at the intersection of global health, public health and social justice. Part I addresses the more conceptual question of how we should think about global health inequality. I suggest that we reject international empirical, operational and normative accounts of global health inequality in favour of genuinely global approaches. I suggest five core features of public health practice and ask whether they are meaningful at the global level. I find no argument for why the features of public health may not relate to the global sphere convincing and therefore tentatively conclude that we might think of global health inequality as a matter of public health. Part II addresses the more normative question of how we should be morally guided in our responses to global health inequality. Through engagement with the public health ethics literature I propose two roles for justice as a core public health value. First, justice may be an ethical principle guiding how public health is practiced, and second justice may provide the normative justification for why public health is practiced. I identify existing accounts of public health ethics and theories of justice reflecting these twin justice roles and evaluate how well they can morally guide our responses to global health inequality. I conclude by suggesting that public health may be a social institution governed by the principles ofjustice at the global level and that public health may be a human right which should be globally fulfilled as requirement of justice.
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Bunten, A. "The application of health psychology to public health." Thesis, City, University of London, 2017. http://openaccess.city.ac.uk/20309/.
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Background: There is strong evidence linking obesity to health issues and long term conditions such as high blood pressure, type II diabetes, heart disease and some cancers (NICE, 2006). Despite this growing evidence base, the prevalence of obesity continues to rise and rates have more than doubled in England in the last 25 years (Public Health England, 2014). Currently 26% of adults are obese (Health Survey for England, 2014), and the proportion of women that are classified as overweight and obese has risen to 57% (Health Survey for England, 2014). Weight loss can reduce the risk of an individual developing these conditions and can increase their healthy life expectancy. It is estimated that approximately one in every two adults in England are actively trying to lose weight, the majority of which are over-weight or obese women (Piernas, Aveyard and Jebb, 2016). This indicates that over-weight and obese women are motivated to lose weight but are struggling to achieve or maintain a healthy weight. To-date potentially effective weight management interventions have been identified as long term multi-component interventions including diet and exercise components along with behavioural strategies. However, weight changes have been small and weight regain has been found to be very common (Loveman, Frampton, Shepherd, Picot, Cooper et al, 2011; Dombrowski, Knittle, Avenell, Araújo-Soare & Sniehotta, 2014). Despite the primary focus on weight loss being to improve health, research suggest that people’s prime motivation to lose weight is unrelated to health (Piernas, Aveyard and Jebb, 2016). Aim: This study aims to improve the understanding of the challenge of achieving and maintaining a healthy weight in overweight and obese young women. In particular, it aims to i) better understand the barriers and facilitators to achieving and maintaining a healthy weight as experienced by these young women, ii) further understand the relationships and influences of these factors, to iii) inform and develop a new theoretical framework in which to capture this social phenomena and societal challenge. Recruitment: This study recruited 14 female participants aged 18- 35 years, with a BMI over 30 (or 28 with co-morbidity), actively seeking support to lose weight. Participants were recruited through purposive sampling in two primary care practices in East London as part of the ‘Peer Support Weight Action Programme’ (SWAP). This was a Randomised Controlled Trial run by Barts Health NHS Trust and Queen Mary’s School of Medicine and Dentistry, funded by the National Institute for Health Research, Health Technology Assessment fund. Design: The research is qualitative in design utilising in-depth semi-structured interviews. Interviews took place with women recruited to take part in a weight loss programme before commencing the intervention, and follow up interviews took place approximately six months after completion of the weight management programme. Grounded Theory Analysis was used to analyse the data. Results and Findings: An overarching theoretical framework is presented from the findings of the data analysis of the pre and post weight loss attempt interviews. A new ‘Emotion and Mindset’ model is presented to explain the challenge of achieving and maintaining a healthier weight in young women. It includes the core categories of sense of self, emotion and mindset, self-efficacy, and stress and conflicting priorities and has been theoretically framed around the concept of Finding the Health Enhancing Equilibrium - maintaining a positive sense of self whilst generating action to achieve and maintain a healthy weight. It describes the balancing act required between these key contributing elements to engage in positive health behaviour which contributes to achieving and maintaining a healthy weight. Recommendations: Based on the findings from this study, and supported by previous findings (Cochrane, 2008), weight management interventions targeting young women need to build in coping strategies to support individuals cognitively, behaviourally and emotionally. These should include building self-efficacy (NOO, 2011; Ashford, Edmunds, French, 2010), sense of self and re-aligning identity (West & Brown, 2013). Individuals need to be taught how to identify, address and re-orient dysfunctional thoughts, to identify potential stressors such as triggers and environmental cues to prevent relapse. Consideration needs to be given to weight loss maintenance and ongoing tailored support. Further research is needed to identify what type and method of support is most effective and for whom.
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Leibe, Mary. "Creating Healthy Urban Environments: Commercial Landscaping, Preference and Public Health." ScholarWorks@UNO, 2016. http://scholarworks.uno.edu/td/2262.
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Landscape development[1] can provide many benefits, including the reduction of stormwater runoff and the creation of habitats for wildlife. It can also provide health benefits. Researchers, such as Roger Ulrich and Rita Berto have demonstrated that views of trees and other vegetation are associated with lower blood pressure and reduced recovery times in hospitals and that environments with more natural elements may lessen mental fatigue (R. Ulrich 1984) and (Berto 2005).
As rebuilding in New Orleans continues 11 years after Hurricane Katrina, landscape development has been limited or lacking, especially in the redevelopment of commercial properties. Two prominent reasons for this deficiency are a lack of funding and, until August of 2015, the absence of a comprehensive landscape ordinance.
The purpose of the research presented here is to determine the degree to which community residents express a preference for healthier commercial environments. As part of my research, I measured community perceptions of four potential redevelopment concepts for a blighted strip shopping center utilizing attention restoration theory (ART), which postulates that certain environmental qualities contribute to reductions in mental fatigue. I found that commercial environments with the most quality landscaping[2] are those that neighborhood residents most prefer and are most conducive to better health.
Keywords: mental fatigue, attention restoration theory, perceived restoration scale, commercial landscape quantity, public health, healthy urban environment
[1] Refer to operational definitions (pages 4-6).
[2] Refer to operational definitions (pages 4-6).
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Wallace, Maria. "Public Health Nurses’ Perceptions of High School Dropout Rates as a Public Health Issue." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7766.
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Education is one of the strongest predictors of health, and well-being. Early termination of education can lead to poorer health, shorter lifespans, and increased stress on the healthcare system. Improving overall high school graduation rates has been debated and discussed by the Toronto District School Board (TDSB) and the Ministry of Education, however, there is a paucity of research on increased graduation rates as they relate to public health in the Canadian context. The purpose of this phenomenological qualitative study was to explore the perceptions of liaison public health nurses (PHNs) who worked directly with the TDSB regarding their roles in terms of influencing students in Toronto, Ontario to complete high school. Bronfenbrenner’s ecological model was the underlying conceptual framework for the study.Purposive sampling was used to select 10 PHNs who were interviewed regarding their role and involvement in high schools. The data was subjected to triangulation and analyzed to identify commonalities, trends and patterns. Findings from this study indicated that liaison PHNs believe that high school dropout rates are a public health issue and collaboration between the Ministry of Education and Public Health is needed to take action. Recommendations include more Canadian research that explores connections between health and school achievements and the expanded role of PHNs in Canadian high schools. Social change implications for this research include highlighting high school dropout rates as a public health concern in Canadian schools, particularly in communities of lower socioeconomic status. With increased research and resources, the Toronto public health system may work toward making improving graduation rates among their core mandate.
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Bosworth, Ryan Cole. "Demand for public health policies /." view abstract or download file of text, 2006. http://proquest.umi.com/pqdweb?index=0&did=1192186841&SrchMode=1&sid=1&Fmt=2&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1176749188&clientId=11238.
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Thesis (Ph. D.)--University of Oregon, 2006.Typescript. Includes vita and abstract. Includes bibliographical references (leaves 127-130). Also available for download via the World Wide Web; free to University of Oregon users.
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Polyakova, Maria A. (Maria Alexandrovna). "Regulation of public health insurance." Thesis, Massachusetts Institute of Technology, 2014. http://hdl.handle.net/1721.1/90128.
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Thesis: Ph. D., Massachusetts Institute of Technology, Department of Economics, 2014.Cataloged from PDF version of thesis.
Includes bibliographical references (pages 147-150).
