The article presents a reflection on conception of poverty as a condition or circumstance that restricts personal autonomy and increases vulnerability. Focusing on bioethical arguments, the authors discuss two perspectives: (i) economic, that relates poverty to incapacity to work and (ii) ethical-philosophical, which relates poverty to inequality and injustice. The first perspective corresponds to the World Bank's view according to its recommendations to the political and economic adjustment in Latin America. The second one is based on concepts of fairness and equality as components of social justice. The subjects' autonomy and vulnerability have been under question in an international movement that requests revision of ethical guidelines for the biomedical research. The bioethical arguments presented in this article enhance a discussion on unfair treatment to subjects enlisted in protocols sponsored by rich countries and hosted by poor nations. (+info)
Consistency between education reported in health survey and recorded in death certificate.
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BACKGROUND: Education level is one indicator of socioeconomic position which, in several countries including South Korea, is provided though death certificate data. Its validity determines the usefulness of death certificate data for exploring the association between socioeconomic position and mortality. This study was to compare education recorded on the death certificate with that reported before death in a nationally representative cohort of participants in the National Health and Nutrition Examination Survey (NHANES). METHODS: The 1998/2001 NHANES data contained unique 13-digit personal identification numbers that were individually linked to death certificate data from the Korean National Statistical Office. Duration of mortality follow-up was 7.1 years. The data from 513 deaths were used to determine sensitivity and specificity of education in death certificate and estimate agreement rates of education level between NHANES data and death certificate data. Odds ratios for agreement in education were also estimated. Covariates considered in the analyses were gender, age, duration between NHANES and death, and cause of death. RESULTS: The proportion of deaths without recorded education in death certificate was very low (0.2%). A total of 29.4% discordant pairs were found. Sensitivity and specificity for college or higher education were 0.84 (95% confidence interval 0.71-0.97) and 0.99 (0.98-1.00). However, sensitivity was poor for middle school education. The overall agreement rate was 70.7% (66.8%-74.6%) when education was categorized into five groups and increased up to 88.9% (86.2%-91.6%) when three education categories were used. The magnitude of validity and reliability for education did not generally vary with age, duration between health survey and death, and cause of death. However, a significantly smaller likelihood of agreement was found for middle and elementary school education after adjusting for covariates. CONCLUSION: Low percentage of missing information on education in South Korean death certificate data could provide a great potential to monitor mortality inequalities. A more collapsed categorization in education would be recommended when a more definitive conclusion on educational mortality inequality is required. (+info)
Global health, equity, and primary care.
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Global health provides a special challenge for primary care and general practice, which will become increasingly important in the future as the prevalence of multimorbidity increases with increasing likelihood of survival from acute manifestations of illness, as populations age, and as costs of care increase with increasing availability of technologic interventions. World organizations of primary care physicians need to take up the challenge before it becomes a crisis. (+info)
To achieve "health for all" we must shift the world's paradigm to "primary care access for all".
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Since the early 1950s, the World Health Organization has proposed programs to promote primary health care around the world. From the 1978 Alma-Ata Declaration to the current promulgation of the Millennium Development Goals, the World Health Organization has tried to improve health in developing countries through a focus on disease-oriented (vertical) programs. The World Health Organization and other organizations have not focused on the horizontal role of primary care. The expectations created by these programs have not been met. Evidence demonstrates that the advent of health care through a base of primary care improves health better than through the traditional vertical disease-oriented health programs used around the globe. The global "family" of family medicine must advocate for a shift from the current solutions to one in which the family doctor is part of a well-trained health care team that can function in networks that incorporate the vertical programs into a broad horizontal approach for better access to primary care. Perhaps in this way "health for all" can be achieved. (+info)
Global health and primary care research.
