>
Is it that there is a difference between how you apply QUALYs to populations
and their subgroups, and how you apply them, or try to apply them, to
individuals? In particular when you are dealing with individuals you are
dealing with a type of consent and decision making which cannot be reproduced
in the same and unconditional way on a population basis. In individual cases
QUALYs aren't the only or the best decision making tool.
Consider the language you use in your example:
"Most members of the public would I think prefer to be in full health than
paralysed from the waist down" might well be true - but A and/or B may be in
the minority of the population.
A clinician confronted with this hypothetical dilema, would, should or could
explain the situation and prognosis in full to both A and B. It only then
becomes a dilema if, when fully informed, both A and B want treatment. In many
cases either A or B - especially where there is an emotional or famillial
attachment between the two - may withold their consent and the dilema
disappears.
A and B may both have the right to be treated, but they also have the right to
withold consent to treatment. If after explanation both A and B continue to
demand treatment then a much more detailed impact assement/judgement of their
individual cases would need to be made. In the UK would this happen in a court
of law?
If for any reason this could not be done, then the fairest way to allocate the
treatment would be by lot, not by the creation of spurious or arbitrary
criteria of "health" which override all others. The simple equation of
physical impairment with health implied in your example doesn't work, and is
arbitrary:
A (say a creative genius) physically impaired is not necessarilly
better/healthier/more worthwhile than B (say a genocidal politician) able
bodied.
What's more interesting is that I have met people for whom impairment was a
positive life changing experience. These are people who would not necessarily
accept the validity of the statement that A abled bodied is better than A
impaired, and I think I would agree with them.
The reason that this is interesting is that this is in fact the thinking
behind the reason that "most people" would say that remaining able bodied is
better than becoming impaired.
The problem may lie not with using quality of life as a determinant of public
policy or clinical judgment, but in having a well-rounded and ethically
competent understanding of life quality and its relationship with quantity of
health, happiness and physical ability.
=========================================================================
Date: Fri, 9 Aug 2002 11:23:46 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: Birth weight and social class linked to educational achievement
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
FYI Paper in this weeks BMJ, I've also attached press release from BMJ =
about this paper.
David McDaid
LSE Health and Social Care
Birth weight, childhood socioeconomic environment, and cognitive=20
development in the 1958 British birth cohort study
Barbara J M H Jefferis, Chris Power, and Clyde Hertzman
BMJ 2002;325 305
http://bmj.com/cgi/content/abstract/325/7359/305
BIRTH WEIGHT AND SOCIAL CLASS LINKED TO EDUCATIONAL ACHIEVEMENT
(Birth weight, childhood socioeconomic environment, and
cognitive development in the 1958 British birth cohort
study)
Birth weight and social class at birth have a strong
influence on cognitive (mental) function in children, say
researchers in this week's BMJ.
The study involved 10,845 males and females born
during 3-9 March 1958 in England, Scotland, and
Wales. The team investigated the combined effect of birth
weight and socioeconomic environment on cognitive tests
and educational achievements at 7, 11, 16, and 33 years.
All cognitive tests and educational achievements
improved significantly with increasing birth weight. For
example, the proportion of men with higher qualifications
increased from 26% in the lowest (2500 g or less) birth
weight group to 34% in the highest (more than 4000 g).
For women, equivalent percentages were 17% and 28%.
Standardised maths scores increased with increasing birth
weight at all ages.
Social background had a strong effect on maths scores,
with children from class I and II gaining higher scores
than those from class IV and V. Looking jointly at the
effects of birth weight and social class, participants of low
birth weight from class I and II had higher average scores
for maths than participants of normal birth weight from
class IV and V. The association between maths score
and social class seemed to strengthen with age, whilst the
association with birth weight remained similar with age.
"Our results suggest a cumulative effect of prenatal (birth
weight) and postnatal (social class) influences on
cognitive development," say the authors. "Although the
overall effect size of differences in cognitive scores
associated with birth weight is small for individuals, the
impact in populations may be important."
The greater explanatory value of social background
suggests that gains in cognitive development may depend
more on efforts to redress disadvantages in childhood
social environment, they conclude.
Contact:
Barbara Jefferis, Research Fellow, Centre for Paediatric
Epidemiology and Biostatistics, Institute of Child Health,
London, UK
Email [log in to unmask]
=========================================================================
Date: Mon, 12 Aug 2002 15:47:41 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: Social capital for health - a new way to target health
inequalities?
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Attached press release from the Health Development Agency in England on =
a new book
Social capital for Health. Insights from qualitative research. Edited by =
Catherine Swann and Antony Morgan. Health Development Agency. 2002
Contributions from Catherine Swann, Antony Morgan, Virginia Morrow, =
Catherine Campbell, Carl MacLean, Judith Sixsmith, Margaret Boneham, =
Vivk Cattell, Rachel Herring, Mildred Baxter, Fiona Poland.