The first chapter takes advantage of the evolution of the regulatory and pricing environment in the first years of a large federal prescription drug insurance program for seniors - Medicare Part D - to explore interactions among adverse selection, switching costs, and regulation. I document evidence of both adverse selection of beneficiaries across contracts and switching costs for beneficiaries in changing contracts within Medicare Part D. Using an empirical model of contract choice and contract pricing, I show that in the present environment, on net, switching costs help sustain an adversely-selected equilibrium with large differences in risks between more and less generous contracts. I then simulate how switching costs may alter the impact of "filling" the Part D donut hole as implemented under the Affordable Care Act. I find that absent any switching costs, this regulation would have eliminated the differences in risks across contracts; however, in the presence of the switching costs that I estimate, the effect of the policy is largely muted. The second chapter (co-authored with Francesco Decarolis and Stephen Ryan) explores federal subsidy policies in Medicare Part D. We estimate an econometric model of supply and demand that incorporates the regulatory pricing distortions in the insurers' objective functions. Using the model, we conduct counterfactual analyses of what the premiums and allocations would be in this market under different ways of providing the subsidies to consumers. We show that some of the supply-side regulatory mechanisms, such as the tying of premiums and subsidies to the realization of average "bids" by insurers in a region, prove to be welfare-decreasing empirically. The third chapter studies two competing systems that comprise the German health insurance landscape. The two systems differ in the ability of insurers to underwrite individual-specific risk. In contrast to the community rating of the statutory insurance system, enrollees of the private plans face full underwriting and may be rejected by the insurers. I empirically assess to what extent the selection of "good risks" dominates the interaction between the two systems, using a regression discontinuity design based on statutory insurance enrollment mandates. I do not find compelling evidence of cream-skimming by private insurers from the statutory system. Motivated by this finding, I quantify the change in consumer welfare that would result if the government relaxed the statutory insurance mandate to lower income levels.
by Maria A. Polyakova.
Ph. D.
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Petersen, J. "Social marketing and public health." Thesis, University College London (University of London), 2009. http://discovery.ucl.ac.uk/18925/.
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The public health field exists to safeguard the general public from health risks by controlling risk factors, classically through immunization programmes that prevent or control epidemics, or through actions such as monitoring the quality of drinking water. In our post-industrialised society, risk factors other than the environment, such as diet, exercise, tobacco and alcohol use, have grown in importance. The policy response to the growing demand upon healthcare services arising from chronic diseases caused by changing lifestyle factors has taking different forms, and these include targeting vulnerable groups using health promoting campaigns. This thesis addresses some of the challenges and opportunities in public health campaigns and healthcare planning that arise from the growing repositories of data that can be made available for targeting at the individual and small area level in a public health setting. The first part sets the scene by describing the concepts of health, public health and social marketing. The intention is to pave the way for broader discussions – in the progress of the thesis – about healthcare planning, population health, and social processes in the light of targeted public health interventions. Part two addresses the problems and possible solutions to a number issues in healthcare planning, starting with studies at the individual, then moving to organisations and ending with area classifications. The thesis draws on a number of case studies for targeting in a public health context including frequent accident and emergency users, teenage users of abortion services, women’s breast screening uptake, GP registration, and the neighbourhood characteristics of chronic disease patients. Finally, part three provides a synopsis of both context (part one), results (part two) and future perspectives on how routinely collected healthcare data can be used to create evidence for the planning of new cost-effective interventions.
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Wettstein, Gal. "Essays on Public Health Insurance." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:33493442.
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Over the last ten years there have been dramatic changes in the health insurance environment in the United States, spurred on by broad reforms in the public health insurance sector. In 2006 the Medicare Prescription Drug, Improvement and Modernization Act went into effect, providing broad access to prescription drug insurance for millions of elderly Americans. In 2014 the main provisions of the Patient Protection and Affordable Care Act began to be felt, dramatically changing health insurance markets, particularly for those seeking non-group coverage. These legislative changes both raise questions regarding how well the policy changes meet their goals, as well as offering new variation with the potential to answer questions of fundamental economic significance.
This dissertation addresses such important questions surrounding the effectiveness of public health insurance in meeting policymakers’ goals, and the implications of public health insurance for private markets. In the three chapters of this dissertation I utilize the policy changes of Medicare Part D and the Affordable Care Act to provide quasi-experimental estimates of retirement lock, of the correlation of risk aversion and crowd-out of private insurance, and of the effectiveness of the individual health insurance mandate in expanding coverage.
The first part studies the implications of public drug insurance for labor markets. This part examines whether the lack of an individual market for prescription drug insurance causes individuals to delay retirement. I exploit the quasi-experiment of the introduction of Medicare Part D, which provided subsidized prescription drug insurance to all Americans over age 65 beginning in 2006. Using a differences-in-differences design, I compare the labor outcomes of individuals turning 65 just after 2006 to those turning 65 just before 2006 in order to estimate the causal effect of eligibility for Part D on labor supply. I find that individuals at age 65 who would have otherwise lost their employer-sponsored drug insurance upon retirement decreased their rate of full-time work by 8.4 percentage points due to Part D, in contrast to individuals with retiree drug insurance even after age 65 for whom no significant change was observed. This reduction was composed of an increase of 5.9 percentage points in part-time work and 2.5 percentage points in complete retirement. I use these estimates to quantify the extent of the distortion due to drug insurance being tied to employment, and the welfare gains from the subsidy correcting that distortion. The results suggest that individuals value $1 of drug insurance subsidy as much as $3 of Social Security wealth.
The second part of this dissertation considers the effect of public drug insurance on private drug coverage, with a focus on the correlation of crowd-out and risk aversion. I utilize Health and Retirement Survey data around the time of introduction of the Medicare Part D prescription drug insurance for the elderly in order to estimate crowd-out of private prescription drug insurance. I use individuals between the ages of 55 and 64, who are not eligible for the program, as a control group relative to individuals aged 65 to 75, who are eligible. I take a differences-in-differences approach to estimation by comparing outcomes before and after 2006, when Medicare Part D went into effect. I construct measures of risk aversion by exploiting unique questions eliciting risk preferences in the Health and Retirement Survey, as well as information on whether individuals have other kinds of insurance, or engage in risky behaviors. I find substantial differential crowd-out by risk aversion: every standard deviation increase in risk aversion was associated with about 5 percentage points less crowd-out, over a base crowd-out rate of 50%-60%. More risk averse individuals also saw greater reductions in out-of-pocket spending on prescription drugs due to Part D, particularly at high levels of spending: at the 85th percentile of spending an individual one standard deviation more risk averse than the average experienced a decline of $110/year due to Part D eligibility, above and beyond the gains for an averagely risk averse individual of $382/year.
The third part of the dissertation estimates the effectiveness of the individual mandate in the Patient Protection and Affordable Care Act in expanding health insurance coverage. This paper studies the impact of the individual health insurance mandate in the Patient Protection and Affordable Care Act (PPACA) on health insurance coverage. This mandate went into effect in 2014, alongside various other elements of the PPACA. I focus on individuals ages 26-64 who are ineligible for the subsidies or Medicaid expansions included in the PPACA to isolate the effect of the mandate from these other components. To account for changes unrelated to the PPACA that occur over time and affect insurance coverage I utilize a control group of residents of Massachusetts who were already subject to mandated insurance following the 2006 health care reform in their state. Employing a differences-in-differences design applied to data from the American Community Survey, I find that the mandate caused an increase of 0.85 percentage points in health insurance coverage, or a 17% decline in the uninsurance rate. This increase was concentrated in coverage purchased directly by individuals, rather than acquired through an employer, and predominantly affected younger individuals. Both these observations are consistent with the mandate ameliorating adverse selection in the individual health insurance market.Economics
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Lee, Karen. "Scaling up public health interventions." Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/27829.
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The scale-up of effective or efficacious public health interventions to prevent chronic disease is important if population wide impacts are to be achieved. However, scale-up is complex and doesn’t happen as often as it should. This is despite growing interest in the area of research translation and scale-up by researchers and policy makers and a plethora of conceptual frameworks developed to guide the scale-up of efficacious interventions.
The objectives of this thesis are to understand how scale-up may be facilitated within a research translation framework as well as in the real-world by understanding the key factors that contribute to facilitating scale-up. A key finding from this thesis is that scale-up in the real-world does not occur in a linear fashion and is often influenced by a range of factors including the political and/or strategic context, values of key actors as well as community needs and the availability of funding. Furthermore, decisions to scale-up are not only determined by the level of evidence available, but also through the convergence of the abovementioned factors into an opportunity for scale-up, ‘the scale-up window’.
