Framing child protection as a public health law issue

During their remarks for a University of Michigan symposium on “Rethinking Foster Care”1 a variety of participants addressed foster care, or even rethinking child protection policy as a whole, from ‘the ground up’. Several speakers referenced the model of public health as a useful framework for child welfare policy. During many formal and informal exchanges, many others alluded to public health, touching on themes such as the importance of promoting primary prevention over later intervention, reducing reliance on punitive models for intervention, and relying more on science as a foundation for child welfare policy development. Given the role of public health as a touchstone2 for these views, likely shared by many non-lawyers, this chapter revisits the nature of public health, and the related field of public health law, before considering briefly a few examples that have been raised as embodying a public health application to child welfare.3 A review of historic and recent public health practices and law cannot be comprehensive, but can be instructive for any who would apply public health to child welfare, and who need to be informed by the workings, achievements and weaknesses of the vast field of public health. Moreover, this can avoid oversimplification and maximize the utility of a public health perspective for child protection policy analysis.4</sup

Experiences and perceptions about cause and prevention of cardiovascular disease among people with cardiometabolic conditions: findings of in-depth interviews from a peri-urban Nepalese community

Background: Nepal currently faces an increasing burden of cardiovascular disease (CVD). Earlier studies on health literacy and the behavior dimension of cardiovascular health reported a substantial gap between knowledge and practice. Objective: This qualitative study aimed to deepen understanding of the community perspective on cardiovascular health from the patients’ viewpoint. Design: We conducted in-depth interviews (IDIs) with 13 individuals with confirmed heart disease, hypertension, or diabetes mellitus. All participants provided verbal consent. We used an IDI guide to ask respondents about their perception and experiences with CVD, particularly regarding causation and preventability. We manually applied qualitative content analysis to evaluate the data and grouped similar content into categories and subcategories. Results: Respondents perceived dietary factors, particularly consumption of salty, fatty, and oily food, as the main determinants of CVD. Similarly, our respondents unanimously linked smoking, alcohol intake, and high blood pressure with cardiac ailments but reported mixed opinion regarding the causal role of body weight and physical inactivity. Although depressed and stressed at the time of diagnosis, respondents learned to handle their situation better over time. Despite good family support for health care, the financial burden of disease was a major issue. All respondents understood the importance of lifestyle modification and relied upon health professionals for information and motivation. Respondents remarked that community awareness of CVD was inadequate and that medical doctors or trained local people should help increase awareness. Conclusions: This study provided insight into the perceptions of patients regarding CVD. Respondents embraced the importance of lifestyle modification only after receiving their diagnosis. Although better health care is important in terms of aiding patients to better understand and cope with their disease, interventions should be tailored to improve the community's cardiovascular health literacy and preventive practices