From problems to opportunities a shift needed for public health

Public health has in the past been a problem orientated discipline which has devoted its energies mainly to defining, prioritizing and trying to solve problems. This means paying attention to the short-term. If we examine the rises and falls of public health as a discipline with its successes and failures in gaining health, and if we compare public health with successful organisations, the need for changing the emphasis from problems to opportunities becomes apparent. In this endeavour for the future, strategic thinking and policy analysis seem appropriate new tools for public health professionals. The economic crisis and the weakness of the welfare state are presented as major opportunities for public health to achieve health gain in Europe

Salud y políticas de las instituciones económicas internacionales

Las políticas son determinantes de la distribución social de los “determinantes sociales de la salud”. A partir de los años 80 las políticas neoliberales de organismos internacionales como el Banco Mundial, el Fondo Monetario y la Organización Mundial del Comercio (OMC) han empujado a los países en desarrollo hacia el suministro privado y la internacionalización de sus sectores económicos. Mecanismos para la implementación de estos objetivos, como los programas de ajuste estructural, han obstaculizado la intervención intersectorial sobre los determinantes sociales de la salud como se había planteado en Alma Ata. El impacto en la salud de este tipo de políticas las ha convertido en objeto de investigación desde la epidemiología política, definida como el estudio de los efectos sobre la salud de las decisiones asumidas o no asumidas por las instituciones derivadas del poder político. Dado que con el proceso de globalización las inequidades en salud cada vez más son consecuencia de políticas que responden a intereses de actores transnacionales, es pertinente aplicar la perspectiva de la epidemiología política en la avaluación del impacto en la salud de las poblaciones

The relationship between economic crisis and health: are austerity policies the relevant issue?

Discusión sobre: Tapia Granados JA. La crisis y la salud en España y en Europa: ¿Está aumentando la mortalidad? Salud Colectiva. 2014;10(1):81-91

Thomas McKeown and Archibald Cochrane: a journey through the diffusion of their ideas

In the 1970s Thomas McKeown and Archibald L Cochrane were two of the most influential voices in criticizing the dominance of medical thinking. A bibliometric study of the citations to McKeown's The Role of Medicine: Dream, Mirage or Nemesis and Cochrane's Effectiveness and Efficiency: Random Reflections on Health Services was performed from the publication of each book until 1988 to study how their ideas have been disseminated. During the study period 430 papers in the Science Citation Index or the Social Sciences Citation Index cited Cochrane's book, 133 cited McKeown's, and 166 cited both. The citations came mainly from original papers published in journals of internal medicine or public health and epidemiology (35%) and written by authors from the United States or the United Kingdom. Cochrane's book was cited most frequently in medical journals, suggesting a higher degree of penetration of his ideas among medical scientists. Although the dominance of original papers among the citations suggests that these books have been important in stimulating new knowledge, the main problems that McKeown and Cochrane identified--namely, the relatively small impact of clinical medicine on health outcomes and the poor use of scientific methods in clinical practice--are still with us

Epidemic of intimate partner violence against women in Spain: temporal distribution and victim age