The opportunities to facilitate scale-up in this thesis include: cementing ‘scale-up’ as the end goal within a research translation framework which places the emphasis on scale-up equally alongside the other research translation activities; conducting research that promotes greater understanding of implementation and scale-up (through replication and scale-up studies) while reducing the traditional focus of smaller efficacy trials that are not conducive for scale-up; encouraging the uptake of pragmatic tools that provide guidance to those considering scale-up, through assessing the potential scalability of interventions considered for scale-up to expedite more informed decision making; and by comprehensively reflecting on and documenting scale-up experiences which contribute to capturing lessons for researchers and policy makers.
Finally, the field of scale-up may benefit from greater clarity around the ‘roles’ within research and policy settings on scale-up, which would increase the accountability for scaling up interventions as well as greater delineation between the growing field of implementation science and scale-up.
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Lazzarato, Fulvio. "Dynamic Models for Public Health." Doctoral thesis, Università del Piemonte Orientale, 2018. https://hdl.handle.net/11579/148543.
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Dynamic models are important tools for public health purposes; they allow esimaing the impact of diferent approaches and can be used for a populaion health improvement planning or to organize a response to an emerging public health issue. The aims of my thesis are to design, build, test, parameterized, and illustrated two dynamic models. One is a populaion-based model of Human Papilloma Virus (HPV) infecion natural history and vaccinaion; the other is an individual based model of tobacco control. Both models have been adapted to account for public health measure of prevenion and control. Also, both models can incorporate enough demographic data to adapt their outputs to speciic populaion, in which realisic intervenions are simulated. The model of HPV transmission and control has been adapted and parameterized to represent diferent populaions from both high- and low-middle-income countries, i.e. Sweden, Italy, US, and India, and diferent HPV types, i.e. 16,18, and 45. By contrast, the model of tobacco control has been designed to reproduce smoking behaviors and demography of the Italian populaion between year 2000 and 2013 and used to evaluate the efect of public health policy, e.g. smoking prevalence on the Italian populaion in year 2030. Both models are coded in C compuing language, according to high-performance programming standards, eicient data structures and algorithms, and opimizaion techniques to maximize the compuing eiciency. In my thesis, I have used the two models to predict the expected impact of selected public health intervenions both for HPV and cervical cancer control and for tobacco control. The outputs of each set of simulations have been analysed using advanced staisical methods/libraries, e.g. GNU Scieniic Library and sotware such as R (CRAN) and STATA. These predicions illustrate the potenial of using mathemaical model for assessing the efeciveness of selected prevenion and control measures.
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Bekker, Marleen Petra Maria. "The politics of healthy policies redesigning health impact assessment to integrate health in public policy /." Delft : Rotterdam : Eburon ; Erasmus University [Host], 2007. http://hdl.handle.net/1765/10491.
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Ratima, M. M. (Mihi M. )., and n/a. "Kia uruuru mai a hauora : being healthy, being Maori: conceptualising Maori health promotion." University of Otago. Wellington School of Medicine & Health Sciences, 2001. http://adt.otago.ac.nz./public/adt-NZDU20070508.152546.
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The Decade of Maori Development (1984-1994) stimulated the re-emergence of distinctly Maori approaches to progressing their own advancement. Maori health promotion is one such approach that has a central concern for improving Maori health outcomes. A range of Maori collectives are providing what they claim to be distinctly Maori health promotion initiatives. However, Maori health promotion has a pragmatic orientation, and this has, at least in part, led to conceptual and theoretical under-development. There is an almost complete lack of empirically and theoretically sound work to conceptualise Maori health promotion. This research programme has focused on identifying the defining characteristics of Maori health promotion.
The primary data source for this research programme was three case studies of Maori health promotion interventions.
Tipu Ora - a Maori community-based well-child programme;
the Plunket Kaiawhina Service - a national Maori focussed initiative located within a mainstream service; and,
the Wairarapa Maori Asthma Project - a tribally-based asthma management initiative.
The main source of data in each of the case studies was in-depth open-ended interviews with programme participants and stakeholders. Data was also drawn from document review and archival records.
The findings of this research indicate that Maori health promotion is based on a broad concept of health, which can be expanded as the basis for a more general argument for Maori advancement. Maori health promotion is the process of enabling Maori to increase control over the determinants of health and strengthen their identity as Maori, and thereby improve their health and position in society. Its defining characteristics have been identified in this research programme, and presented in �Kia uruuru mai a hauora�, a framework for Maori health promotion. The Framework has the potential to provide the basis for a more consistent and rigorous approach to Maori health promotion practice, policy, purchasing, and research. Aspects of the Framework may also have wider application to generic health promotion and other indigenous peoples� approaches to health promotion.
This study concludes that Maori health promotion draws primarily on the heritage and new knowledge that arises from Maori and Western experiences. However, it remains grounded in the distinctive concepts and values of Maori worldviews. Maori health promotion is a distinctly Maori process, in step with and indigenous health promotion, but primarily on the determination of Maori to be Maori.
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Pankaj, Vibha. "Mobilising knowledge in public health : analysis of the functioning of the Scottish Public Health Network." Thesis, University of Edinburgh, 2014. http://hdl.handle.net/1842/9440.
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The extent to which the knowledge mobilisation potential of public health networks is actually achieved in their functioning has not been previously studied. There are prescriptions from policy documents and from research literature as to the form networks in health should take and the way they should operate. However, there has been little research connecting the nature of the networks and the manner in which they function to their knowledge mobilising ability. Constituted in 2006, the Scottish Public Health Network (ScotPHN), which is the primary vehicle in Scotland for mobilising public health knowledge and informing policy and practice, constitutes the location for this study investigating this knowledge mobilisation and how networks function in public health. Feedback from the consultation conducted prior to the formation of ScotPHN was obtained. Interviews were conducted with the members of the ScotPHN steering group, a project group and the stakeholder group. Two ScotPHN steering group meetings were also attended by the author as an observer. The consultation feedback, transcripts of the interviews and those of steering group meetings were analysed using the constructivist version of the grounded theory approach. The process involved coding and abstracting codes to categories and themes. The emerging themes were reviewed in the light of existing literature on networks and knowledge mobilisation. These themes were then used to develop a model to understand how the network operates and consequently mobilises knowledge. The study shows that prior to its formation ScotPHN was expected to address the fragmentation of the public health workforce; significantly enhance links amongst existing public health networks; support ground level knowledge exchange amongst practitioners and significantly enhance multisectorial working. None of these expectations appear to have been met. ScotPHN has, however, managed to fill the gap left by the demise of the Scottish Needs Assessment Programme (SNAP). ScotPHN’s structure and the manner in which it is controlled lead to it being akin to a policy community rather than an issue network. The generic public health concerns of the steering group and the selective nature of the project group prevent it from functioning as an issue network. The dominance of people from the medical profession also causes a social closedness in the ScotPHN steering group. The limited multisectorial participation in its activities results in: a lack of constructionist learning; limited inclusion of the social context of knowledge; and a deficit of Mode 2 knowledge mobilisation. In the context of knowledge conversion there is some evidence of externalisation but no socialisation. ScotPHN is not a network that can be classed as a community of practice. This study highlights how health policies, which have advocated the establishment of networks, could derive considerable guidance from research into how networks actually function. With respect to the knowledge mobilisation activity of these networks the study finds that top-down and prescribed structures are unable to capture the transdisciplinarity and diverse intellectual frameworks that contribute to public health knowledge. It is seen that the hierarchical network structures can undermine the engagement of actors from the less represented sectors. Additionally the study finds that the established patterns of professional power and control further hinder multisectorial engagement.
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French, Martin Andrew. "Picturing public health surveillance : tracing the material dimensions of information in Ontario's public health system." Kingston, Ont. : [s.n.], 2009. http://hdl.handle.net/1974/1689.
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Wang, Xiaochuan (Sherry). "Three essays on population health and public health policy." Thesis, University of Ottawa (Canada), 2005. http://hdl.handle.net/10393/29270.
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Empowered patient or empowered physician. An analysis of the importance of the gatekeeper in the health delivery system. This paper examines the important role of the gatekeeper in the health delivery system. A simple theoretical model is developed which compares the resource allocation when physicians act as gatekeepers with the decisions taken when patients are empowered. It is shown that even when there is no asymmetry of information---and so patients and doctors are equally able to identify the appropriate therapy---that the institutional arrangement matters. Patients demand more time with physicians when they are empowered whereas physicians want to spend more time developing their expertise when they are empowered. The reaction of physicians and patients to changes in policy instruments also differs across institutional arrangements. The analysis also draws attention to the design of the compensation scheme for physicians, and investigates the benefits of using a non-linear scheme.