The book itself can be downloaded at
http://www.hda-online.org.uk/downloads/pdfs/social_capital_complete_jul02=
.pdf
Best wishes
David McDaid
LSE Health and Social Care
HDA Press Release 7th August 2002
http://www.hda-online.org.uk/html/about/press/07082002.html
A new book that examines the use of social capital to improve health and =
reduce health inequalities has been published by the Health Development =
Agency. 'Social capital for health: Insights from qualitative research' =
draws together a range of studies that attempt to assess the relative =
importance of the concept as it relates to different age groups, gender =
and ethnic groups. The implications of the research findings for social =
policy, particularly social policy relating to health behaviours, are =
discussed.=20
Social capital is a concept that recognises that a range of social and =
community circumstances can influence health-related behaviour, and that =
an individual's health and well-being can be affected by the way they =
relate to social networks and communities. Some of the main indicators =
of social capital include community and civic participation, social =
relationships and social support, reciprocal activities (eg. child care =
arrangements) and levels of trust in others.=20
The book finds that on the issue of gender, men in the community are =
reluctant to take responsibility for their health, tending to devolve =
responsibility for health matters to girlfriends, wives and mothers. It =
also reports the views of African-Caribbean residents of a deprived =
multi-ethnic town in the south of England, providing one of the few =
examinations of the role of ethnic minority status in shaping the ways =
that people create, sustain and access social capital.=20
How social capital relates to children and young people is also =
explored, by looking at a range of issues including their attitudes to =
local facilities and social networks. Some of the findings suggest that =
children and young people should be included when views are sought from =
communities, as they are often overlooked in this process. This is =
especially relevant, as this group is frequently perceived as 'the =
problem' in urban and suburban environments.=20
These findings are complemented by a chapter examining relationships =
between social capital, health and age group through interviews with =
different generations of East London residents. Their views on subjects =
including how society has changed over the years and community =
participation give a picture of what role social capital plays in =
residents' lives. The book also includes research analysing quantitative =
surveys that measure social capital and a small study on whether typical =
social capital survey questions relate to how respondents' view their =
health.=20
Social capital can contribute to reducing health inequalities but it is =
only one part of an approach to health improvement that must also =
include measures to raise the absolute income levels and material living =
standards of the worst off in society. 'Social capital for health: =
Insights from qualitative research' will be of interest to health, local =
authority and voluntary sector audiences
Notes to Editors=20
1. 'Social capital for health: Insights from qualitative research' is =
part of the HDA's major programme of research on the use of social =
capital to improve health and reduce health inequalities =
(www.social-action.org.uk). The findings from this conference will =
support the implementation of the range of existing and emerging =
Government policies and programmes set up to address the determinants of =
inequalities at national and local level. These include New Deal for =
Communities, Neighbourhood Renewal, Healthy Living Centres, Local =
Strategic Partnerships and the Healthy Communities Collaborative.=20
=========================================================================
Date: Mon, 12 Aug 2002 16:06:05 +0100
Reply-To: [log in to unmask]
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: Ian Horrigan <[log in to unmask]>
Subject: Statistician jobs at CHI
Mime-Version: 1.0
Content-Type: text/plain; charset=iso-8859-1
Content-Transfer-Encoding: quoted-printable
Apologies for cross-posting
The following two positions at the Commission for Health Improvement (CHI) =
will shortly be appearing in the Health Services Journal:
Senior Statistician=09=09=09
Circa. =A345,000=09=09=09=09=09=09=09ref: SS10
You'll lead and develop a small team of statisticians and analyst programme=
rs to provide appropriate and robust statistical and analytical services. =
An experienced professional with staff management skills, you'll select and=
apply the most suitable statistical techniques to CHI's work. As CHI evol=
ves, the development of new methods to support our role in performance asse=
ssment, clinical governance reviews, and other functions, will be needed. =
=20
You will have a degree in statistics or a related subject, knowledge of NHS=
data sets and experience of routinely collected data sets commonly used in=
health care research.
Statistician=09=09=09=09
Circa. =A335,000=09=09=09=09=09=09=09ref: S11
Working in a small team, you will be responsible for undertaking statistica=
l analyses of large, complex data sets and oversee the work of a team of an=
alysts/programmers.
You will implement improvements in the methods of analysis used by CHI in p=
erformance assessment, clinical governance reviews and other functions. Yo=
u will have a degree in statistics or a related subject, be familiar with a=
range of statistical software (eg SAS, SPSS, STATA and GLIM) and have soun=
d analytical skills.
To request an application pack, which will include full job descriptions an=
d role specific criteria, please call our recruitment line on 0870 4422574.=
Lines are open between 8am-7pm Monday to Friday and 9am-2pm on Saturdays (=
answerphone out of these hours). Please quote reference numbers. Email:chi@=
kads.co.uk
Closing date for completed applications: 22nd August 2002
For further opportunities please visit www.chi.nhs.uk
CHI welcomes applicants from all sections of the community, regardless of g=
ender, race, disability or age.
=========================================================================
Date: Mon, 12 Aug 2002 16:13:22 +0100
Reply-To: "Roberts, Carol" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Roberts, Carol" <[log in to unmask]>
Subject: re email mailing list
MIME-Version: 1.0
Content-Type: text/plain
Hello, would you be so kind as to add me to your email mailing list?
Many thanks
Carol Roberts
Carol Roberts
Project Development Manager
Eastbourne Sure Start
01323 415963
=========================================================================
Date: Tue, 13 Aug 2002 16:41:46 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: GeoHealth 2002
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
-----Original Message-----
From: Jan Rigby [mailto:[log in to unmask]]
Please excuse the inevitable cross-postings
Planning for GeoHealth 2002 is well underway. Details on the Call for
Papers, Registration and Accommodation are all available from the web =
site
www.geohealth.org.nz. Please note that the deadline for abstracts is 31
August, so we look forward to hearing from you soon.
All good wishes
Jan Rigby & Chris Skelly
([log in to unmask])
=========================================================================
Date: Wed, 14 Aug 2002 09:58:38 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: Evaluation of pilot scheme to treat Enlglish patients in the
EU/EEA
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Dear Colleagues
Apologies for any cross posting
York Health Economics Consortium were commissioned by the English =
Department of Health to conduct an evaluation of the pilot scheme in =
England to send patients to other parts of the EU/EEA for treatment.
The report by Karin Lowson, Peter West, Stephen Chaplin and Jacqueline =
O'Reilly can now be freely accessed at=20
http://www.doh.gov.uk/international/report02.pdf
There is also a report on the BBC website relating to publication of the =
report with some reactions from various parties. This is at
http://news.bbc.co.uk/1/hi/health/2190251.stm
I've also attached below brief iinital information from background =
section of report.
Best wishes
David McDaid
LSE Health and Social Care
Background
Following European Court of Justice (ECJ) rulings in July 2001, patients =
in the UK are
entitled to receive hospital care in other countries in the European =
Economic Area (which
comprises the European Union, Iceland, Norway and Liechtenstein). =
Therefore, healthcare
organisations in the UK, for example, health authorities (HA), Primary =
Care Trusts (PCTs)
and Trusts, may commission treatment from other healthcare organisations =
within the EU.
To this end, the Department of Health has been working with three pilot =
sites in the South-
East of England to address the clinical, legal and quality issues =
involved in sending patients
to other EU countries for treatment. The aim of the project was to =
implement processes and
thence to publish guidance for the NHS.
York Health Economics Consortium (YHEC Ltd) was commissioned by the =
Department of
Health to design and undertake the evaluation. The timetable for the =
evaluation was
determined primarily by the time taken to arrange overseas treatment.
Evaluation Framework
The terms of reference from the Department of Health (DoH) for the =
evaluation focused on
the process of the treatment rather than the outcome. The aim of the =
evaluation was to
produce a descriptive report on the test-bed sites, including the =
experiences of the key groups
of participants, as well as an appraisal of the processes used. Key =
questions from the
Department of Health were:
What aspect of the process have stakeholders found worked well/badly?
