Developing the effectiveness of an intersectoral food policy coalition through formative evaluation.
There is a difference between bringing parties together and making them work effectively. We present a case study of an intersectoral food policy Committee, part of a three-tiered coalition nested within local municipal government, which sought to promote and nutrition in a rapidly growing metropolitan region by tackling food supply issues in the first instance. This was new territory for all players. After 12 months, the group felt it was floundering and requested an evaluation. In-depth qualitative interviews with committee members (n = 21) and quantitative assessment of Committee processes revealed insufficient mechanisms for engaging new members, conflict between perceived roles for the group and a notable lack of confidence in the group's capacity to achieve its goals, or outcome efficacy. Feedback of the data and subsequent discussion led to a reform of project structure, stronger mechanisms to realize its goals and better incentive management, or ways to maximize the benefits and limit the costs for the diverse parties involved. The impact was reflected in a 4 year time series analysis of media releases, decision making and related municipal government actions. The study illustrates how theory-informed formative evaluation can help to improve health promotion practice. (+info)
Reducing firearm injuries: the role of local public health departments.
OBJECTIVE: The purpose of this study was to gather data regarding local public health departments' involvement in activities to prevent firearm-related morbidity and mortality. METHODS: A questionnaire was sent to local public health departments serving cities with populations > or =60,000 to assess their perceptions of the magnitude of the firearm injury problem in their jurisdictions and the activities in which they were engaged to reduce firearm-related injuries. RESULTS: Almost half (49.7%) of respondents said that their departments had not seriously thought about being involved in activities to reduce firearm-related injuries, and fewer than one in five (17.8%) reported that their departments were involved in such activities. Respondents identified three barriers to involvement in activities to reduce firearm injuries: limited financial resources (62.7% of respondents), lack of expertise (50.8%), and not enough time (47%). CONCLUSIONS: Despite the extent of firearm injuries in the US, systematic collection of local data on firearm morbidity and mortality to help guide policy development is lacking. (+info)
Cancer incidence near municipal solid waste incinerators in Great Britain. Part 2: histopathological and case-note review of primary liver cancer cases.
We reported previously a 37% excess risk of liver cancer within 1 km of municipal incinerators. Of 119/235 (51%) cases reviewed, primary liver cancer was confirmed in 66 (55%) with 21 (18%) definite secondary cancers. The proportions of true primaries ranging between 55% and 82% (i.e. excluding secondary cancers) give revised estimates of between 0.53 and 0.78 excess cases per 10(5) per year within 1 km. (+info)
Conceptualizing and applying a minimum basic needs approach in southern Philippines.
This study, a collaboration between Canadian and Filipino researchers, focuses on how the national government's Minimum Basic Needs (MBN) Approach has been implemented at the local level in some selected sites in Region XI on the Philippine island of Mindanao. This case study of MBN implementation focuses on the experiences of three municipalities and three barangays (villages) within them. The research explores, through interviews and group discussions, what the mayors, technical working groups and volunteer health workers in these areas thought about MBN and how they participated in the initiative. The objectives of the study were: to explore models of MBN data utilization at the municipal and barangay levels; to understand how the MBN data guided decision-making about community priorities and resource allocation; to examine the role that community volunteers played in promoting the use of MBN data, and in community health and development activities which ensued; and to determine what factors challenged or encouraged the use of MBN data for social development at the barangay level. In all the sites, MBN had some impact, most often due to methods of concentrating information on unmet basic needs locally and making use of it in planning and project development processes. The findings show that although there is still some way to go before MBN is effectively integrated into local planning and project development, some responses to problems have been implemented and innovative projects were undertaken or being considered. (+info)
The city government's role in community health improvement.
Amid increasing pressures to address complex issues not traditionally assigned to localities, Healthy Cities is seen as a powerful model for community improvement and quality-of-life enhancements for individuals and organizations willing to think beyond the traditional local government management models and responsibilities. As a model for community-oriented government, it offers opportunities for fostering a return to "barnraising" concepts, civic responsibility, participation, tailoring solutions to local circumstances, and the transition of local government to governance models. (+info)
Mandated managed care for blind and disabled Medicaid beneficiaries in a county-organized health system: implementation challenges and access issues.
OBJECTIVES: The challenges of Medicaid managed care organizations that serve blind and disabled members are reviewed. Beneficiary satisfaction and access to care are assessed, and access problems are identified and resolved or minimized to the greatest degree possible. STUDY DESIGN: Formative evaluation consisting of a mailed survey and follow-up telephone outreach contacts. PATIENTS AND METHODS: A written survey was sent to more than 18,000 Supplemental Security Income (SSI) beneficiary members who were blind or disabled, with 5574 recipients responding. Of these, 1981 members identified issues that warranted 2106 follow-up telephone calls. RESULTS: Survey responses showed that beneficiaries had limited experience with managed care and were generally satisfied with access to primary care. The healthcare system used the study findings to develop focused training programs and materials, to initiate a special needs liaison program, and to revise guidelines to simplify and standardize authorization procedures for obtaining medical supplies and repairing equipment. CONCLUSIONS: Factors found to be associated with the success of a Medicaid managed care program serving blind and disabled beneficiaries include educating the members and providers for better understanding of managed care, incorporating collaborative service improvement activities, and documenting trends. (+info)
Privatization and the scope of public health: a national survey of local health department directors.
OBJECTIVES: This study sought to obtain and analyze nationally representative data on (1) privatization of local health department services, (2) local health department directors' beliefs and perspectives on the desirable role and focus of health departments, and (3) the influence of these views on privatization practices. METHODS: A stratified representative national sample of 380 local health department directors was drawn, and 347 directors were interviewed by telephone. Logistic regression established the independent effects of various factors on decisions to privatize. RESULTS: Almost three quarters (73%) of the local health departments privatized public health services of some type. The 12% of the directors who believed that local health departments should be restricted to the core public health functions and move entirely out of direct provision of personal health care were more likely to privatize services. The 77% of the directors who believed that local health departments should be involved in an increasing array of social problems were more likely to privatize. CONCLUSIONS: Privatization has quietly and quickly become commonplace in public health, and privatization practices are intimately related to divergent conceptions of public health and the role of local health departments. (+info)
Optimal fluoridation--The concept and its application to municipal water fluoridation.
Optimal fluoridation has been defined as that fluoride exposure which confers maximal cariostasis with minimal toxicity and its values have been previously determined to be 0.5 to 1 mg per day for infants and 1 to 1.5 mg per day for an average child. Total fluoride ingestion and urine excretion were studied in Marin County, California, children in 1973 before municipal water fluoridation. Results showed fluoride exposure to be higher than anticipated and fulfilled previously accepted criteria for optimal fluoridation. Present and future water fluoridation plans need to be reevaluated in light of total environmental fluoride exposure. (+info)