Wealth, health, and the pursuit of happiness. This paper provides a theoretical framework to illustrate the relationship between income, utility maximization, and healthy choices. The analysis indicates that the choices of individuals who maximize utility are not the same as those arising were the individual to maximize wellness. In fact, rational individuals will over-eat and under-exercise relative to health maximizing levels. Yet as individuals get wealthier, they have better health. The paper also compares different strategies for health promotion. Income redistribution may lead to a net increase in population health and in social welfare. By contrast, policies that specifically target lifestyle choices may succeed in persuading citizens to choose a health-maximizing lifestyle, but result in a net welfare loss to society.
An empirical investigation of household income and income polices on obesity in Canada. Using the master files of the Canadian Community Health Survey (CCHS), this paper examines the effect of income on obesity and individuals' body-mass index. An instrumental variable technique is employed to derive consistent estimates of this effect and to take account of the possible endogeneity between income and body weight. It is found that higher income will lead to lower body weight for women, while its effect on the body-weight outcome of men is unclear. This chapter uses the estimates of the relationship between income and body weight to simulate the impact of government income policies---like social assistance and child support---on obesity. It is shown that incomes policies may not only decrease income inequality but may also contribute to a lower incidence of obesity amongst the poorer population thus decreasing overall health care costs.
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Minarcine, Scott. "Health Security Intelligence : Assessing the Nascent Public Health Capability." Thesis, Monterey, California. Naval Postgraduate School, 2012. http://hdl.handle.net/10945/6836.
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Approved for public release; distribution is unlimitedThis thesis explores the current state of public healths (HS) intelligence capability across State, Local, Tribal and Territorial (SLTT) jurisdictions through qualitative analysis of current public health jurisdiction plans for the collection, analysis, product creation, dissemination and programmatic oversight related to public health inputs into the homeland security intelligence apparatus. An assessment was conducted using an online Plan Assessment Tool, or PLAT, that allowed jurisdictional public health leadership to provide de-identified responses. This assessment of 25 of the 62 federally funded SLTT public health preparedness programs indicates one impediment to the continued maturation of this new intelligence capability is the lack of codified plans. The results also suggest that while public health programs at the SLTT level do indeed have much room for improvement, there is a burgeoning intelligence capability within public health. However, to sustain and improve this emergent capability will require a national effort to create mission focus and centralized guidance.
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Boyle, Melissa Ann. "Health and utilization effects of expanding public health insurance." Thesis, Massachusetts Institute of Technology, 2005. http://hdl.handle.net/1721.1/32410.
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Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Economics, 2005.Includes bibliographical references.
This thesis exploits a major overhaul in the U.S. Department of Veterans Affairs health care system to answer various questions about publicly-provided health care. The VA restructuring involved the adoption of a capitated payment system and treatment methods based on the managed care model. This reorganization was accompanied by a major expansion in the population eligible to receive VA care. Chapter one analyzes both the efficiency of providing public health care in a managed care setting and the effectiveness of expanding coverage to healthier and wealthier populations. I estimate that between 35 and 70 percent of new take-up of VA care was the result of individuals dropping private health insurance. While utilization of services increased, estimates indicate that the policy change did not result in net health improvements. Regions providing more care to healthier, newly-eligible veterans experienced bigger reductions in hospital care and larger increases in outpatient services for previously-eligible veterans. This shift away from specialty care may help to explain the aggregate health declines. Chapter two examines the impact of the introduction of a VA-sponsored drug benefit on Medicare-eligible veterans. Results suggest that a drug benefit does not result in changes in the quantity of drugs consumed, but does lead to an increase in spending and a shift in who pays for the prescriptions. The benefit appears to have a larger effect on lower-income individuals. Results also show suggestive evidence of positive health effects as a result of the drug benefit, an outcome which could be cost-saving in the long run.
(cont.) Chapter three utilizes the change in government health care coverage for veterans to test whether employer-provided insurance leads to inefficiencies in the labor market, and the degree to which such inefficiencies might be alleviated by expanding public health insurance programs. We examine the impact of health care coverage on labor force participation and retirement by comparing veterans and non-veterans before and after the VA expansion. Results indicate that workers are significantly more likely to cease working as a result of becoming eligible for public insurance, and are also more likely to move to part-time work.
by Melissa Ann Boyle.
Ph.D.
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Annear, Peter Leslie, and mikewood@deakin edu au. "Healthy markets - Heathly people? Reforming health care in Cambodia." Deakin University. School of Health Sciences, 2001. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20050825.134836.
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Health care reform has been described as a global epidemic. This thesis deals with nature and experience of health care reform in developing countries. Increasing privatisation, economic transition, and structural adjustment have provided the context for health system changes. Different approaches to reform have been developed by international organisations such as the World Bank, WHO and UNICEF. What has driven national health care reforms? Are such policies really appropriate to developing countries? Has a consensus now emerged in relation to international health policy? Has a new health care model appeared? The study of health care reform in Cambodia is a timely opportunity to investigate the implementation of health care reform under extreme conditions. These conditions include a legacy of genocide, long-term conflict, political isolation, and economic transition. This case study uses both qualitative and quantitative methods and multiple sources of data to analyse the reform program. The study reinforces the conclusion that, under conditions of extreme poverty, market based reforms are likely to have limited positive impact. Rather, understanding the cultural conditions that determine demand, delivering health care of a satisfactory quality, providing appropriate incentives for health practitioners, and supporting services with adequate public funding are the prerequisites for improved service delivery and utilisation. Cambodia's strategy of integrated district health service development and universal population coverage may provide an instructive example of reform. Emerging policy issues identified by this case study include the fundamental role of equity in service provision, the influence of the social determinants of health and illness and interest in the appropriate use of evidence in international health policy-making.
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Aceves, Martins Magaly. "Health promotion in youth as a global public health challenge: effective strategies to encourage healthy lifestyles." Doctoral thesis, Universitat Rovira i Virgili, 2016. http://hdl.handle.net/10803/396152.
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La combinació de més d'un strategia metodològica (com el màrqueting social, la participació de la joventut, l'educació dirigida per iguals i l'ús dels mitjans de comunicació social) i strategias de cambio de antorn (intervenció basada en l'escola, basada en la intervenció restaurant, basat en la família de la intervenció) pot augmentar l'eficàcia de involucrar els joves en les intervencions de salut destinades a fomentar hàbits i estils de vida saludables. Aquesta tesi té com a objectiu comprendre els factors que intervenen en l'epidèmia de l'obesitat juvenil a tot el món i com influeixen en l'obesitat. En resposta a aquest desafiament global, aquest treball proporciona estratègies basades en proves científiques innovadores, eficaces i de qualitat per millorar els estils de vida saludables entre els joves. Aquestes estratègies podrien donar lloc a un enfocament d'investigació més fort que podrien beneficiar tant a la comunitat científica i el coneixement general de les parts interessades i els responsables polítics, fomentant així un enfocament multidisciplinari participatiu i inclusiu per obtenir resultats duradors i eficaçosLa combinación de más de una estrategía metodológica (como el marketing social, la participación de la juventud, la educación dirigida por pares y el uso de los medios de comunicación social) y/o de una estrategia de cambio de entorno (intervención basada en la escuela, basada en la intervención restaurante, basado en la familia de la intervención) puede aumentar la eficacia de involucrar a los jóvenes en las intervenciones de salud destinadas a fomentar hábitos y estilos de vida saludables. Esta tesis tiene como objetivo comprender los factores que intervienen en la epidemia de la obesidad juvenil en todo el mundo. En respuesta a este desafío global, este trabajo proporciona estrategias basadas en pruebas científicas innovadoras, eficaces y de calidad para mejorar los estilos de vida saludables entre los jóvenes. Estas estrategias podrían dar lugar a un enfoque de investigaciónque podrían beneficiar tanto a la comunidad científica y el conocimiento general de las partes interesadas en prevenir este problema así como a responsables políticos, fomentando así un enfoque multidisciplinario participativo e inclusivo para obtener resultados duraderos y eficaces.
The combination of more than one methodological (such as social marketing, youth involvement, peer-led education and social media usage) and environmental (school-based intervention, restaurant-based intervention, family-based-intervention) strategy may increase the effectiveness of engaging young people in health interventions aimed at encouraging healthy habits and lifestyles. This thesis aims to understand the factors involved in the worldwide youth obesity epidemic and how they influence obesity. In response to this global challenge, this work provides innovative, effective and quality scientific evidence-based strategies for improving healthy lifestyles among young people. These strategies could lead to a stronger research approach that could benefit both the scientific community and the general knowledge of relevant stakeholders and policy makers, thus fostering a participatory and inclusive multidisciplinary approach for long-lasting and effective results.
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Carry, Wendy M. "Public bioethics : an intermediary between public health and the media /." abstract and full text PDF (free order & download UNR users only), 2007. http://0-gateway.proquest.com.innopac.library.unr.edu/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:1448328.