How highly do patients rate the non-clinical side of the care provided?
How highly do the commissioners rate the non-clinical care provided?
Where can processes be improved for the benefit of patients?
How seamless has the care provided been?
Was there clear understanding of relative roles and responsibilities?
Were the contractual arrangements clear?
In what ways could the processes be improved?
=========================================================================
Date: Wed, 14 Aug 2002 11:16:22 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: Housing and inequalities in Health / Glossary for health
inequalities
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Dear Colleagues
A quick note to let you know that the latest issue of the JECH has an =
editorial and research report on the realtionship between housing and =
inequalities in health status. Also a glossary on health inequalities.
Information provided below on selected articles . Full table of contents =
for the journal can be accessed at
http://jech.bmjjournals.com/content/vol56/issue9/index.shtml
Best wishes
David
David McDaid
LSE Health and Social Care
J Epidemiol Community Health Table of Contents for 1 September 2002; =
Vol. 56, No. 9
-----------------------------------------------------------------
Editorials
-----------------------------------------------------------------
Housing and inequalities in health
P Howden-Chapman
J Epidemiol Community Health 2002;56 645-646
=20
-----------------------------------------------------------------
Glossary
-----------------------------------------------------------------
A glossary for health inequalities
I Kawachi, S V Subramanian, and N Almeida-Filho
J Epidemiol Community Health 2002;56 647-652
http://jech.bmjjournals.com/cgi/content/abstract/56/9/647
-----------------------------------------------------------------
Research reports
-----------------------------------------------------------------
Housing and inequalities in health: a study of socioeconomic dimensions =
of=20
housing and self reported health from a survey of Vancouver residents
J R Dunn
J Epidemiol Community Health 2002;56 671-681
http://jech.bmjjournals.com/cgi/content/abstract/56/9/671
=========================================================================
Date: Wed, 14 Aug 2002 12:14:15 +0200
Reply-To: Jan De Maeseneer <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: Jan De Maeseneer <[log in to unmask]>
Subject: Fw: SES and the doctor-patient communication
MIME-Version: 1.0
Content-Type: multipart/alternative;
boundary="----=_NextPart_000_0008_01C2438C.1B3D9BA0"
This is a multi-part message in MIME format.
------=_NextPart_000_0008_01C2438C.1B3D9BA0
Content-Type: text/plain;
charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
----- Original Message -----=20
From: Jan De Maeseneer=20
To: [log in to unmask]
Sent: Friday, August 02, 2002 4:25 PM
Subject: SES and the doctor-patient communication
Dear Mr. Oliver,
I work as a PhD and assistent at the University of Ghent. In february =
this year I received a scholarship for a project about the influence of =
the socio-economic status of patients on the doctor-patient =
communication. The aim is to review the literature and to use the =
Eurocom Study-database to perform a quantitative study on this subject. =
Unfortunately, little has been published concerning this particular part =
of inequalities in health.=20
I performed a thourough search using Pubmed and journal databases, now I =
am writing this email to several people who I think might have =
interesting articles or other links that could help me.=20
Would you be so kind as to consider my question?
Any tips can be send to my private email: [log in to unmask]
Thank you for your cooperation!
Dr. St=E9phanie De Maesschalck
Vakgroep Huisartsgeneeskunde=20
en Eerstelijnsgezondheidszorg.
Department of General Practice and Primary Health Care.
U.Z. - 1K3
De Pintelaan 185
B-9000 Gent
Tel: ++32 9 240 35 42
Fax: ++32 9 240 49 67
e-mail: [log in to unmask]
------=_NextPart_000_0008_01C2438C.1B3D9BA0
Content-Type: text/html;
charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML><HEAD>
<META http-equiv=3DContent-Type content=3D"text/html; =
charset=3Diso-8859-1">
<META content=3D"MSHTML 6.00.2600.0" name=3DGENERATOR>
<STYLE></STYLE>
</HEAD>
<BODY bgColor=3D#d6e6f8>
<DIV> </DIV>
<DIV><FONT size=3D2></FONT> </DIV>
<DIV> </DIV>
<DIV>----- Original Message ----- </DIV>
<DIV style=3D"FONT: 10pt arial">
<DIV style=3D"BACKGROUND: #e4e4e4; font-color: black"><B>From:</B> <A=20
[log in to unmask] =
href=3D"mailto:[log in to unmask]">Jan De=20
Maeseneer</A> </DIV>
<DIV><B>To:</B> <A [log in to unmask]
href=3D"mailto:[log in to unmask]">[log in to unmask]</A> </DIV>
<DIV><B>Sent:</B> Friday, August 02, 2002 4:25 PM</DIV>
<DIV><B>Subject:</B> SES and the doctor-patient =
communication</DIV></DIV>
<DIV><BR></DIV>
<DIV> </DIV>
<DIV>Dear Mr. Oliver,</DIV>
<DIV> </DIV>
<DIV>I work as a PhD and assistent at the University of Ghent. In =
february this=20
year I received a scholarship for a project about the influence of the=20
socio-economic status of patients on the doctor-patient communication. =
The aim=20
is to review the literature and to use the Eurocom Study-database to =
perform a=20
quantitative study on this subject. Unfortunately, little has been =
published=20
concerning this particular part of inequalities in health. </DIV>
<DIV>I performed a thourough search using Pubmed and journal databases, =
now I am=20
writing this email to several people who I think might have interesting =
articles=20
or other links that could help me. </DIV>
<DIV>Would you be so kind as to consider my question?</DIV>
<DIV>Any tips can be send to my private email: <A=20
href=3D"mailto:[log in to unmask]">[log in to unmask]</A></DI=
V>
<DIV> </DIV>
<DIV>Thank you for your cooperation!</DIV>
<DIV> </DIV>
<DIV>Dr. St=E9phanie De Maesschalck</DIV>
<DIV> </DIV>
<DIV>Vakgroep Huisartsgeneeskunde <BR>en =
Eerstelijnsgezondheidszorg.</DIV>
<DIV> </DIV>
<DIV>Department of General Practice and Primary Health Care.<BR>U.Z. - =
1K3<BR>De=20
Pintelaan 185<BR>B-9000 Gent</DIV>
<DIV> </DIV>
<DIV><BR>Tel: ++32 9 240 35 42<BR>Fax: ++32 9 240 49 67<BR>e-mail: <A=20
href=3D"mailto:[log in to unmask]">[log in to unmask]</A></=
DIV></BODY></HTML>
------=_NextPart_000_0008_01C2438C.1B3D9BA0--
=========================================================================
Date: Wed, 14 Aug 2002 09:53:04 -0400
Reply-To: Barbara Krimgold <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: Barbara Krimgold <[log in to unmask]>
Subject: Re: SES and the doctor-patient communication
Comments: To: Jan De Maeseneer <[log in to unmask]>
MIME-Version: 1.0
Content-Type: multipart/alternative;
boundary="----_=_NextPart_001_01C24399.EC2D6350"
This message is in MIME format. Since your mail reader does not understand
this format, some or all of this message may not be legible.
