Prospects for progress on health inequalities in England in the post-primary care trust era : professional views on challenges, risks and opportunities

Background - Addressing health inequalities remains a prominent policy objective of the current UK government, but current NHS reforms involve a significant shift in roles and responsibilities. Clinicians are now placed at the heart of healthcare commissioning through which significant inequalities in access, uptake and impact of healthcare services must be addressed. Questions arise as to whether these new arrangements will help or hinder progress on health inequalities. This paper explores the perspectives of experienced healthcare professionals working within the commissioning arena; many of whom are likely to remain key actors in this unfolding scenario. Methods - Semi-structured interviews were conducted with 42 professionals involved with health and social care commissioning at national and local levels. These included representatives from the Department of Health, Primary Care Trusts, Strategic Health Authorities, Local Authorities, and third sector organisations. Results - In general, respondents lamented the lack of progress on health inequalities during the PCT commissioning era, where strong policy had not resulted in measurable improvements. However, there was concern that GP-led commissioning will fare little better, particularly in a time of reduced spending. Specific concerns centred on: reduced commitment to a health inequalities agenda; inadequate skills and loss of expertise; and weakened partnership working and engagement. There were more mixed opinions as to whether GP commissioners would be better able than their predecessors to challenge large provider trusts and shift spend towards prevention and early intervention, and whether GPs’ clinical experience would support commissioning action on inequalities. Though largely pessimistic, respondents highlighted some opportunities, including the potential for greater accountability of healthcare commissioners to the public and more influential needs assessments via emergent Health & Wellbeing Boards. Conclusions - There is doubt about the ability of GP commissioners to take clearer action on health inequalities than PCTs have historically achieved. Key actors expect the contribution from commissioning to address health inequalities to become even more piecemeal in the new arrangements, as it will be dependent upon the interest and agency of particular individuals within the new commissioning groups to engage and influence a wider range of stakeholders.</p

The control, content, and consequences of edTPA: World language teacher educators’ perceptions

Implemented in more than 870 teacher education programs across 41 states and the District of Columbia, edTPA is marketed as a content-specific, standardized portfolio assessment of beginning teacher performance. However, concerns about edTPA and its content-specificity are pervasive. To that end, the researchers surveyed teacher educators with World Language edTPA experience (N = 88) to ascertain their perceptions of the assessment, including its impact on teacher candidates, teacher education programs, and clinical placements, as well as the resources required, support experienced, and consequences perceived as a result of its implementation. Using Cochran-Smith et al.’s (2018) framework of teacher education accountability, the researchers explore issues of control, content, and consequences related to power relationships and the World Language edTPA, centering on the assessment’s intended content-specificity, while recounting an ACTFL task force’s efforts in 2016 to influence the assessment’s content

Globalization, educational targeting and stable inequalities : a comparative analysis of Argentina, Brazil and Chile

This article analyzes educational targeting in Argentina, Brazil and Chile from a sociological point of view. In essence, it presents the 'logic of induction' as an ideal type. This pedagogic discourse is the vehicle of an educational anti-poverty strategy that expects to induce clearly targeted groups to improve on their own. The analysis explores the influence of the global educational agenda, the empirical connection between this discourse and the mechanism of emulation as well as the territorialization of educational inequality. Emulation plays the main role inasmuch as the logic of induction eventually leads the target groups to compare their adverse situation with more privileged groups, what legitimizes the current structures of categorical inequality (Tilly 1998). Finally, a brief statistical summary reports that the trends of educational inequality have remained stable as far as urban- rural ratios (in Brazil and Chile) and regional disparities (in the three countries) are concerned

Rethinking Research Ethics for Latinos: The Policy Paradox of Health Reform and the Role of Social Justice

http://dx.doi.org/10.1080/10508422.2012.72999

The spatial pattern of premature mortality in Hong Kong: how does it relate to public housing?

Research into understanding the relationship between access to housing, health and wellbeing in cities has yielded mixed evidence to date and has been limited to case studies from Western countries. Many studies appear to highlight the negative effects of public housing in influencing the health of its residents. Current trends in the urban housing markets in cities of advanced Asian economies and debates surrounding the role of government in providing housing underscore the need for more focused research into housing and health. In this paper, we investigate Hong Kong as an example of a thriving Asian city by exploring and comparing the intra-urban geographies of premature mortality and public housing provision in the city. Using a fully Bayesian spatial structural model, we estimate associations between public housing provision and different types of premature mortality. We find significant geographic variations in premature mortality within Hong Kong during the five-year period 2005–2009, with positive associations between the residents of public housing and premature mortality risk. But the associations attenuate or are even reversed for premature mortality of injuries and non-communicable diseases after controlling for local deprivation, housing instability, access to local amenities and other neighbourhood characteristics. The results indicate that public housing may have a protective effect on community health, which contradicts the findings of similar studies carried out in Western cities. We suggest reasons why the association between public housing and health differs in Hong Kong and discuss the implications for housing policy in Hong Kong and other Asian cities