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A strong primary health care system is essential to provide effective and efficient health care in both resource-rich and resource-poor countries. Although a direct link has not been proven, we can reasonably expect better economic status when the health of the population is improved. Research in primary care is essential to inform practice and to develop better health systems and health policies. Among the challenges for primary care, especially in countries with limited resources, is the need to enhance the research capacity and to engage primary care clinicians in the research enterprise. These caregivers need to be an integral part of the research enterprise so the right questions will be asked, the results from research will be used in practice, and a scholarly and evidence-based approach to primary care will become the norm. The challenge of developing research in primary care can be met only by creating a strong infrastructure. This will include strengthening academic departments, enhancing links to researchers in other fields, improving training programs for future primary care researchers, developing more practice-based primary care research networks, and increasing funding for research in primary care. A greatly increased commitment on the part of international organizations both within and outside of primary care is needed, in particular those organizations involved with funding research. We provide suggestions to improve the global primary care research enterprise for the benefit of the world's population. (+info)
Reaching out to those in need: the case for community health science.
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The present health care delivery model in the United States does not work; it perpetuates unequal access to care, favors treatment over prevention, and contributes to persistent health disparities and lack of insurance. The vast majority of those who suffer from preventable diseases and health disparities, and who are at greatest risk of not having insurance, are minorities (Native Americans, Hispanics, and African Americans) and those of lower socioeconomic status. Because the nation's poor are most affected by built-in inequities in the health care system and because they have little political power, policy makers have been able to ignore their responsibility to this group. Family medicine leaders have an opportunity to integrate community health science into their academic departments and throughout the specialty in a way that might improve health care for the underserved. The specialty could adapt existing structures to better educate and involve students, residents, and faculty in community health. Family medicine can also involve community practices and respond to community needs through practice based research networks and community based participatory research models. It may also be possible to coordinate the community activities of family medicine organizations to be more responsive to the health crisis of those in need. More emphasis on community health science is consistent with family medicine's roots in social reform, and its historical and philosophical commitment to the principle of uninhibited access to medical care for the underserved. (+info)
The role of poverty in antimicrobial resistance.
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Antimicrobial resistance is a worldwide problem that has deleterious long-term effects as the development of drug resistance outpaces the development of new drugs. Poverty has been cited by the World Health Organization as a major force driving the development of antimicrobial resistance. In developing countries, factors such as inadequate access to effective drugs, unregulated dispensing and manufacture of antimicrobials, and truncated antimicrobial therapy because of cost are contributing to the development of multidrug-resistant organisms. Within the United States, poverty-driven practices such as medication-sharing, use of "leftover" antibiotics, and the purchase and use of foreign-made drugs of questionable quality are likely contributing to antimicrobial resistance. However, there is currently a dearth of studies in the United States analyzing the socioeconomic and behavioral factors behind antimicrobial resistance in United States communities. Further studies of these factors, with an emphasis on poverty-driven practices, need to be undertaken in order to fully understand the problem of antimicrobial resistance in the United States and to develop effective intervention to combat this problem. (+info)
The health status of patients of a student-run free medical clinic in inner-city Buffalo, NY.
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BACKGROUND: This study explores the health status and the social and economic correlates of adults 20 years of age and older who presented at an urban free medical clinic in Buffalo, NY, between 2002 and 2005. METHODS: Clinic staff asked patients to fill out a Health Risk Assessment questionnaire that addressed their chronic disease and illness history, mental health, social support, substance use, income, education, and housing. Through statistical analysis of 469 anonymous patient questionnaires, we identified prevalent health conditions in this patient population and compared these rates to regional and national data. RESULTS: Of those patients 20 years of age and older, 70% earned less than US $10,000 a year. The rates of obesity, hypertension, asthma, diabetes, anxiety, and depression were higher in this population than in the Buffalo, NY, region and the general United States population. CONCLUSION: The data reflect the health disparity experienced by low-income minority populations in the United States and emphasize a need to plan additional services that target hypertension, heart disease, obesity, diabetes, and mental health disorders such as anxiety and depression. Findings also serve as an introduction to the patient population for volunteer medical students who have limited exposure to urban, low-income populations. (+info)