------_=_NextPart_001_01C24399.EC2D6350
Content-Type: text/plain;
charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
You might look at work in the US around Race and Unequal Treatment,
in particular the recent study of the US Institute of Medicine, =
"Unequal
Treatment:
Confronting Racial and Ethnic Disparities in Health Care." In the US, =
we
have a goal, in our governmental health document, Healthy People 2010,
of eliminating health disparities by race/ethnicity, gender and income/
socioeconomic status. Since the US does not always collect data by
class/SES, much of our literature -- literally hundreds of studies of
differential treatment for cancer and cardiovascular disease, etc --
uses race as a proxy for class (plus other discriminatory treatment)
and documents unequal treatment by race.=20
=20
This might provide a comparison to your work in the EU on =
doctor-patient
communication by SES, the "white coat" phenomenon etc.
=20
If you find this idea of interest, you can find the study on the IOM
website,
www.nas.edu <http://www.nas.edu> . Look under www.nas.edu/health
<http://www.nas.edu/health> and you will find the=20
executive summary of the report which you can read or order online,
if you find it of interest.
=20
Best regards,
=20
Barbara Krimgold
Center for the Advancement of Health
2000 Florida Ave. NW, Suite 210
Washington, DC 20009
Tel: 202-387-2829 ext. 109
Fax: 202-387-2857
[log in to unmask] <mailto:[log in to unmask]>=20
=20
=20
-----Original Message-----
From: Jan De Maeseneer [mailto:[log in to unmask]]
Sent: Wednesday, August 14, 2002 6:14 AM
To: [log in to unmask]
Subject: Fw: SES and the doctor-patient communication
=20
=20
=20
----- Original Message -----=20
From: Jan De <mailto:[log in to unmask]> Maeseneer=20
To: [log in to unmask] <mailto:[log in to unmask]> =20
Sent: Friday, August 02, 2002 4:25 PM
Subject: SES and the doctor-patient communication
=20
Dear Mr. Oliver,
=20
I work as a PhD and assistent at the University of Ghent. In february =
this
year I received a scholarship for a project about the influence of the
socio-economic status of patients on the doctor-patient communication. =
The
aim is to review the literature and to use the Eurocom Study-database =
to
perform a quantitative study on this subject. Unfortunately, little has =
been
published concerning this particular part of inequalities in health.=20
I performed a thourough search using Pubmed and journal databases, now =
I am
writing this email to several people who I think might have interesting
articles or other links that could help me.=20
Would you be so kind as to consider my question?
Any tips can be send to my private email: [log in to unmask]
<mailto:[log in to unmask]>=20
=20
Thank you for your cooperation!
=20
Dr. St=E9phanie De Maesschalck
=20
Vakgroep Huisartsgeneeskunde=20
en Eerstelijnsgezondheidszorg.
=20
Department of General Practice and Primary Health Care.
U.Z. - 1K3
De Pintelaan 185
B-9000 Gent
=20
Tel: ++32 9 240 35 42
Fax: ++32 9 240 49 67
e-mail: [log in to unmask] <mailto:[log in to unmask]>=20
------_=_NextPart_001_01C24399.EC2D6350
Content-Type: text/html;
charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
X-MIME-Autoconverted: from 8bit to quoted-printable by ori.rl.ac.uk id g7EE1Vr25446
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML><HEAD>
<META HTTP-EQUIV=3D"Content-Type" CONTENT=3D"text/html; charset=3Diso-885=
9-1">
<META content=3D"MSHTML 5.50.4807.2300" name=3DGENERATOR>
<STYLE></STYLE>
</HEAD>
<BODY bgColor=3D#d6e6f8>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff size=3D2>You=20
might look at work in the US around Race and Unequal=20
Treatment,</FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff size=3D2>in=20
particular the recent study of the US Institute of Medicine, "Unequal=20
Treatment:</FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff=20
size=3D2>Confronting Racial and Ethnic Disparities in Health Care."  =
;In the=20
US, we</FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff=20
size=3D2>have a goal, in our governmental health document, Healthy People=
=20
2010,</FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff size=3D2>of=20
eliminating health disparities by race/ethnicity, gender and=20
income/</FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff=20
size=3D2>socioeconomic status. Since the US does not always collect=
data=20
by</FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff=20
size=3D2>class/SES, much of our literature -- literally hundreds of studi=
es=20
of</FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff=20
size=3D2>differential treatment for cancer and cardiovascular disease, et=
c=20
--</FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff=20
size=3D2>uses race as a proxy for class (plus other discriminatory=20
treatment)</FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff size=3D2>and=20
documents unequal treatment by race. </FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff=20
size=3D2></FONT></SPAN> </DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff=20
size=3D2>This might provide a comparison to your work in the EU on=20
doctor-patient</FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff=20
size=3D2>communication by SES, the "white coat" phenomenon=20
etc.</FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff=20
size=3D2></FONT></SPAN> </DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff size=3D2>If=20
you find this idea of interest, you can find the study on the IOM=20
website,</FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff size=3D2><A=20
href=3D"http://www.nas.edu">www.nas.edu</A>. Look under <A=20
href=3D"http://www.nas.edu/health">www.nas.edu/health</A> and you will fi=
nd the=20
</FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff=20
size=3D2>executive summary of the report which you can read or order=20