Monitoring fever treatment behaviour and equitable access to effective medicines in the context of initiatives to improve ACT access: baseline results and implications for programming in six African countries

BACKGROUND: Access to artemisinin-based combination therapy (ACT) remains limited in high malaria-burden countries, and there are concerns that the poorest people are particularly disadvantaged. This paper presents new evidence on household treatment-seeking behaviour in six African countries. These data provide a baseline for monitoring interventions to increase ACT coverage, such as the Affordable Medicines Facility for malaria (AMFm). METHODS: Nationally representative household surveys were conducted in Benin, the Democratic Republic of Congo (DRC), Madagascar, Nigeria, Uganda and Zambia between 2008 and 2010. Caregivers responded to questions about management of recent fevers in children under five. Treatment indicators were tabulated across countries, and differences in case management provided by the public versus private sector were examined using chi-square tests. Logistic regression was used to test for association between socioeconomic status and 1) malaria blood testing, and 2) ACT treatment. RESULTS: Fever treatment with an ACT is low in Benin (10%), the DRC (5%), Madagascar (3%) and Nigeria (5%), but higher in Uganda (21%) and Zambia (21%). The wealthiest children are significantly more likely to receive ACT compared to the poorest children in Benin (OR = 2.68, 95% CI = 1.12-6.42); the DRC (OR = 2.18, 95% CI = 1.12-4.24); Madagascar (OR = 5.37, 95% CI = 1.58-18.24); and Nigeria (OR = 6.59, 95% CI = 2.73-15.89). Most caregivers seek treatment outside of the home, and private sector outlets are commonly the sole external source of treatment (except in Zambia). However, children treated in the public sector are significantly more likely to receive ACT treatment than those treated in the private sector (except in Madagascar). Nonetheless, levels of testing and ACT treatment in the public sector are low. Few caregivers name the national first-line drug as most effective for treating malaria in Madagascar (2%), the DRC (2%), Nigeria (4%) and Benin (10%). Awareness is higher in Zambia (49%) and Uganda (33%). CONCLUSIONS: Levels of effective fever treatment are low and inequitable in many contexts. The private sector is frequently accessed however case management practices are relatively poor in comparison with the public sector. Supporting interventions to inform caregiver demand for ACT and to improve provider behaviour in both the public and private sectors are needed to achieve maximum gains in the context of improved access to effective treatment

Job satisfaction and motivation of health workers in public and private sectors: cross-sectional analysis from two Indian states

<p>Abstract</p> <p>Background</p> <p>Ensuring health worker job satisfaction and motivation are important if health workers are to be retained and effectively deliver health services in many developing countries, whether they work in the public or private sector. The objectives of the paper are to identify important aspects of health worker satisfaction and motivation in two Indian states working in public and private sectors.</p> <p>Methods</p> <p>Cross-sectional surveys of 1916 public and private sector health workers in Andhra Pradesh and Uttar Pradesh, India, were conducted using a standardized instrument to identify health workers' satisfaction with key work factors related to motivation. Ratings were compared with how important health workers consider these factors.</p> <p>Results</p> <p>There was high variability in the ratings for areas of satisfaction and motivation across the different practice settings, but there were also commonalities. Four groups of factors were identified, with those relating to job content and work environment viewed as the most important characteristics of the ideal job, and rated higher than a good income. In both states, public sector health workers rated "good employment benefits" as significantly more important than private sector workers, as well as a "superior who recognizes work". There were large differences in whether these factors were considered present on the job, particularly between public and private sector health workers in Uttar Pradesh, where the public sector fared consistently lower (<it>P </it>< 0.01). Discordance between what motivational factors health workers considered important and their perceptions of actual presence of these factors were also highest in Uttar Pradesh in the public sector, where all 17 items had greater discordance for public sector workers than for workers in the private sector (<it>P </it>< 0.001).</p> <p>Conclusion</p> <p>There are common areas of health worker motivation that should be considered by managers and policy makers, particularly the importance of non-financial motivators such as working environment and skill development opportunities. But managers also need to focus on the importance of locally assessing conditions and managing incentives to ensure health workers are motivated in their work.</p