Objetivo: Explorar la distribución temporal y por edad de las muertes y denuncias de mujeres por violencia del compañero íntimo (VCI) para ilustrar una aproximación a los resultados de las medidas desarrolladas en España en torno a este problema. Métodos: Estudio epidemiológico descriptivo basado en los datos de la Federación de Mujeres Separadas y Divorciadas, Centro Reina Sofía para el estudio de la Violencia y Anuarios Estadísticos del Ministerio del Interior (1998-2005). Cálculo de tasas de mortalidad y denuncias de VCI por edad ( 50 años) y año. Razón entre casos (denuncias y muertes) dados en un mes determinado y mediana de los producidos en el mismo mes en los 5 años anteriores (índice epidémico). Resultados: Desde finales de 2004 se observa una tendencia decreciente en las puntuaciones del índice epidémico de mortalidad y denuncias por VCI. Las mujeres de 21-50 años de edad son las que mayores tasas y puntuaciones del índice epidémico de mortalidad y denuncias presentan en el período de estudio, excepto en 2004, en que las tasas de mortalidad en mujeres menores de 21 años fueron las más elevadas, y en 2005, en que se incrementan las tasas de denuncias en las mujeres mayores de 50 años. Conclusiones: En 2005, la epidemia por VCI parece remitir. El hecho de que se trata de un problema que afecta fundamentalmente a mujeres en edades fértiles y laboralmente activas muestra el carácter instrumental de la VCI para retroalimentar una situación de subordinación femenina.Objective: To explore temporal distribution and victim age in deaths and women’s reports of intimate partner violence (IPV) to illustrate an approach to the results of the measures developed in Spain to combat this problem. Methods: We performed a descriptive epidemiological study based on statistics from the Federation of Divorced and Separated Women, the Queen Sofía Centre for the study of Violence, and the Home Affairs databases (1998-2005). Rates of mortality and reports of IPV were calculated by age (< 21 years old, from 21 to 50 years, > 50 years) and year. The ratio between the actual number of IPV deaths and reports in a given month and the median number of cases in the same month in the 5 preceding years (epidemic index) was calculated. Results: From the end of 2004, the epidemic index scores indicate that rates of mortality and reports due to intimate partner violence have tended to decrease. The highest IPV murder and report rates and epidemic index scores were observed in women aged 21-50 years old throughout the period, except in 2004, when mortality rates in women aged less than 21 years were highest, and in 2005, when report rates in women aged more than 50 years increased. Conclusion: In the last year, 2005, the IPV epidemic seemed to be decreasing. The fact that this problem affects women mostly in ages when they are fertile and active in the workforce suggests the instrumental use of IPV to keep women in a subordinate position.Instituto de Salud Carlos III a través de la Red de Investigación sobre Salud y Género. Observatorio de Salud de las Mujeres del Ministerio de Sanidad y Consumo de España

Engendering epidemiology

Contributions from the Spanish Research Network for Health and Gende

Advertising of foods and beverages in social media aimed at children: high exposure and low control

Background: This work is aimed to describe the recent scientific literature developed in the food/beverage sector and social networks aimed at children and adolescents, as well as current regulations. Methods: A rapid review of the studies on advertising and social media aimed at children, published from 2010 tp 2020 is carried out, following the established inclusion criteria. In addition, the regulations in the countries in which the studies were carried out were also reviewed. Results: Of the 573 articles, 7 met these criteria. The great attraction of unhealthy foods for children is observed, who remembered and recognized a greater number of unhealthy food brands and, by extension, the ability to influence of communication in social networks. Each country has its own self-regulation, two (Ireland and USA) have legislation on children’s food advertising, and Australia has legislation that applies only to open television. However, none of the analyzed countries have specific regulations on food, children and media advertising. Conclusions: Given the fact that there is evidence about the great attraction that social networks suppose for the child, that they are a stimulus for the consumption of food and that many of these foods are harmful to their health; we should work in two directions: 1) Promote public policies based on promoting healthy habits among minors; and 2) Monitor and implement regulations in commercial communication social media

Influences and hegemonies in health reform research

Analizamos la evolución de las publicaciones, incluidas en MEDLINE, LILACS y Sociological Abstracts, sobre las Reformas de Salud en el mundo y las influencias que determinan su orientación y distribución en el período de 1990-2004. En total se seleccionaron 8.729 publicaciones. Los principios de “Sostenibilidad” y “Calidad y Efectividad” son los más atendidos, existiendo distintos patrones de atención, dependiendo de regiones y países. De 199 países, el 61% tiene referencia sobre sus procesos de reforma, siendo Estados Unidos y Gran Bretaña los que agrupan la mayor cantidad. Se observó que existen fuertes influencias para el estudio de las Reformas de Salud, provenientes de los patrones Británico y Norteamericano de atención a los Principios de Reforma. Esto puede estar limitando la visibilidad científica de cuestiones como la equidad, participación y eficiencia.The authors analyze the evolution in publications indexed in MEDLINE, LILACS, and Sociological Abstracts concerning health reforms around the world and the determinants of their orientation and distribution from 1990 to 2004. A total of 8,729 publications were selected. The principles of “sustainability” and “quality and effectiveness” were dealt with most frequently, with different patterns of attention, depending on the regions and countries. Of 199 countries, 61% included references as to their health reform processes, with the largest numbers in the United States and the Great Britain. The British and U.S. standards for attention to health reform principles displayed strong influences on the study of health reforms elsewhere. This may limit the scientific visibility of issues like equity, participation, and efficiency