online,</FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff size=3D2>if=20
you find it of interest.</FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff=20
size=3D2></FONT></SPAN> </DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff=20
size=3D2>Best regards,</FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff=20
size=3D2></FONT></SPAN> </DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff size=3D2>
<P align=3Dleft><FONT face=3DRockwell color=3D#000080><FONT size=3D2>Barb=
ara=20
Krimgold</FONT></FONT><FONT face=3DRockwell><BR><FONT color=3D#000080 siz=
e=3D2>Center=20
for the Advancement of Health<BR>2000 Florida Ave. NW, Suite 210<BR>Washi=
ngton,=20
DC 20009<BR>Tel: 202-387-2829 ext. 109<BR>Fax:=20
202-387-2857</FONT></FONT><FONT face=3DRockwell></FONT></P>
<P align=3Dleft><FONT size=3D2><FONT face=3DRockwell color=3D#000080><A=20
href=3D"mailto:[log in to unmask]">[log in to unmask]</A><BR></P></FONT><=
/FONT></FONT></SPAN></DIV>
<DIV><SPAN class=3D080431114-14082002><FONT face=3DRockwell color=3D#0000=
ff=20
size=3D2></FONT></SPAN> </DIV>
<DIV><SPAN class=3D080431114-14082002></SPAN> </DIV>
<BLOCKQUOTE dir=3Dltr style=3D"MARGIN-RIGHT: 0px">
<DIV class=3DOutlookMessageHeader dir=3Dltr align=3Dleft><FONT face=3DT=
ahoma=20
size=3D2>-----Original Message-----<BR><B>From:</B> Jan De Maeseneer=20
[mailto:[log in to unmask]]<BR><B>Sent:</B> Wednesday, August 14=
, 2002=20
6:14 AM<BR><B>To:</B> [log in to unmask]<BR><B>Subjec=
t:</B>=20
Fw: SES and the doctor-patient communication<BR><BR></FONT></DIV>
<DIV> </DIV>
<DIV><FONT size=3D2></FONT> </DIV>
<DIV> </DIV>
<DIV>----- Original Message ----- </DIV>
<DIV style=3D"FONT: 10pt arial">
<DIV style=3D"BACKGROUND: #e4e4e4; font-color: black"><B>From:</B> <A=20
[log in to unmask] href=3D"mailto:[log in to unmask]
.be">Jan De=20
Maeseneer</A> </DIV>
<DIV><B>To:</B> <A [log in to unmask]
href=3D"mailto:[log in to unmask]">[log in to unmask]</A> </DIV>
<DIV><B>Sent:</B> Friday, August 02, 2002 4:25 PM</DIV>
<DIV><B>Subject:</B> SES and the doctor-patient communication</DIV></DI=
V>
<DIV><BR></DIV>
<DIV> </DIV>
<DIV>Dear Mr. Oliver,</DIV>
<DIV> </DIV>
<DIV>I work as a PhD and assistent at the University of Ghent. In febru=
ary=20
this year I received a scholarship for a project about the influence of=
the=20
socio-economic status of patients on the doctor-patient communication. =
The aim=20
is to review the literature and to use the Eurocom Study-database to pe=
rform a=20
quantitative study on this subject. Unfortunately, little has been publ=
ished=20
concerning this particular part of inequalities in health. </DIV>
<DIV>I performed a thourough search using Pubmed and journal databases,=
now I=20
am writing this email to several people who I think might have interest=
ing=20
articles or other links that could help me. </DIV>
<DIV>Would you be so kind as to consider my question?</DIV>
<DIV>Any tips can be send to my private email: <A=20
href=3D"mailto:[log in to unmask]">[log in to unmask]</A></=
DIV>
<DIV> </DIV>
<DIV>Thank you for your cooperation!</DIV>
<DIV> </DIV>
<DIV>Dr. St=E9phanie De Maesschalck</DIV>
<DIV> </DIV>
<DIV>Vakgroep Huisartsgeneeskunde <BR>en Eerstelijnsgezondheidszorg.</D=
IV>
<DIV> </DIV>
<DIV>Department of General Practice and Primary Health Care.<BR>U.Z. -=20
1K3<BR>De Pintelaan 185<BR>B-9000 Gent</DIV>
<DIV> </DIV>
<DIV><BR>Tel: ++32 9 240 35 42<BR>Fax: ++32 9 240 49 67<BR>e-mail: <A=20
href=3D"mailto:[log in to unmask]">[log in to unmask]</A>=
</DIV></BLOCKQUOTE></BODY></HTML>
------_=_NextPart_001_01C24399.EC2D6350--
=========================================================================
Date: Wed, 14 Aug 2002 16:18:41 +0100
Reply-To: "Oliver,AJ" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Oliver,AJ" <[log in to unmask]>
Subject: Re: SES and the doctor-patient communication
Comments: To: Barbara Krimgold <[log in to unmask]>
MIME-Version: 1.0
Content-Type: text/plain; charset="utf-8"
Content-Transfer-Encoding: base64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=========================================================================
Date: Wed, 14 Aug 2002 11:36:36 -0400
Reply-To: =?utf-8?B?QmFyYmFyYSBLcmltZ29sZA==?= <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: =?utf-8?B?QmFyYmFyYSBLcmltZ29sZA==?= <[log in to unmask]>
Subject: =?utf-8?B?UkU6IFNFUyBhbmQgdGhlIGRvY3Rvci1wYXRpZW50IGNvbW11bmlj?=
=?utf-8?B?YXRpb24=?=
Comments: To: =?utf-8?B?J09saXZlcixBSic=?= <[log in to unmask]>
MIME-Version: 1.0
Content-Type: text/plain; charset="utf-8"
Content-Transfer-Encoding: quoted-printable
Dear Adam,
This is not lobbying. This is part of the US Department of Health and Hu=
man
Services (DHHS) Report,=20
Healthy People 2010, which guides US health policy for the decade. The g=
oal
-- whatever you
or others may think of its feasibility -- is the elimination of health
disparities by race/ethnicity,
gender and income/socioeconomic status. Our previous Surgeon General, Dr.
David Satcher,=20
promulgated this goal -- along with several disease-oriented objectives -=
-
and the DHHS has research
programs, Centers of Excellence, and intervention demonstration programs =
--
focused on disparities
by socioeconomic status, gender and/or race ethnicity -- underway to purs=
ue
this goal. =20
While some researchers acknowledge, as you do, that this goal may be
"impossible" to achieve,=20
many policy officials involved in establishing this policy for DHHS Healt=
hy
People 2010 believed=20
it was important, as Martin Luther King's "I have a Dream" speech was
important, to have a goal=20
to reach for, a real vision of fairness in health -- which makes it
different from other Healthy People=20
2010 incremental disease-oriented goals,which may be more amenable to hea=
lth
care interventions.
Of course, the goal of eliminating health disparities implies reducing
differential outcomes.