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Thesis (M.P.H.)--University of Nevada, Reno, 2007."December, 2007." Includes bibliographical references (leaves 52-54). Online version available on the World Wide Web. Library also has microfilm. Ann Arbor, Mich. : ProQuest Information and Learning Company, [2007]. 1 microfilm reel ; 35 mm.
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Keenaghan, C. "Public consultation in public health policy and planning in Ireland." Thesis, Queen's University Belfast, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.432596.
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Saramunee, Kritsanee. "General public views on community pharmacy services in public health." Thesis, Liverpool John Moores University, 2013. http://researchonline.ljmu.ac.uk/6170/.
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Community pharmacists are increasingly providing public health services in response to government policies. Published literature regarding the views of the general public related to pharmacy public health services, although important in ensuring uptake of these services, was limited. This study series aim to explore the general public's perspective on how to maximise the appropriate utilisation of community pharmacy services for improving public health. A large study comprising four sequential phases was designed and conducted in Sefton borough. Initially, to gather background information, focus group discussions (FGDs) and semi-structured interviews were undertaken with the general public and key stakeholders. The second phase involved the development and testing of a questionnaire extracted from the qualitative findings and a literature review. The questionnaire focused upon seven pharmacy public health services related to cardiovascular risks as well as views on factors influencing pharmacy use and advertising/promotion techniques. Geodemographic concepts, widely recognised in public health, were also included to identify potential benefits to pharmacy practice research. Next, a large scale survey was administered among the general public using eight survey modes, to additionally evaluate the range of methods available/for gathering public views. Finally, survey findings were evaluated by representatives of survey respondents using a FGD. Results indicated that, although stakeholders considered that community pharmacy can make an extensive contribution in supporting public health, pharmacy public health services are used at a relatively low level by the general public and awareness of services is also low. Survey respondents indicated a willingness to use services in the future. Important factors influencing pharmacy use include loyalty, location and convenient accessibility. Appropriate promotional campaigns are a key facilitator to help raise the public's awareness. The findings will help the profession to increase uptake of pharmacy public health services. The variety of survey modes used proved beneficial in obtaining diverse population demographics, with street survey being the optimal technique, however, the potential for social desirability bias must be considered with this and other interviewer-assisted approaches. MOSAIC™ as a geodemographic tool is potentially useful in helping to target services for specific groups and is recommended for use in further research.
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Ardalan, Christine. "Forging Professional Public Health Nursing in a Southern State: Florida's Public Health Nurses, 1889 to 1934." FIU Digital Commons, 2012. http://digitalcommons.fiu.edu/etd/663.
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From 1889 to 1934, Florida’s nurses belonging to a new group of professional women ushered in a pioneering phase of public health nursing in Florida. During this era, the nurses’ ability to confront health and professional issues varied a great deal but in quiet and forceful ways they tackled cultural and environmental problems to assist people who were ill or help prevent people from becoming ill. This dissertation places the development of professional public health nursing in its social context by uncovering the relationships public health nurses formed with clubwomen, the medical profession, city leaders, midwives, and others.
In 1888, there were few graduate nurses in the state, no state board of health and no organized nursing service to respond to Jacksonville’s great yellow fever epidemic. By 1934, national and state leaders of public health nursing had built up the profession to become an essential part of the State Board of Health’s service to the community. Between these milestones, in the era of white supremacy and Jim Crow, public health nurses combined their professional training with a pioneer spirit of innovation and risk-taking. In the predominately rural state, the public health nurses’ resolve to overcome environmental hazards and cultural obstacles stands out as they attempted to reach those who were unserved or underserved by modern medicine.
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Carter, Nakia, and Rick Wallace. "Collaborating with Public Libraries, Public Health Departments, and Rural Hospitals to Provide Consumer Health Information Services." Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/8682.
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East Tennessee State University Quillen College of Medicine Library (ETSUQCOML) developed a training program to enable public libraries, public health workers, and rural hospital staff to be consumer health information providers. Four NN/LM-developed classes were taught to public libraries. Regional public library directors were invaluable in obtaining the concurrence of their boards for release time for class attendance. Classes were also developed for the public health workforce and rural hospital staff. Five-hundred thirty-three students attended the classes. Fifty-two public library workers will receive the MLA's Consumer Health Information Specialist certification. Thirty-one public libraries have joined NN/LM. All ordered MedlinePlus marketing materials for their libraries from InformationRx.org.
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Yrjälä, Ann. "Public health and Rockefeller wealth : alliances strategies in the early formation of Finnish public health nursing /." Åbo : Åbo Akademi University Press, 2005. http://catalogue.bnf.fr/ark:/12148/cb40236478x.
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Peeso, Jennifer. "The Effects of Personal Health Assessments on Health Knowledge and Health Behavior Among Students Enrolled in an Undergraduate Personal Health Course." TopSCHOLAR®, 1996. http://digitalcommons.wku.edu/theses/796.
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The purpose of this research was to determine whether personal health assessments would increase Personal Health 100 students' health knowledge and healthy behaviors. This research is important because of the objectives set by Healthy People 2000 to promote health and because of the need for comprehensive school health education programs. By focusing on health promotion in the school setting, more effective preventive programs can be devised. The factors investigated included health knowledge and the following health behaviors: exercise, alcohol consumption, use of tobacco, sleep, breakfast, sexual activity, and seatbelt use. These factors were chosen based on a longevity theory. Data were collected for this study in the spring semester 1996 at Western Kentucky University. The responses from 244 undergraduate students were collected using the HKI (Health Knowledge Inventory) and a behavioral assessment. The data were analyzed using an analysis of covariance and a chi- square analysis. None of the factors^ were found to be significantly affected by the personal health assessments. The results revealed that the methods to increase health knowledge and healthy behaviors had no short-term effects on the undergraduate students.
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Wagner, Steven M. "Public Sponsored Health Insurance to Improve Health Outcomes with Implications for Government Health Policy, Design, and Decision Making." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/1002.
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This research sought to ascertain the extent to which providing public sponsored health insurance (PSHI) to previously uninsured Mexican-American Hispanics improves health outcomes among those requiring ongoing treatment to control diabetes. Prior research utilizing insurance access theory; access, equity, and health outcome interrelationship theory; health affordability theory; and financial and resource burden theory suggests the uninsured receive less care than the insured, with delayed treatment, leading to chronic conditions. This research tested each of those major theoretical constructs into a blended conceptual framework based on the notion that providing health insurance helps alleviate the disabling effects of diabetes among this population. This study used an unobtrusive, longitudinal, one group pretest-posttest design. Research questions were designed to measure the strength of the relationship between PSHI and patient health outcomes using physical examination data, laboratory results, and diagnosis of 712 diabetic patients with 5,300 medical visits over 3 years before and after enrolling for PSHI. Logistic regression was used to analyze data related to age, gender, time enrolled in PSHI, and service location relative to health outcomes. Findings support the theories that accessibility increases with the provision of health insurance but also show that health outcomes do not improve after enrollment in a PSHI. This study contributes to the body of knowledge in public health policy and administration by quantifying the strength and significance of the relationship between health insurance and health outcomes and effects positive social change by measuring the effectiveness of legislation providing the uninsured with health insurance in order to improve health outcomes.
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Sofia, Gustina, and n/a. "Information needs of health researchers at the National Institute of Health Research and Development, Ministry of Health, Indonesia." University of Canberra. Information, Language & Culture, 1992. http://erl.canberra.edu.au./public/adt-AUC20061109.083237.
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The present study attempted to investigate the information needs/information seeking
behaviour of health researchers at the National Institute of Health Research and
Development, Ministry of Health, Indonesia. Its objective was to identify the
relationship between information needs/information seeking behaviour and the
characteristics of those health professionals. Those characteristics include institution
to which health professionals belonged, institution geographic location, level of
appointment, level of education, and work experience.
Research was carried out through survey by using a questionnaire. This survey
obtained a response rate of 92 percent from a sample of 131 health professionals.
Their information needs/information seeking behaviour were correlated with their
characteristics to determine relationships, and the Statistical Package for the Social
Sciences (SPSS) was used to analyse the data. Frequency distribution, chi-square
analysis, and descriptive analysis were used to obtain the results.