Including the public in pandemic planning: a deliberative approach

Background: Against a background of pandemic threat posed by SARS and avian H5N1 influenza, this study used deliberative forums to elucidate informed community perspectives on aspects of pandemic planning. Methods: Two deliberative forums were carried out with members of the South Australian community. The forums were supported by a qualitative study with adults and youths, systematic reviews of the literature and the involvement of an extended group of academic experts and policy makers. The forum discussions were recorded with simultaneous transcription and analysed thematically. Results: Participants allocated scarce resources of antiviral drugs and pandemic vaccine based on a desire to preserve society function in a time of crisis. Participants were divided on the acceptability of social distancing and quarantine measures. However, should such measures be adopted, they thought that reasonable financial, household and psychological support was essential. In addition, provided such support was present, the participants, in general, were willing to impose strict sanctions on those who violated quarantine and social distancing measures. Conclusions: The recommendations from the forums suggest that the implementation of pandemic plans in a severe pandemic will be challenging, but not impossible. Implementation may be more successful if the public is engaged in pandemic planning before a pandemic, effective communication of key points is practiced before and during a pandemic and if judicious use is made of supportive measures to assist those in quarantine or affected by social isolation measures.Annette J Braunack-Mayer, Jackie M Street, Wendy A Rogers, Rodney Givney, John R Moss, Janet E Hiller, Flu Views tea

Equity in health and healthcare in Malawi: analysis of trends

<p>Abstract</p> <p>Background</p> <p>Growing scientific evidence points to the pervasiveness of inequities in health and health care and the persistence of the <it>inverse care law</it>, that is the availability of good quality healthcare seems to be inversely related to the need for it in developing countries. Achievement of the Millennium Development Goals is likely to be compromised if inequities in health/healthcare are not properly addressed.</p> <p>Objective</p> <p>This study attempts to assess trends in inequities in selected indicators of health status and health service utilization in Malawi using data from the Demographic and Health Surveys of 1992, 2000 and 2004.</p> <p>Methods</p> <p>Data from Demographic and Health Surveys of 1992, 2000 and 2004 are analysed for inequities in health/healthcare using quintile ratios and concentration curves/indices.</p> <p>Results</p> <p>Overall, the findings indicate that in most of the selected indicators there are pro-rich inequities and that they have been widening during the period under consideration. Furthermore, vertical inequities are observed in the use of interventions (treatment of diarrhoea, ARI among under-five children), in that the non-poor who experience less burden from these diseases receive more of the treatment/interventions, whereas the poor who have a greater proportion of the disease burden use less of the interventions. It is also observed that the publicly provided services for some of the selected interventions (e.g. child delivery) benefit the non-poor more than the poor.</p> <p>Conclusion</p> <p>The widening trend in inequities, in particular healthcare utilization for proven cost-effective interventions is likely to jeopardize the achievement of the Millennium Development Goals and other national and regional targets. To counteract the inequities it is recommended that coverage in poor communities be increased through appropriate targeting mechanisms and effective service delivery strategies. There is also a need for studies to identify which service delivery mechanisms are effective in the Malawian context.</p

Drone-Based Computer Vision-Enabled Vehicle Dynamic Mobility and Safety Performance Monitoring

This report documents the research activities to develop a drone-based computer vision-enabled vehicle dynamic safety performance monitoring in Rural, Isolated, Tribal, or Indigenous (RITI) communities. The acquisition of traffic system information, especially the vehicle speed and trajectory information, is of great significance to the study of the characteristics and management of the traffic system in RITI communities. The traditional method of relying on video analysis to obtain vehicle number and trajectory information has its application scenarios, but the common video source is often a camera fixed on a roadside device. In the videos obtained in this way, vehicles are likely to occlude each other, which seriously affects the accuracy of vehicle detection and the estimation of speed. Although there are methods to obtain high-view road video by means of aircraft and satellites, the corresponding cost will be high. Therefore, considering that drones can obtain high-definition video at a higher viewing angle, and the cost is relatively low, we decided to use drones to obtain road videos to complete vehicle detection. In order to overcome the shortcomings of traditional object detection methods when facing a large number of targets and complex scenes of RITI communities, our proposed method uses convolutional neural network (CNN) technology. We modified the YOLO v3 network structure and used a vehicle data set captured by drones for transfer learning, and finally trained a network that can detect and classify vehicles in videos captured by drones. A self-calibrated road boundary extraction method based on image sequences was used to extract road boundaries and filter vehicles to improve the detection accuracy of cars on the road. Using the results of neural network detection as input, we use video-based object tracking to complete the extraction of vehicle trajectory information for traffic safety improvements. Finally, the number of vehicles, speed and trajectory information of vehicles were calculated, and the average speed and density of the traffic flow were estimated on this basis. By analyzing the acquiesced data, we can estimate the traffic condition of the monitored area to predict possible crashes on the highways