At the DHHS minority health summit in June, there were panels on 1) Do We
Know What We Need to
Know to Reduce Disparities in Healthcare Access? and 2) Do We Know What =
We
Need to Know to Reduce
Disparities in Health Outcomes? These are two quite different issues &
research areas in the US.
The Institute of Medicine Report, not official policy but our highly
regarded medical research part of
our National Academy of Sciences, released their report "Unequal Treatmen=
t:
Confronting Racial and
Ethnic Disparities in Health Care" this spring, a report on differential
treatment in the health care sector,
also with differential outcomes, attributable not to lack of insurance, b=
ut
to differences in health care.
We realize that health treatment disparities are an important part of -- =
but
clearly not the only factor in=20
health disparities.
In short, I didnt make this up, and it is not lobbying, although it is
certainly advocacy for more equity in health --
in US health care, in health policy, in social & economic policy. The g=
oal
is part of official US DHHS policy goals,=20
however unrealistic it might seem to you -- or to others in the UK or EU.
In the US, I would be the first to admit, we have some gaps between our
ideals and our policy & practice.
Barbara
Barbara Krimgold
Center for the Advancement of Health
2000 Florida Ave. NW, Suite 210
Washington, DC 20009
Tel: 202-387-2829 ext. 109
Fax: 202-387-2857
[log in to unmask] <mailto:[log in to unmask]>=20
-----Original Message-----
-----Original Message-----
From: Oliver,AJ [mailto:[log in to unmask]]
Sent: Wednesday, August 14, 2002 11:19 AM
To: [log in to unmask]
Subject: Re: SES and the doctor-patient communication
Dear Barbara,
=20
I don't mean to sound awkward, but isn't the goal of "eliminating health
disparities by race/ethnicity, gender and income/socioeconomic status"
verging on the ridiculous.
=20
What sort of disparities? (e.g access, utilisation or outcome? Did you me=
an
'health' or 'health care')
=20
How can they possibly be eliminated by 2010? (there's hardly any proven,
effective policies to reduce disparities in health)
=20
And won't at least some of the disparities possibly be equitable (i.e.
arising from choice)?
=20
Perhaps its just me, but I see the creation of equitable societies as roo=
ted
in ethics and social science rather than lobbying.
=20
Adam
-----Original Message-----=20
From: Barbara Krimgold [mailto:[log in to unmask]]=20
Sent: Wed 8/14/2002 2:53 PM=20
To: [log in to unmask]
Cc:=20
Subject: Re: SES and the doctor-patient communication
=09
=09
You might look at work in the US around Race and Unequal Treatment,
in particular the recent study of the US Institute of Medicine,
"Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health Care." In the
US, we
have a goal, in our governmental health document, Healthy People
2010,
of eliminating health disparities by race/ethnicity, gender and
income/
socioeconomic status. Since the US does not always collect data by
class/SES, much of our literature -- literally hundreds of studies
of
differential treatment for cancer and cardiovascular disease, etc --
uses race as a proxy for class (plus other discriminatory treatment)
and documents unequal treatment by race.=20
=20
This might provide a comparison to your work in the EU on
doctor-patient
communication by SES, the "white coat" phenomenon etc.
=20
If you find this idea of interest, you can find the study on the IOM
website,
www.nas.edu. Look under www.nas.edu/health and you will find the=20
executive summary of the report which you can read or order online,
if you find it of interest.
=20
Best regards,
=20
Barbara Krimgold
Center for the Advancement of Health
2000 Florida Ave. NW, Suite 210
Washington, DC 20009
Tel: 202-387-2829 ext. 109
Fax: 202-387-2857
[log in to unmask]
=09
=20
=20
-----Original Message-----
From: Jan De Maeseneer [mailto:[log in to unmask]]
Sent: Wednesday, August 14, 2002 6:14 AM
To: [log in to unmask]
Subject: Fw: SES and the doctor-patient communication
=09
=09
=20
=20
=20
----- Original Message -----=20
From: Jan De Maeseneer <mailto:[log in to unmask]> =20
To: [log in to unmask]
Sent: Friday, August 02, 2002 4:25 PM
Subject: SES and the doctor-patient communication
=20
Dear Mr. Oliver,
=20
I work as a PhD and assistent at the University of Ghent. In
february this year I received a scholarship for a project about the
influence of the socio-economic status of patients on the doctor-patient
communication. The aim is to review the literature and to use the Eurocom
Study-database to perform a quantitative study on this subject.
Unfortunately, little has been published concerning this particular part =
of
inequalities in health.=20
I performed a thourough search using Pubmed and journal
databases, now I am writing this email to several people who I think migh=
t
have interesting articles or other links that could help me.=20
Would you be so kind as to consider my question?
Any tips can be send to my private email:
[log in to unmask]
=20
Thank you for your cooperation!
=20
Dr. St=C3=A9phanie De Maesschalck
=20
Vakgroep Huisartsgeneeskunde=20
en Eerstelijnsgezondheidszorg.
=20
Department of General Practice and Primary Health Care.
U.Z. - 1K3
De Pintelaan 185
B-9000 Gent
=20
Tel: ++32 9 240 35 42
Fax: ++32 9 240 49 67
e-mail: [log in to unmask]
=========================================================================
Date: Wed, 14 Aug 2002 16:59:38 +0100
Reply-To: "Oliver,AJ" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Oliver,AJ" <[log in to unmask]>
Subject: Re: SES and the doctor-patient communication
Comments: To: Barbara Krimgold <[log in to unmask]>
MIME-Version: 1.0
Content-Type: text/plain; charset="utf-8"
Content-Transfer-Encoding: base64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=========================================================================
Date: Wed, 14 Aug 2002 12:01:12 -0400
Reply-To: =?utf-8?B?QmFyYmFyYSBLcmltZ29sZA==?= <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: =?utf-8?B?QmFyYmFyYSBLcmltZ29sZA==?= <[log in to unmask]>
Subject: =?utf-8?B?UkU6IFNFUyBhbmQgdGhlIGRvY3Rvci1wYXRpZW50IGNvbW11bmlj?=
=?utf-8?B?YXRpb24=?=
Comments: To: =?utf-8?B?J09saXZlcixBSic=?= <[log in to unmask]>
MIME-Version: 1.0
Content-Type: text/plain; charset="utf-8"
Content-Transfer-Encoding: quoted-printable
Adam,
And I thank you. Creating a more equitable society sounds to me like "a
great rallying cry."
