Dear Colleagues
Attached information and links to abtracts of two papers which may be of interest to you from the December edition of the American Journal of Public Health, one of issues in allocation of resources to HIV prevention initiatives and one on racial differences in prenatal care utilisation.
David McDaid
LSE Health and Social Care
1 December 2002; Vol. 92, No. 12
URL: http://www.ajph.org/content/vol92/issue12/index.shtml?etoc
Allocating HIV-Prevention Resources: Balancing Efficiency and Equity
Edward H. Kaplan and Michael H. Merson
Am J Public Health 2002;92 1905-1907
http://www.ajph.org/cgi/content/abstract/92/12/1905
Abstract
The primary goal of HIV prevention is to prevent as many infections as possible. This requires allocating HIV-prevention resources according to costeffectiveness principles: those activities that prevent more infections per dollar are favored over those that prevent fewer. This is not current practice in the United States, where prevention resources from the federal government to the states flow in proportion to reported AIDS cases. Although such allocations might be considered equitable, more infections could be prevented for the same expenditures were cost-effectiveness principles invoked. The downside of pure cost-effective allocations is that they violate common norms of equity. In this article, we argue for a middle ground that promotes both equity and efficiency in allocating federal HIV-prevention resources.
Racial Differences in Prenatal Care Use in the United States: Are Disparities Decreasing?
Greg R. Alexander, Michael D. Kogan, and Sara Nabukera
Am J Public Health 2002;92 1970-1975
http://www.ajph.org/cgi/content/abstract/92/12/1970?etoc
Abstract
Objectives. We examined trends and racial disparities (White, African American) in trimester of prenatal care initiation and adequacy of prenatal care utilization for US women and specific high-risk subgroups, e.g., unmarried, young, or less-educated mothers. Methods. Data from 1981-1998 US natality files on singleton live births to US resident mothers were examined. Results. Overall, early and adequate use of care improved for both racial groups, and racial disparities in prenatal care use have been markedly reduced, except for some young mothers. Conclusions. While improvements are evident, it is doubtful that the Healthy People 2000 objective for prenatal care will soon be attained for African Americans or Whites. Further efforts are needed to understand influences on and to address barriers to prenatal care.
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