Understanding Political Priority Development for Public Health Issues in Turkey: Lessons from Tobacco Control & Road Safety

Background: In the last decade, tobacco control received political priority in Turkey while road safety did not despite the large health and economic burden road traffic injuries posed on the Turkish population. Political priority relates to the agenda-setting phase of the policy process and has been widely acknowledged as an important facilitating factor in the attainment of public health goals. Unfortunately, however, few studies currently exist to help us understand how it develops for public health issues in countries like Turkey. Objective: Using a framework adapted from John Kingdon’s Multiple Streams Theory, the primary objective of this study was to compare tobacco control with road safety for the purpose of assessing how political priority for public health issues develop in Turkey. Method: A comparative mixed-methods case study design was used. Qualitative data were gathered from key informant interviews (N=42), and documents (N=307) and quantitative data were collected from online self-administered surveys (N=153). For each case, qualitative data were analyzed using deductive and inductive coding and quantitative data were analyzed using descriptive statistics and nonparametric tests. All results were triangulated. Finally, cross-case analysis was employed such that the themes from the two cases could be compared. Results: Political priority emerged for tobacco control as a result of the development and convergence of four streams – problem, policy, political, and global – while a policy window was opened. Although the full development of all streams was found to be crucial, the transformation of the political stream appeared to be most significant. These streams were found to overlap at different points in time and influenced by an integrated group of diverse actors. Without all of these events and actors in place at the same time, the study showed that a public health problem is not likely to reach political priority in Turkey as seen in the case of road safety where only two of the four streams were developed, a policy window never opened, and many key actors were absent. Conclusion: The revised framework generated from this study could potentially help actors promoting public health issues in Turkey or other similar contexts

Fall Detection and Motion Analysis Using Visual Approaches

Falls are considered one of the most ubiquitous problems leading to morbidity and disability in the elderly. This paper presents a vision-based approach toward the care and rehabilitation of the elderly by examining the important body symmetry features in falls and activities of daily living (ADL). The proposed method carries out human skeleton estimation and detection on image datasets for feature extraction to predict falls and to analyze gait motion. The extracted skeletal information is further evaluated and analyzed for the fall risk factors in order to predict a fall event. Four critical risk factors are found to be highly correlated to falls, including 2D motion (gait speed), gait pose, 3D trunk angle or body orientation, and body shape (width-to-height ratio). Different variants of deep architectures, including 1D Convolutional Neural Network (CNN), Long Short-Term Memory (LSTM) Network, Gated Recurrent Units (GRU) model, and attention-based mechanism, are investigated with several fusion techniques to predict the fall based on human body balance study. A given test gait sequence will be classified into one of the three phases: non-fall, pre-impact fall, and fall. With the attention-based GRU architecture, an accuracy of 96.2% can be achieved for predicting a falling event

Perceptions and utilization of primary health care services in Iraq: findings from a national household survey

<p>Abstract</p> <p>Background</p> <p>After many years of sanctions and conflict, Iraq is rebuilding its health system, with a strong emphasis on the traditional hospital-based services. A network exists of public sector hospitals and clinics, as well as private clinics and a few private hospitals. Little data are available about the approximately 1400 Primary Health Care clinics (PHCCs) staffed with doctors. How do Iraqis utilize primary health care services? What are their preferences and perceptions of public primary health care clinics and private primary care services in general? How does household wealth affect choice of services?</p> <p>Methods</p> <p>A 1256 household national survey was conducted in the catchment areas of randomly selected PHCCs in Iraq. A cluster of 10 households, beginning with a randomly selected start household, were interviewed in the service areas of seven public sector PHCC facilities in each of 17 of Iraq's 18 governorates. A questionnaire was developed using key informants. Teams of interviewers, including both males and females, were recruited and provided a week of training which included field practice. Teams then gathered data from households in the service areas of randomly selected clinics.</p> <p>Results</p> <p>Iraqi participants are generally satisfied with the quality of primary care services available both in the public and private sector. Private clinics are generally the most popular source of primary care, however the PHCCs are utilized more by poorer households. In spite of free services available at PHCCs many households expressed difficulty in affording health care, especially in the purchase of medications. There is no evidence of informal payments to secure health services in the public sector.</p> <p>Conclusions</p> <p>There is widespread satisfaction reported with primary health care services, and levels did not differ appreciably between public and private sectors. The public sector PHCCs are preferentially used by poorer populations where they are important providers. PHCC services are indeed free, with little evidence of informal payments to providers.</p