In a country that really places a high value on competition, individual
initiative/responsibility,
and winner-take all rewards, and that basically believes economic inequal=
ity
fuels the
motor of a dynamic economy, creating a more equitable society sounds as
"impossible" as the
goal of "eliminating health disparities." =20
Anyway, neither are easy nor do I expect either to be achieved in the sho=
rt
term in the US --=20
but that doesnt mean it isnt worth working toward both of those goals.
Barbara
-----Original Message-----
From: Oliver,AJ [mailto:[log in to unmask]]
Sent: Wednesday, August 14, 2002 12:00 PM
To: [log in to unmask]
Subject: Re: SES and the doctor-patient communication
Barbara
Thanks for your message. I think a first point a call, however, that I do=
n't
think you mention in your reply, is "do we know why, which and to what
extent we wish to reduce health disparities". Of course, calling for the
elimination of health disparities is a great rallying cry (not least beca=
use
many people - I think incorrectly - equate inequality with inequity), but=
it
might not have that much to do with creating a more equitable society. =20
-----Original Message-----=20
From: Barbara Krimgold [mailto:[log in to unmask]]=20
Sent: Wed 8/14/2002 4:36 PM=20
To: [log in to unmask]
Cc:=20
Subject: RE: SES and the doctor-patient communication
=09
=09
Dear Adam,
=09
This is not lobbying. This is part of the US Department of Health
and Human
Services (DHHS) Report,
Healthy People 2010, which guides US health policy for the decade.
The goal
-- whatever you
or others may think of its feasibility -- is the elimination of
health
disparities by race/ethnicity,
gender and income/socioeconomic status. Our previous Surgeon
General, Dr.
David Satcher,
promulgated this goal -- along with several disease-oriented
objectives --
and the DHHS has research
programs, Centers of Excellence, and intervention demonstration
programs --
focused on disparities
by socioeconomic status, gender and/or race ethnicity -- underway to
pursue
this goal.=20
=09
While some researchers acknowledge, as you do, that this goal may be
"impossible" to achieve,
many policy officials involved in establishing this policy for DHHS
Healthy
People 2010 believed
it was important, as Martin Luther King's "I have a Dream" speech
was
important, to have a goal
to reach for, a real vision of fairness in health -- which makes it
different from other Healthy People
2010 incremental disease-oriented goals,which may be more amenable
to health
care interventions.
=09
Of course, the goal of eliminating health disparities implies
reducing
differential outcomes.
At the DHHS minority health summit in June, there were panels on 1)
Do We
Know What We Need to
Know to Reduce Disparities in Healthcare Access? and 2) Do We Know
What We
Need to Know to Reduce
Disparities in Health Outcomes? These are two quite different
issues &
research areas in the US.
=09
The Institute of Medicine Report, not official policy but our highly
regarded medical research part of
our National Academy of Sciences, released their report "Unequal
Treatment:
Confronting Racial and
Ethnic Disparities in Health Care" this spring, a report on
differential
treatment in the health care sector,
also with differential outcomes, attributable not to lack of
insurance, but
to differences in health care.
We realize that health treatment disparities are an important part
of -- but
clearly not the only factor in
health disparities.
=09
In short, I didnt make this up, and it is not lobbying, although it
is
certainly advocacy for more equity in health --
in US health care, in health policy, in social & economic policy.
The goal
is part of official US DHHS policy goals,
however unrealistic it might seem to you -- or to others in the UK
or EU.
=09
In the US, I would be the first to admit, we have some gaps between
our
ideals and our policy & practice.
=09
Barbara
=09
Barbara Krimgold
Center for the Advancement of Health
2000 Florida Ave. NW, Suite 210
Washington, DC 20009
Tel: 202-387-2829 ext. 109
Fax: 202-387-2857
=09
[log in to unmask] <mailto:[log in to unmask]>
=09
=09
=09
-----Original Message-----
=09
-----Original Message-----
From: Oliver,AJ [mailto:[log in to unmask]]
Sent: Wednesday, August 14, 2002 11:19 AM
To: [log in to unmask]
Subject: Re: SES and the doctor-patient communication
=09
=09
Dear Barbara,
=09
I don't mean to sound awkward, but isn't the goal of "eliminating
health
disparities by race/ethnicity, gender and income/socioeconomic
status"
verging on the ridiculous.
=09
What sort of disparities? (e.g access, utilisation or outcome? Did
you mean
'health' or 'health care')
=09
How can they possibly be eliminated by 2010? (there's hardly any
proven,
effective policies to reduce disparities in health)
=09
And won't at least some of the disparities possibly be equitable
(i.e.
arising from choice)?
=09
Perhaps its just me, but I see the creation of equitable societies
as rooted
in ethics and social science rather than lobbying.
=09
Adam
=09
-----Original Message-----
From: Barbara Krimgold [mailto:[log in to unmask]]
Sent: Wed 8/14/2002 2:53 PM
To: [log in to unmask]
Cc:
Subject: Re: SES and the doctor-patient communication
=20
=20
You might look at work in the US around Race and Unequal
Treatment,
in particular the recent study of the US Institute of
Medicine,
"Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health Care."
In the
US, we
have a goal, in our governmental health document, Healthy
People
2010,
of eliminating health disparities by race/ethnicity, gender
and
income/
socioeconomic status. Since the US does not always collect
data by
class/SES, much of our literature -- literally hundreds of
studies
of
differential treatment for cancer and cardiovascular
disease, etc --
uses race as a proxy for class (plus other discriminatory
treatment)
and documents unequal treatment by race.
=20
This might provide a comparison to your work in the EU on
doctor-patient
communication by SES, the "white coat" phenomenon etc.
=20
If you find this idea of interest, you can find the study on
the IOM
website,
www.nas.edu. Look under www.nas.edu/health and you will
find the
executive summary of the report which you can read or order
online,
if you find it of interest.
=20
Best regards,
=20
Barbara Krimgold
Center for the Advancement of Health
2000 Florida Ave. NW, Suite 210
Washington, DC 20009
Tel: 202-387-2829 ext. 109
Fax: 202-387-2857
=09
[log in to unmask]
=20
=09
=20
=20
=09
-----Original Message-----
From: Jan De Maeseneer
[mailto:[log in to unmask]]
Sent: Wednesday, August 14, 2002 6:14 AM
To: [log in to unmask]
Subject: Fw: SES and the doctor-patient
communication
=20
=20
=20
=20
=20
----- Original Message -----
From: Jan De Maeseneer
<mailto:[log in to unmask]>=20
To: [log in to unmask]
Sent: Friday, August 02, 2002 4:25 PM
Subject: SES and the doctor-patient communication
=09
=20
Dear Mr. Oliver,
=20
I work as a PhD and assistent at the University of
Ghent. In
february this year I received a scholarship for a project about the
influence of the socio-economic status of patients on the
doctor-patient
communication. The aim is to review the literature and to use the
Eurocom
Study-database to perform a quantitative study on this subject.