The study found that the health information available did not match the health
professionals' needs and that there was strong demand by these personnel for automated
information services. It also found that total hours reading per week was significantly
related to level of appointment, level of education, and work experience at other
institutions. The perceived usefulness of journals as information sources was
significantly related to institution, geographic location, level of appointment, level of
education and work experience at other institutions. Government publications and
statistical data as a source of information were found to be related significantly to
institution and geographic location. There was also a relationship between the
perceived value of reference books and work experience at the current institution. The
usefulness of library catalogues as a guide to information was found to be related
significantly to institution and geographic location, as was the usefulness of abstracting
and indexing services to level of education. Frequency of visiting libraries was
significantly related to institution, geographic location and level of appointment. The
membership of professional organizations and obtaining useful information from
friends, colleagues or personal contact were found to be significantly related to level of
education.
The study concludes with recommendations and suggestions for further research.
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Grill, Kalle. "Anti-paternalism and Public Health Policy." Doctoral thesis, KTH, Filosofi och teknikhistoria, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-10947.
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This thesis is an attempt to constructively interpret and critically evaluate the liberal doctrine that we may not limit a person’s liberty for her own good, and to discuss its implications and alternatives in some concrete areas of public health policy. The thesis starts theoretical and goes ever more practical. The first paper is devoted to positive interpretation of anti-paternalism with special focus on the reason component – personal good. A novel generic definition of paternalism is proposed, intended to capture, in a generous fashion, the object of traditional liberal resistance to paternalism – the invocation of personal good reasons for limiting of or interfering with a person’s liberty. In the second paper, the normative aspect of this resistance is given a somewhat technical interpretation in terms of invalidation of reasons – the blocking of reasons from influencing the moral status of actions according to their strength. It is then argued that normative anti-paternalism so understood is unreasonable, on three grounds: 1) Since the doctrine only applies to sufficiently voluntary action, voluntariness determines validity of reasons, which is unwarranted and leads to wrong answers to moral questions. 2) Since voluntariness comes in degrees, a threshold must be set where personal good reasons are invalidated, leading to peculiar jumps in the justifiability of actions. 3) Anti-paternalism imposes an untenable and unhelpful distinction between the value of respecting choices that are sufficiently voluntary and choices that are not. The third paper adds to this critique the fourth argument that none of the action types typically proposed to specify the action component of paternalism is such that performing an action of that type out of benevolence is essentially morally problematic. The fourth paper ignores the critique in the second and third papers and proposes, in an anti-paternalistic spirit, a series of rules for the justification of option-restricting policies aimed at groups where some members consent to the policy and some do not. Such policies present the liberal with a dilemma where the value of not restricting people’s options without their consent conflicts with the value of allowing people to shape their lives according to their own wishes. The fifth paper applies the understanding of anti-paternalism developed in the earlier papers to product safety regulation, as an example of a public health policy area. The sixth paper explores in more detail a specific public health policy, namely that of mandatory alcohol interlocks in all cars, proposed by the former Swedish government and supported by the Swedish National Road Administration. The policy is evaluated for cost-effectiveness, for possible diffusion of individual responsibility, and for paternalistic treatment of drivers. The seventh paper argues for a liberal policy in the area of dissemination of information about uncertain threats to public health. The argument against paternalism is based on common sense consequentialist considerations, avoiding any appeal to the normative anti-paternalism rejected earlier in the thesis.QC 20100714
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Polk, Pamela. "Intercultural competence for public health nurses." Scholarly Commons, 2005. https://scholarlycommons.pacific.edu/uop_etds/625.
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Public health nurses are required to communicate important communicable disease and preventative health information to an increasing number of immigrants and refugees accessing the American public health system. They must also obtain information on a broad scope of topics about clients and/or their children. Little attention has been paid to the study of intercultural communication between public health nurses and their diverse clientele. The purpose of this study was to identify barriers affecting communication between public health nurses and their immigrant and refugee clients. The Developmental Model of Intercultural Sensitivity developed by Milton Bennett provided a conceptual framework for review and analysis of study results. Data were collected using semi-structured formal interviews with a network sample of 17 nurses. Analysis of the data indicated four major themes: (1) common use of a Western- European, ethnocentric communication style; (2) insufficient recognition of how the dominant culture's values, beliefs, and behaviors affect those from non-dominant cultures; (3) inadequate or irrelevant prior diversity training; and ( 4) lack of available and competent interpreters necessary for translation of information during interviews. These categories capture the essential barriers preventing effective communication with culturally diverse clients.
From the perspective of the nurses, communication barriers due to cultural or language differences result in difficulty obtaining compliance with public health mandates such as childhood immunization and medication regimens, and limit understanding of preventative healthcare practices. The results of this study provide information and insight for the development of intercultural sensitivity training for public health nurses. A training program that demonstrates cultural training theory, methods, and suggested sequencing is included. An additional sample training outline follows that offers public health nurses culture specific information regarding Hmong refugees.
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Sedig, Sheila Marie Dolan. "Public Health Perspectives of Cultural Competence." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/594537.
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Racial health disparities and social injustices in health care continue in the United States (US) despite decades of research, policies, and programs dedicated to their elimination (Feagin & Bennefield, 2014). Cultural competency education of health care providers has been one way purported to help sensitize professionals to these inequities, thus seeking to address racial bias, unequal treatment, and misunderstandings of minority populations (Office of Minority Health, 2001). Such education can begin when students enter academia to commence their health care education, and certainly occurs as a student moves on through their academic career, particularly as they enter their post-graduate level studies. Investigating the required cultural competency course of a Master of Public Health (MPH) program through the perspectives of faculty, current students, and alumni for its ability to develop culturally sensitive health care practitioners was the aim of this case study. Document analysis and direct observation of the one cultural competency course required for all concentrations in one MPH program was undertaken. This was a semester-long course and was offered face-to-face and online; both were observed. In-depth interviews of faculty, current students, and alumni of the same program were also conducted. Using the public health critical race (PHCR) praxis theoretical framework (Ford & Airhihenbuwa, 2010b), data was analyzed to determine how, and to what extent, faculty teach cultural competency, students internalize this instruction, and alumni put this education into practice. By using a critical theoretical framework designed for public health program development, this study found that such a framework has effective utility as a curriculum – this framework could be used to increase students understanding of racial issues that impact health and health care. Data also revealed a schematic believed, by faculty, students, and alumni, to be important for the development of cultural competence. The findings also point to the importance of creating space in the classroom for both minority and majority voices to feel free to express difficult issues without repercussions of stereo-typing and name-calling; and for faculty to be able to effectively deal with such discourse. Curriculum that addresses issues of health disparities and social justice, classroom praxis, and faculty role-modeling can be combined to create the institutional environment where culturally sensitive and socially just health care practitioners may emerge.
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Heath, Paul J. "Social philosophy and modern public health." Thesis, Keele University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.392306.
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Holmes, M. V. "Public health applications of cardiovascular genomics." Thesis, University College London (University of London), 2014. http://discovery.ucl.ac.uk/1417112/.