Implementation of 85% health warning labels in India: advocacy success factors

Background Tobacco control policies are critical to tackling the global tobacco epidemic. Unfortunately, little research has documented the factors that facilitate the implementation of tobacco control policies in low- and middle-income countries. In this study, we explored tactics and arguments used in India to advocate for the implementation of the 2014 rules increasing the size of pictorial health warning labels (HWLs) on tobacco products from 20% to 85% of the principle display area. Methods A case study approach was used. Key informant interviews (N=22) were conducted between June and September 2017 with individuals who were purposively selected based on their significant role in the fight for implementation of the 2014 HWL rules. Sixty-eight documents were purposively selected for review. Documents and interviews were analyzed using inductive and deductive coding in HyperRESEARCH, then triangulated. Results Litigation, media advocacy using personal anecdotes, sensitization of key political figures, scientific evidence of tobacco-caused disease, and lobbying emerged as the most impactful tactics. Collaboration between anti-tobacco organizations facilitated the presentation of a consistent message to the media and to policy makers, and also ensured that efforts were not duplicated and each organization could prioritize tactics that utilized their expertise. Arguments countering opponents' claims regarding economic impact of the law, anecdotes from individuals with tobacco-caused diseases, and scientific evidence were used to persuade key decision makers and judges to support HWL implementation. Conclusions The use of multiple, complementary tactics facilitated the success of the advocacy campaign to increase the size of HWLs in India. Arguing from both a scientific evidence base as well as a more humanizing standpoint using anecdotes through lobbying, litigation, and media advocacy was successful in the case of implementing larger HWLs in India. Advocates in other countries hoping to pass and implement tobacco control legislation may find these arguments and tactics helpful in their own countries

WHY POLITICAL PRIORITY DID NOT EMERGE FOR ROAD SAFETY IN TURKEY: A POLICY ANALYSIS

Background Political priority pertains to the agenda setting phase of the policy process whereby an issue emerges as one that draws the attention of and triggers action from high-level decision makers. Few studies have investigated why political priority fails to develop or reemerge for certain public health issues in middle-income countries. In Turkey, road traffic injuries are a major cause of mortality and morbidity. Although, the issue has gained attention in recent years, it has, unfortunately, not received political priority

Increasing taxes on tobacco: advocacy lessons from Ukraine.

Tobacco use in Ukraine is a major public health problem that imposes a substantial health and economic burden on the country. On December 17, 2017, the government passed a seven-year plan (2018-2024) laying out annual increases in the price of cigarettes. This seven-year plan is significant as, for the first time in the history of tobacco excise taxes in Ukraine, annual increases in the specific tax rate imposed on cigarettes are mandatory for many years into the future. Given Ukraine’s success, a case study was conducted to explore the process and determinants that led to the passage of the seven-year plan, with a specific focus on the tactics and arguments used by proponents and opponents. Data were gathered between February and June 2019 from two sources: key informant interviews document review. Results showed that this achievement was attained through an effective advocacy campaign grounded in scientific evidence and an in-depth understanding of the political economy of the country. Lessons from this case can be used by tobacco tax proponents in other countries interested in pursuing similar policy change

Burden of Road Traffic Injuries in Turkey

Objective: Road traffic injuries (RTIs) are one of the leading causes of global deaths, contributing to 1.3 million lives lost each year Although all regions are affected, low- and middle-income countries share a disproportionate burden. The significance of this public health threat is growing in Turkey, where current estimates show that 2.0 percent of all deaths in the country are due to RTIs. Despite the significance of this growing epidemic, data pertaining to RTIs in Turkey are limited. In order to address the gap in knowledge, this article presents an overview of the epidemiology of RTIs in Turkey through an analysis of available secondary data sets and a comprehensive review of scientifically published studies

The Relationship Between Hofstede’s Cultural Dimensions, Schwartz’s Cultural Values, and Obesity

According to the World Health Organization, obesity is a major public health issue. In 2014, there were more than 600 million obese people around the world. According to the data of the World Health Organization, obesity rates differ among countries. One possible underlying reason of the difference can be culture, more specifically shared cultural values. The strategies and policies regarding obesity were developed; however, the effect of culture is not adequately considered. The aim of the study is to investigate the relationship between obesity rates of countries, Hofstede's cultural dimensions, Schwartz's values, and Gross National Income per capita per country. The data consist of obesity ranking (i.e., the percentage of the population with a body mass index of 30 kg/m(2) or higher), Gross National Income per capita for each country, and cultural variables (i.e., Hofstede's cultural dimensions for 54 nations and Schwartz's cultural values for 57 nations). Hierarchical regression analysis results revealed that Gross National Income per capita was not a significantly related obesity at the aggregated level. Among Hofstede's dimensions, individualism and uncertainty avoidance were positively associated with obesity, and long-term orientation was negatively associated with obesity. The relationship between Schwartz's cultural values and obesity was not found to be significant. Findings suggest that Hofstede's cultural dimensions should be considered when developing national level strategies and campaigns to decrease obesity