Epidemiological research methods. Part VII. Epidemiological research in health planning

CITATION: Yach, D. & Botha, J. L. 1987. Epidemiological research methods. Part VII. Epidemiological research in health planning. South African Medical Journal, 72:633-636.The original publication is available at http://www.samj.org.zaThe goal of epidemiology is to improve the health status of human populations. In our series thus far we have srressed the need to use the correct design for epidemiological studies, a sampling scheme that yields interpretable results, measurements that are both valid and reliable, and finally the appropriate analysis. These methodological considerations are of importance if the goal is to be reached. In this article we assume that most of these issues have been adequately dealt with and focus on how the results of epidemiological research can be used by health planners to improve the health status of regions and the country as a whole.Publisher’s versio

Epidemiological research methods. Part II. Descriptive studies

CITATION: Botha, J. L. & Yach, D. 1986. Epidemiological research methods. Part II. Descriptive studies. South African Medical Journal, 70:766-772.The original publication is available at http://www.samj.org.zaIn a descriptive study, therefore, the magnitude and distribution of a health problem in a specified population is studied in terms of TIME (when did it occur?), PLACE (where did it occur?) and PERSON (which groups are affected?). The design starts with an idea that occurs to the researcher about a particular problem. This is followed by selecting a group of individuals to be studied (sampling), considering which attributes to measure (measurement), describing the findings, and finally drawing conclusions on the basis of the findings. Commonly, new ideas or hypotheses are generated in this final stage, usually regarding possible explanations for the health problems described (cause-effect relationships). Such relationships may be attempts to explain the aetiology of diseases or the effect of preventive, curative or rehabilitative measures. Important issues affecting the reliability of the sampling and measurement processes are discussed, some descriptive statistical measures demonstrated and how conclusions are affected by these, are indicated.Publisher’s versio

National Institutes of Health Funding for Behavioral Interventions to Prevent Chronic Diseases

Chronic non-communicable diseases (NCDs) cause the majority of premature deaths, disability, and healthcare expenditures in the U.S. Six largely modifiable risk behaviors and factors (tobacco use, poor nutrition, physical inactivity, alcohol abuse, drug abuse, and poor mental health) account for more than 50% of premature mortality and considerably more morbidity and disability. The IOM proposed that population burden of disease and preventability should be major determinants of the amount of research funding provided by the U.S. NIH. Data on NIH prevention funding between fiscal years 2010 and 2012 for human behavioral interventions that target the modifiable risk factors of NCDs were analyzed during 2013–2014. The NIH prevention portfolio comprises approximately 37% human behavioral studies and 63% basic biomedical, genetic, and animal studies. Approximately 65% of studies were secondary prevention versus 23% for primary prevention, and 71% of studies intervened at the individual and family levels. Diet and exercise were the most-studied risk factors (41%), and few studies conducted economic analyses (12%). NIH spends an estimated $2.2–$2.6 billion annually (7%–9% of the total of $30 billion) on human behavioral interventions to prevent NCDs. Although NIH prevention funding broadly aligns with the current burden of disease, overall funding remains low compared to funding for treatment, which suggests funding misalignment with the preventability of chronic diseases

Research to stop tobacco deaths

In 2003, governments adopted the Framework Convention on Tobacco Control, the world’s first global health treaty. In the decade since the treaty was adopted by 178 member states of the World Health Organization, there have been substantial achievements in reducing tobacco use around the world. Research and evidence on the impact of interventions and policies have helped drive this policy progress. An increased and sustained focus on research is needed in the future to ensure that the gains of the global tobacco control movement are maintained, particularly in low- and middle-income countries, which are affected most strongly by the tobacco epidemic. In addition to current priorities, greater attention is needed to research related to trade agreements, prevention among girls, and the appropriate response to nicotine-based noncombustibles (including e-cigarettes)

The 'Diverse, Dynamic New World of Global Tobacco Control'?:An Analysis of Participation in the Conference of the Parties to the WHO Framework Convention on Tobacco Control