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Background Genetic epidemiology is at the interface of translational and basic research and the pace of progress has been unprecedented, with findings representing some of the most robust available in the Scientific literature. However, how we can translate this high- fidelity genomic information into improvements in health of the population? Two dis¬tinct translational opportunities include personalized medicine (pharmacogenetics) and using Mendelian randomization to investigate disease aetiology to inform public health policy and develop new therapies. Objectives In this PhD thesis, I investigated the evidence base underlying the well-publicized use of the pharmacogenetic biomarker CYP2C19 genotype to predict the response to clopi¬dogrel, a widely prescribed antiplatelet drug. Second, I used Mendelian randomization to investigate the role of an endogenous biomarker, secretory phospholipase A2-IIA (sPLA2-IIA), thought to be a pro-atherogenic enzyme and a potential drug target for the prevention of cardiovascular disease (CVD). Third, I used Mendelian randomization to investigate the relationship between alcohol, an exogenous exposure, and cardiovas¬cular traits and disease events. Results CYP2C19 and cardiovascular disease I identified 32 studies of 42,016 patients reporting 3545 CVD events. Only 6 studies were set within randomized trials (“effect-modification” design) and the remaining 26 reported individuals exposed to clopidogrel (“treatment-only” design). In treatment- only studies, possession of one or more *2-*8 CYP2C19 alleles was associated with lower cytochrome P450 C19 (CYP2C19) enzyme activity and a higher risk of CVD events (RR 1.18; 95%CI:1.09, 1.28), however, there was strong evidence of small-study bias (Harbord test P=0.001) and, when restricted to large studies (≥200 events), the association of CYP2C19 *2-*8 carrier status with CVD was null (RR 0.97; 95%CI: 0.86, 1.09). In the effect-modification studies, CYP2C19 genotype did not modify the effect of clopidogrel on CVD end-points. These findings cast doubt on whether information on CYP2C19 genotype would be helpful to guide selection of the dose of clopidogrel or use of an alternative antiplatelet agent. The role of secretory phospholipase A2-IIA (sPLA2-IIA) in CVD I used Mendelian randomization to make causal inference on the role of sPLA2-IIA in CVD. I identified a single nucleotide polymorphism (SNP) in PLA2G2A (rs11573 156) that was specific for and had a very strong impact on circulating levels of the sPLA2-IIA isoform. Using data from 36 studies and over 100,000 participants, instrumental variable analysis found no association between sPLA2-IIA with incident, prevalent or recurrent CVD events. These findings suggest sPLA2-IIA is not a valid therapeutic target for CVD prevention, which was in keeping with a phase III randomized clinical trial that was halted for futility in 2012 (during this thesis). Alcohol and CVD I used a SNP in ADH1B to investigate the relationship between alcohol and coronary heart disease (CHD) in >260,000 participants. The genetic variant (ADH1B rs1229984 A-allele) showed very strong association with reduced alcohol consumption when evalu¬ated as volume of alcohol consumed, binge drinking and abstaining from alcohol. The A-allele of rs1229984 showed associations with SBP, CRP, IL-6, BMI and waist circum¬ference that were all directionally concordant with a reduced risk of CHD. Indeed, when the clinical outcome CHD was investigated, individuals carrying the A-allele (who con¬sumed less alcohol than non-carriers) had a reduced risk of CHD at all levels of alcohol consumption. No evidence of a cardioprotective association of alcohol with CHD was identified. Conclusions My investigation into use of CYP2C19 genotype as a pharmacogenetic biomarker for clopidogrel response did not identify evidence to support its clinical use and limitations were identified that could apply to other pharmacogenetic tests. Use of Mendelian randomization revealed no evidence to support a causal role of sPLA2- IIA in CVD, which paralleled findings from a phase III randomized clinical trial, and provides support for the use of Mendelian randomization studies more widely to in¬form drug development. Finally, using the ADH1B gene to interrogate the relationship of alcohol yielded findings that argue against a cardioprotective effect of alcohol con¬sumption. These findings should encourage rethinking of public health advice about the cardiovascular benefits of moderate levels of alcohol consumption.
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Quinn, Megan, and M. Baker. "Public Health Opportunities in Northeast Tennessee." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/6793.
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Chartres, Nicholas. "Reducing Bias in Public Health Guidelines." Thesis, The University of Sydney, 2019. https://hdl.handle.net/2123/21776.
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Background and Objectives Bias in research and the methods used for developing public health guidelines may put the public’s health at risk. This dissertation explores three possible sources of influence on the recommendations made in public health guidelines: • Commercial Influences on Nutrition Research: Primary research studies and systematic reviews form the evidence base for dietary guidelines. The association between funding sources and the outcomes of nutrition studies was therefore explored; • Methods Used for Public Health Guideline Development: Heterogenous methodologies used in the development of public health guidelines may lead to conflicting recommendations. I conducted a systematic analysis of the methods used in their development; • Social Influences on Public Health Guideline Development: The interactions within guideline groups may be a significant influence on the final recommendations made. I aimed to understand the experiences of the participants involved in developing public health guidelines. Methods My methods included: 1) Meta-analysis and systematic review to measure bias in primary nutrition research; 2) Content analysis to understand the methods used in synthesising evidence for public health guidance development; and 3) Qualitative analysis of interviews to understand social influences on guideline development. Results My major findings were: I found an association with industry sponsorship with the outcomes of studies, even when controlling for the internal validity between the studies; I established heterogenous methodologies are being used by organisations that conduct hazard identification and risk assessment; and I identified that the public health guideline process in Australia is a divided one. Conclusions Through greater transparency of funding practices, the development of nutrition study registries and improvements in risk of bias tools used to evaluate the evidence, industry influence on the outcomes of nutrition studies relevant to dietary guidelines can be accounted for. Further, the use of standardised, transparent methodological processes and collaboration between systematic review teams and guideline groups will lead to increased comparability and validity of guidelines and ensure that the recommendations made from them will protect the public’s health.
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Mabhala, Mzwandile A. "Embodying knowledge of teaching public health." Thesis, University of Brighton, 2012. https://research.brighton.ac.uk/en/studentTheses/5113a6b4-3b6a-4230-bff9-56516d7e0885.
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Recent UK health policies have identified nurses as key contributors to public health strategies to reduce health inequalities, on the assumption that all nurses understand and wish to contribute to the public health agenda. Following the policy shift, public health content within pre-registration nursing curricula increased. Public health nurse educators come from varying backgrounds, and some had limited formal public health training or involvement in or understanding of policy required to contribute effectively to it. However, their knowledge of this subject, their understanding and interpretation of how it could be taught, was not fully understood. This research aimed to understand how public health nurse educators' (PHNEs) professional knowledge could be conceptualised and to develop a substantive theory of their knowledge of teaching public health, using a qualitative data analysis approach. Semi-structured interviews (n=26) were conducted with higher education institution-based PHNEs. The research concluded that PHNEs are embodying knowledge in teaching through critical pedagogy, which involves them engaging in transformative, interpretive and integrative processes to refashion public health concepts; this requires PHNEs who possess a vision of what to teach, know how to teach, and are able to learn from experience. Their vision of public health is influenced by social justice principles in that health inequalities, socioeconomic determinants of health, epidemiology, and policy and politics are seen as essential areas of the public health curriculum. They have developed appropriate critical pedagogical practices to make these concepts intelligible to students, and teaching strategies which put greater emphasis on students' engagement with them, allowing students to recognise the connectedness of public health with their lives. They believe in forms of teaching that achieve social transformation at individual, behavioural and societal levels, while also enabling learners to recognise their capacity to effect change and to reflect upon their own and others' experiences in their teaching practice.
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Burton, Scott H. "Computational Techniques for Public Health Surveillance." BYU ScholarsArchive, 2013. https://scholarsarchive.byu.edu/etd/3637.
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Public health surveillance is a critical part of understanding, and ultimately influencing, health behaviors. Traditional methods, such as questionnaires and focus groups have significant limitations including cost, delay, and size. Online social media data has the potential to overcome many of the challenges of traditional methods, but its exploitation is not trivial. We develop and apply computational techniques to enable public health surveillance in novel ways and on a larger scale than currently performed.In this regard, we present techniques for mining the who, what, and where of public health surveillance in social media. We show how computational methods can identify health content and conversations in social media, and that people do in fact speak openly about health topics, including those that might be considered private. In addition, we demonstrate how location information can be mined and used to study distributions of various conditions. Finally, and perhaps most importantly, we develop techniques to identify and leverage pertinent social network relationships in public health surveillance. We demonstrate each of these approaches in large data sets of actual social networks spanning blogs, micro-blogs, and video-sharing sites.
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Barclay, Lee. "Public health law in Timor-Leste." Thesis, Curtin University, 2011. http://hdl.handle.net/20.500.11937/875.
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Post-conflict, ‘fragile’ nations face significant health, social, economic and political challenges. The international community is, on the whole, organised and effective in assisting these nations to address urgent priorities. Often, however, prioritisation of immediate concerns has resulted in less focus being given to capacity building, including the fostering of lasting, effective and autonomous systems within these nations.This study examined the post-conflict, transitional nation of Timor-Leste. In particular, it focused on the potential for a health systems-strengthening approach, public health law, to improve the exceptionally poor level of population health found in Timor-Leste. Public health law has a long history within the developed world of success in facilitating the prevention and control of disease. The extent to which law can assist in addressing key health concerns within the developing world has, however, attracted little attention to date.This thesis documents a social and political history of Timor-Leste and provides a review of selected population health indicators. An overview of the Timorese health and legal systems is provided with a focus on system capacity, existing public health law and reported strategic directions. The review is complemented by a survey of 245 residents of Dili, the capital of Timor-Leste, in order to ascertain levels of community awareness of, and support for, selected existing public health laws. Further context was provided through in-depth interviews with 19 health and legal professionals living and working in Timor-Leste. Importantly the study was designed and conducted according to guidance provided by four Timorese cultural advisors.Awareness of law is clearly essential if it is to be effective as a preventive intervention. Community support for law is arguably also fundamental if there is to be widespread adherence to law and political willingness to pursue law reform. Key dependent variables within the community survey and interviews with professionals included awareness of, and support for, public health law amongst a suite of specific regulatory areas including road safety, the sale of alcohol and tobacco to children, food safety and water safety. These areas were selected due to their existing or steadily increasing importance in the developing world. Quantitative analytical methods included Chi-square for examining differences between survey sub-groups, and Kendall’s tau-b for examining correlations between ordinal variables. Qualitative data from interviews was subject to thematic analysis.Analysis of survey and interview data highlighted a poor level of awareness of selected existing public health laws in Timor-Leste amongst participating community members and health and legal professionals. A number of demographic factors were identified as being statistically associated with levels of awareness within the community and these provide direction for future educative efforts. Encouragingly, this study has also identified a strong level of support for public health law amongst both community and professional groups. Support was high for the legal approach to health law overall and for each of the regulatory areas examined. Attitudinal factors associated with community support were identified and these provide guidance for future efforts to raise understanding and acceptance of public health law in Timor- Leste.The review of the health and legal systems, however, highlights that there currently exists an incomplete set of laws that lacks cohesion and accessibility in Timor-Leste: an analysis of applicable law requires a detailed investigation of Timorese and Indonesian law, and United Nations regulations. There appears also to be little systemic capacity to enforce existing, or develop additional, law and regulation. Public health law reform, furthermore, does not appear to be among the Timor-Leste government’s strategic directions.This study is one of few undertaken globally on public health law in a developing, post-conflict transitional society. The observation of widespread support for the legal approach to health provides impetus and direction to the proposition of a coordinated and resourced public health law strategy in Timor-Leste. Recommendations have been provided to address some of the current barriers to such a strategy, including capacity constraints, low awareness and low political and public service profile. Finally a theoretical framework is provided to specifically guide further research and implementation of public health law in Timor-Leste and similar settings.
