The impact of health system governance and policy processes on health services in Iraqi Kurdistan

BACKGROUND: Relative to the amount of global attention and media coverage since the first and second Gulf Wars, very little has been published in the health services research literature regarding the state of health services in Iraq, and particularly on the semi-autonomous region of Kurdistan. Building on findings from a field visit, this paper describes the state of health services in Kurdistan, analyzes their underlying governance structures and policy processes, and their overall impact on the quality, accessibility and cost of the health system, while stressing the importance of reinvesting in public health and community-based primary care. DISCUSSION: Very little validated, research-based data exists relating to the state of population health and health services in Kurdistan. What little evidence exists, points to a region experiencing an epidemiological polarization, with different segments of the population experiencing rapidly-diverging rates of morbidity and mortality related to different etiological patterns of communicable, non-communicable, acute and chronic illness and disease. Simply put, the rural poor suffer from malnutrition and cholera, while the urban middle and upper classes deal with issues of obesity and Type 2 diabetes. The inequity is exacerbated by a poorly governed, fragmented, unregulated, specialized and heavily privatized system, that not only leads to poor quality of care and catastrophic health expenditures, but also threatens the economic and political stability of the region. There is an urgent need to revisit and clearly define the core values and goals of a future health system, and to develop an inclusive governance and policy framework for change, towards a more equitable and effective primary care-based health system, with attention to broader social determinants of health and salutogenesis. SUMMARY: This paper not only frames the situation in Kurdistan in terms of a human rights or special political issue of a minority population, but provides important generalizable lessons for other constituencies, highlighting the need for political action before effective public health policies can be implemented - as embodied by Rudolf Virchow, the father of European public health and pathology, in his famous quote "politics is nothing but medicine at a larger scale"

Earthquake-Induced Structural and Nonstructural Damage in Hospitals

This article was published in the journal, Earthquake Spectra [© (2011) Earthquake Engineering Research Institute]. This article may be downloaded for personal use only. Any other use requires prior permission of the Earthquake Engineering Research Institute.The Sichuan (China) and L’Aquila (Italy) earthquakes have again highlighted the question of our preparedness for natural hazards. Within a few seconds, an earthquake can demolish many buildings, destroy infrastructure, and kill and injure thousands of people. In order to reduce the impact of earthquakes on human life and to prepare hospitals to cope with future disasters, this paper discusses earthquake-related damage to healthcare facilities. It investigates the damage to 34 healthcare facilities in seven countries caused by nine earthquakes between 1994 and 2004, in order to determine common and specific issues. The investigation shows that structural and architectural damage tended to be different and specific to the situation, while utility supplies and equipment damage were similar in most cases and some common trends emerged

"Would a man smell a rose then throw it away?" Jordanian men's perspectives on women's breast cancer and breast health

Background: Breast cancer is the most common malignancy afflicting women, and the most common cancer overall in Jordan. A woman's decision to go for screening is influenced by her social support network. This study aims to explore Jordanian men's individual and contextual perspectives on women's breast cancer and their own role in the breast health of the females within their families. Methods: An explorative qualitative design was used to purposively recruit 24 married men aged 27 to 65 years (median 43 years) from four governorates in Jordan. Data in the form of interviews transcriptions was subjected to qualitative content analysis. Results: Three themes were identified: a) Supporting one's wife; b) Marital needs and obligations; c) Constrained by a culture of destiny and shame. The first theme was built on men's feelings of responsibility for the family's health and well-being, their experiences of encouraging their wives to seek health care and their providing counselling and instrumental support. The second theme emerged from men's views about other men's rejection of a wife inflicted by breast cancer, their own perceptions of diminished femininity due to mastectomy and their own concerns about protecting the family from the hereditary risk of breast cancer. The third theme was seen in men's perception of breast cancer as an inevitable act of God that is far away from one's own family, in associating breast cancer with improper behaviour and in their readiness to face the culture of Eib (shame). Conclusions: Jordanian men perceive themselves as having a vital role in supporting, guiding and encouraging their wives to follow breast cancer early detection recommendations. Breast health awareness campaigns could involve husbands to capitalize on family support

Securing life: the emerging practices of biosecurity

In this paper we review recent social science work on the issue of biosecurity and suggest ways in which geographers and social scientists can approach and intervene in current biosecurity practices. Our argument is that it is both useful and necessary to locate and intervene at sites where the ordering of biomatters is open to doubt and/or contestation. We pitch discourses of biological immanence and emergence against forms of social science thinking which tend to trace overarching logics or seemingly unstoppable forces in matters of power and politics. While acknowledging the import of both literatures, our aim is to engage with the fraught empirical practicalities of making biomatters secure in order to bring to the fore the ways in which life matters are patterned by any number of processes and the ways in which these patterns are always conditional on sociomaterial contingencies

Explaining the increase in coronary heart disease mortality in Syria between 1996 and 2006

<p>Abstract</p> <p>Background</p> <p>Despite advances made in treating coronary heart disease (CHD), mortality due to CHD in Syria has been increasing for the past two decades. This study aims to assess CHD mortality trends in Syria between 1996 and 2006 and to investigate the main factors associated with them.</p> <p>Methods</p> <p>The IMPACT model was used to analyze CHD mortality trends in Syria based on numbers of CHD patients, utilization of specific treatments, trends in major cardiovascular risk factors in apparently healthy persons and CHD patients. Data sources for the IMPACT model included official statistics, published and unpublished surveys, data from neighboring countries, expert opinions, and randomized trials and meta-analyses.</p> <p>Results</p> <p>Between 1996 and 2006, CHD mortality rate in Syria increased by 64%, which translates into 6370 excess CHD deaths in 2006 as compared to the number expected had the 1996 baseline rate held constant. Using the IMPACT model, it was estimated that increases in cardiovascular risk factors could explain approximately 5140 (81%) of the CHD deaths, while some 2145 deaths were prevented or postponed by medical and surgical treatments for CHD.</p> <p>Conclusion</p> <p>Most of the recent increase in CHD mortality in Syria is attributable to increases in major cardiovascular risk factors. Treatments for CHD were able to prevent about a quarter of excess CHD deaths, despite suboptimal implementation. These findings stress the importance of population-based primary prevention strategies targeting major risk factors for CHD, as well as policies aimed at improving access and adherence to modern treatments of CHD.</p