INTRODUCTION: The increasingly inequitable impacts of tobacco use highlight the importance of ensuring developing countries’ ongoing participation in global tobacco control. The WHO Framework Convention on Tobacco Control (FCTC) has been widely regarded as reflecting the high engagement and effective influence of developing countries. METHODS: We examined participation in FCTC governance based on records from the first four meetings of the Conference of the Parties (COP), comparing representation and delegate diversity across income levels and WHO regions. RESULTS: While attendance at the COP sessions is high, there are substantial disparities in the relative representation of different income levels and regions, with lower middle and low income countries contributing only 18% and 10% of total meeting delegates, respectively. In regional terms, Europe provided the single largest share of delegates at all except the Durban (2008) meeting. Thirty-nine percent of low income countries and 27% of those from Africa were only ever represented by a single person delegation compared with 10% for high income countries and 11% for Europe. Rotation of the COP meeting location outside of Europe is associated with better representation of other regions and a stronger presence of delegates from national ministries of health and focal points for tobacco control. CONCLUSIONS: Developing countries face particular barriers to participating in the COP process, and their engagement in global tobacco control is likely to diminish in the absence of specific measures to support their effective participation

Meta-analysis in epidemiology

Meta-analysis is the structured and systematic qualitative and quantitative integration of the results of several independent studies (Le. the epidemiology of results). As in any epidemiological study, a meta-analysis needs to start with clearly stated aims and objectives. Attention needs to be paid to selection bias in selecting the study population (all publications on the topic). An initial qualitative assessment (conducted blinded to results) categorises projects on the basis of their methods, as unacceptable (dropped from later analysis) and acceptable or good. Further analysis could be conducted by stratifying or weighting independent studies according to preset quality criteria. The quantitative assessment involves deriving a pooled measure of outcome (usually the relative or attributable risk). Tests for heterogeneity are required before pooling. By pooling the results from many settings using different methods, the ability to generalise them in terms of their public health relevance is increased.S Afr Med J 1990; 78: 94·97

The impact of diabetes on employment in Mexico

This study explores the impact of diabetes on employment in Mexico using data from the Mexican Family Life Survey (MxFLS) (2005), taking into account the possible endogeneity of diabetes via an instrumental variable estimation strategy. We find that diabetes significantly decreases employment probabilities for men by about 10 percentage points (

Globalization and Health: Exploring the opportunities and constraints for health arising from globalization

The tremendous benefits which have been conferred to almost 5 billion people through improved technologies and knowledge highlights the concomitant challenge of bringing these changes to the 1 billion people living mostly in sub-Saharan Africa and South Asia who are yet to benefit. There is a growing awareness of the need to reduce human suffering and of the necessary participation of governments, non-government organizations and industry within this process. This awareness has recently translated into new funding mechanisms to address HIV/Aids and vaccines, a global push for debt relief and better trade opportunities for the poorest countries, and recognition of how global norms that address food safety, infectious diseases and tobacco benefit all. 'Globalization and Health' will encourage an exchange of views on how the global architecture for health governance needs to changes in the light of global threats and opportunities

The role of business in addressing the long-term implications of the current food crisis

Before the onset of the current food crisis, the evidence of a severely neglected nutrition crisis was starting to receive attention. Increased food prices are having severe impacts on the nutritional status of populations. Our current food system has evolved over decades in a largely unplanned manner and without consideration for the complexity and implications of linkages between health, nutrition, agricultural, economic, trade and security issues. The underlying causes for the nutrition crisis include the above, as well as decades of neglect with regard to nutrition, and agricultural science (especially in emerging markets); a failure of governance with respect to the major players involved in nutrition, a weak response by government donors and Foundations to invest in basic nutrition (in contrast to growing support for humanitarian aspects of food aid), and a reluctance to develop private-public partnerships. The emergence of new business models that tackle social problems while remaining profitable offers promise that the long term nutrition needs of people can be met. Businesses can have greater impact acting collectively than individually. Food, retail, food service, chemical and pharmaceutical companies have expertise, distribution systems and customers insights, if well harnessed, could leapfrog progress in addressing the food and nutrition crises. While business can do lots more, its combined impact will be minimal if a range of essential government actions and policies are not addressed. Governments need to create innovative and complementary opportunities that include incentives for businesses including: setting clear nutritional guidelines for fortification and for ready-to eat products; offering agreements to endorse approved products and support their distribution to clinics and schools; eliminating duties on imported vitamins and other micronutrients; and providing tax and other incentives for industry to invest with donors in essential nutrition and agricultural research. Currently governments in developed countries provide a wide range of incentives to the pharmaceutical industry to develop medicated solutions to nutritional problems. We need equivalent effort to be given to the development of more sustainable agricultural and food based solutions. We now face a truly global set of interlinked crises related to food that affect all people. The same degree of urgency and high level leadership and partnership seen during the Second World War is required on a global basis. This time it will need to simultaneously address agricultural, environmental and health considerations with the aim being the attainment of optimal nutrition for all within a framework of sustainable development