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Kato, Ryuta. "Three essays in health economics : uncertainty and public health policy." Thesis, University of Essex, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310085.
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Johnson, S., M. Belcher, M. Moody, and Megan Quinn. "Collaboration Between Local Health Department and College of Public Health." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6794.
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Gleeson, J. A. "Using policy analysis to explore the reciprocal impact of health policy on public health nursing and public health nursing on policy." Thesis, Bournemouth University, 2013. http://eprints.bournemouth.ac.uk/21387/.
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The overall aim of this study was to explore the reciprocal impact of health policy on public health nursing and public health nursing on policy. This study uses a new approach to considering public health nurses’ engagement in policy: one which puts public health nurses, as actors in the policy process, at the centre of the investigation. The overall philosophical lens through which the research was conducted was critical social theory and the methodology was a grounded theory influenced research design. The study adopted a three stage data collection and analysis process: primary data (questionnaires and interviews), detailed policy analyses of two specific White Papers and secondary data (extant documents). The data were collected and analysed through a grounded theory approach in order to answer four research questions: 1. What do public health nurses know about policy, specifically in relation to two English Department of Health White Papers: Creating A Patient-Led NHS (DOH 2005) and Our Health, Our Care, Our Say (DOH 2006)? 2. How do they engage in the policy process? 3. What affects their implementation of policy? 4. Is there a policy-practice gap? A triangulated approach to data collection and analysis was used. Primary data were collected through questionnaires and follow up telephone interviews with public health nurses (health visitors and school nurses) in four PCTs and one social enterprise in five different geographical areas of England. Further data from detailed policy analyses using frameworks by Popple and Leighninger (2008) and Walt and Gilson (1994) were also considered. Finally, secondary data from extant documents including newspapers, websites and organisational documents were reviewed. At the end of the research process, it was possible to answer the four research questions. In addition to this, new knowledge and theory emerged around three main themes: i) A proposal for a new combined framework for policy analysis which leads to a comprehensive and analytical account of policy content and context combined with a detailed consideration of the role of public health nurses as actors in the policy process. ii) Theories as to why and how public health nurses lack influence in the policy process. iii) Analysis of the effect of lack of resources on inhibiting practice innovation in response to policy agendas. Consideration of these theories led to several recommendations for practice. Throughout the research process, there was continued interaction between the three phases of data collection, analysis and theory development.
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Lynch, U. B. "Public health: why are the Cubans so successful: a case study of public health governance in Cuba." Thesis, Queen's University Belfast, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.484977.
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Key words: public health, equity, integration, citizenship Health outcomes: infant mortality and life expectancy are closely correlated with GOP. Countries with higher GOP generally have better health outcomes. Cuba is, the classic outlier in this regard. Economically a third world country, life expectancy in Cuba is equivalent to the Republic of Ireland, and infant mortality rates are comparable with all of the high income countries. A case study research design is used to examine pUblic health in Cuba, in order to identify the reasons behind the conspicuously good health outcomes. Twenty weeks of fieldwork, divided into two phases, was carried out in Cuba. The literature review sets the context and rationale for the study. It highlights critical junctures in modern Cuban history and analyses public health in Cuba. The case study design employed a variety of methods: participant and non-participant observation, reflective diary, focus group interviews and semi structured interviews. The factors in the study which facilitated access to the 'elites' in Cuban public health are identified. Triangulation and analysis of data is described. Ten themes emerged form the findings: Ministry of Public Health; focus on prevention and health promotion; education; integration; primary care; citizenship; equity; public system; socialism and political will. The metaphor of a repaired umbrella is used as the basis for a theoretical model to explain Cuba's success. The key to success is identified as being the strong political commitment to public health in Cuba and the pre-eminence of the Ministry of Public Health vis avis other ministries. The study concludes that Cuba is successful in public health because health has become emblematic of the revolution and that political will is central to this achievement. Recommendations distilled from the study include: development of health policy based on systematic needs assessment; that the UK learns from Cuba's experience in preparing large numbers of high quality professional and further research using the Cuban model of Public Health as a tool for a comparative study of public health governance in the UK.
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Davidson, Nicholas E. "Defining the role of Public Health in Disaster Recovery: An Evaluation of State Public Health Planning Efforts." Monterey California. Naval Postgraduate School, 2013. http://hdl.handle.net/10945/32809.
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CHDS State/LocalThere is very little to direct public health planning for long-term disaster recovery. This research surveyed plans from nine hurricane-prone states to determine the extent to which those plans comply with recently published standards from the Centers for Disease Control (CDC) in 2011. An abstraction form was devised to score each plan and to document novel or innovative components within each plan. Results indicate poor compliance with the CDC standards; 79 percent of the assessments of individual preparedness components resulted in a score of zero (on a scale of zero to four). Particularly notable was a lack of planning for continuity of operations and the insufficient plans for advising residents and partner agencies as to the plans and locations for providing services after a disaster. A complicating factor was the general lack of acceptance, by public health, of the fact that public health recovery should be focused on restoring community services instead of simply restoring operations of public health agencies. This research identifies smart practices that can be adopted by public health agencies in an attempt to ensure a robust level of recovery preparedness.
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Wirrmann, Erica. "Talking about 'public health' : an exploration of the public health roles of primary care practitioners in England." Thesis, Oxford Brookes University, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.424590.
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The British Government, since 1997, have placed a strong emphasis on public health and the reduction of health inequalities. Alongside this, they have progressed a major reform of the NHS which aims to 'shift the balance of power' to the frontline. Primary care is an increasingly important aspect of the Government's new agenda, which aims to improve health for everyone, and for the worst off in particular. This thesis identifies general practice, and the core practitioners that work within it, as key potential contributors to a public health agenda. But 'public health' is a conceptually contested terrain, and as a concept, can be understood and interpreted in a myriad of ways. The impact of this lack of shared understanding is explored both for policy making and implementation, and for the development of public health practice in primary care. This research brings together public health and primary care literatures in order to illuminate the historical and organisational contexts within which current developments are taking place. It critically analyses the public health discourse of New Labour policy documents in order to explore the ways in which 'public health' is understood and talked about within recent government policy, and the government's expectations of primary care practitioners, in terms of their public health roles. Finally, the research draws on case study material from one (pre-2002) health authority area in England to examine practitioners' understandings of public health, and their perceptions of their public health roles. Using Wenger's (1998a) social theory of learning as a framework, it looks at the organisational and wider contexts in which practitioners work, and explores how varied and unclear understandings of public health, both in policy and practice, might be affecting practitioners' engagement with public health. The study highlights the dangers of vagueness surrounding the term public health, and finds a tendency both in policy and practice to regard it as a set of activities, rather than as an approach to work. Its malleability means that it can be interpreted both in a politically acceptable way, and in a way that fits within existing practice. Thus, as a concept, it loses its radical edge and is no longer something that challenges or guides policy and practice. The research finds that the ways in which practitioners interpret public health can contribute to their non-engagement in the public health agenda. This is not helped by conflicts within policy which threaten the development of stronger public health roles within general practices. The thesis concludes by recommending the development of shared understandings of public health, particularly as a valuedriven approach to work, rather than as a set of activities.
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Garske, Gary L. "Continuity planning for local public health agencies in northern Wisconsin : providing essential public health services after displacement /." Connect to online version, 2009. http://digital.library.wisc.edu/1793/37472.
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