Unfortunately, little has been published concerning this particular
part of
inequalities in health.
I performed a thourough search using Pubmed and
journal
databases, now I am writing this email to several people who I think
might
have interesting articles or other links that could help me.
Would you be so kind as to consider my question?
Any tips can be send to my private email:
[log in to unmask]
=20
Thank you for your cooperation!
=20
Dr. St=C3=A9phanie De Maesschalck
=20
Vakgroep Huisartsgeneeskunde
en Eerstelijnsgezondheidszorg.
=20
Department of General Practice and Primary Health
Care.
U.Z. - 1K3
De Pintelaan 185
B-9000 Gent
=20
=09
Tel: ++32 9 240 35 42
Fax: ++32 9 240 49 67
e-mail: [log in to unmask]
=09
=========================================================================
Date: Wed, 14 Aug 2002 13:11:00 -0400
Reply-To: [log in to unmask]
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Victor W. Sidel" <[log in to unmask]>
Subject: Re: Fw: SES and the doctor-patient communication
Comments: To: Jan De Maeseneer <[log in to unmask]>
Dr. Stéphanie De Maesschalck
Your may find useful Dr. Howard Waitzkin's book, The Politics of Medical
Encounters: How Patients and Doctors Deal with Social Problems.
Victor Sidel
On Wed, 14 Aug 2002 12:14:15 +0200 Jan De Maeseneer
<[log in to unmask]> wrote:
----- Original Message -----
From: <A
[log in to unmask] href="mailto:[log in to unmask]">Jan De
Maeseneer</A>
To: <A [log in to unmask]
href="mailto:[log in to unmask]">[log in to unmask]</A>
Sent: Friday, August 02, 2002 4:25 PM
Subject: SES and the doctor-patient communication
Dear Mr. Oliver,
I work as a PhD and assistent at the University of Ghent. In february this
year I received a scholarship for a project about the influence of the
socio-economic status of patients on the doctor-patient communication. The aim
is to review the literature and to use the Eurocom Study-database to perform a
quantitative study on this subject. Unfortunately, little has been published
concerning this particular part of inequalities in health.
I performed a thourough search using Pubmed and journal databases, now I am
writing this email to several people who I think might have interesting
articles
or other links that could help me.
Would you be so kind as to consider my question?
Any tips can be send to my private email: <A
href="mailto:[log in to unmask]">[log in to unmask]</A>
Thank you for your cooperation!
Dr. Stéphanie De Maesschalck
Vakgroep Huisartsgeneeskunde
en Eerstelijnsgezondheidszorg.
Department of General Practice and Primary Health Care.
U.Z. - 1K3
De
Pintelaan 185
B-9000 Gent
Tel: ++32 9 240 35 42
Fax: ++32 9 240 49 67
e-mail: <A
href="mailto:[log in to unmask]">[log in to unmask]</A>
=========================================================================
Date: Wed, 14 Aug 2002 18:50:44 +0100
Reply-To: Mel Bartley <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: Mel Bartley <[log in to unmask]>
Subject: Re: SES and the doctor-patient communication
Comments: To: "Oliver,AJ" <[log in to unmask]>,
Barbara Krimgold <[log in to unmask]>
MIME-Version: 1.0
Content-Type: text/plain; charset="utf-8"
Content-Transfer-Encoding: 8bit
It seems so easy to confuse health differences with health inequalities and
health inequities. I am sure no-one regards health differences between
smokers and non smokers as inequitable and maybe not unequal
in any very interesting way. But a life expectancy difference of nine
years between people in professional and higher management jobs and
those in unskilled manual jobs (and their families, in fact the differences
are if anything greater in wives of such men, at least for heart disease)
does seem to be to be both unequal and inequitable. I cannot for the
life of me think of any reason why a person would choose to have a
poorly paid, arduous and hazardous job, and the numbers of sons of
professionals/managers who are found in such jobs is miniscule. So if we
are talking about health differences between those with more well paid
jobs in better working conditions and those with poorly paid jobs in
worse working conditions, can we agree that this is an inequity?
Mel
> Barbara
> Thanks for your message. I think a first point a call, however, that I
don't think you mention in your reply, is "do we know why, which and to what
extent we wish to reduce health disparities". Of course, calling for the
elimination of health disparities is a great rallying cry (not least because
many people - I think incorrectly - equate inequality with inequity), but it
might not have that much to do with creating a more equitable society.
>
> -----Original Message-----
> From: Barbara Krimgold [mailto:[log in to unmask]]
> Sent: Wed 8/14/2002 4:36 PM
> To: [log in to unmask]
> Cc:
> Subject: RE: SES and the doctor-patient communication
>
>
>
> Dear Adam,
>
> This is not lobbying. This is part of the US Department of Health and
Human
> Services (DHHS) Report,
> Healthy People 2010, which guides US health policy for the decade. The
goal
> -- whatever you
> or others may think of its feasibility -- is the elimination of health
> disparities by race/ethnicity,
> gender and income/socioeconomic status. Our previous Surgeon General, Dr.
> David Satcher,
> promulgated this goal -- along with several disease-oriented objectives --
> and the DHHS has research
> programs, Centers of Excellence, and intervention demonstration
programs --
> focused on disparities
> by socioeconomic status, gender and/or race ethnicity -- underway to
pursue
> this goal.
>
> While some researchers acknowledge, as you do, that this goal may be
> "impossible" to achieve,
> many policy officials involved in establishing this policy for DHHS
Healthy
> People 2010 believed
> it was important, as Martin Luther King's "I have a Dream" speech was
> important, to have a goal
> to reach for, a real vision of fairness in health -- which makes it
> different from other Healthy People
> 2010 incremental disease-oriented goals,which may be more amenable to
health
> care interventions.
>
> Of course, the goal of eliminating health disparities implies reducing
> differential outcomes.
> At the DHHS minority health summit in June, there were panels on 1) Do We
> Know What We Need to
> Know to Reduce Disparities in Healthcare Access? and 2) Do We Know What
We
> Need to Know to Reduce
> Disparities in Health Outcomes? These are two quite different issues &
> research areas in the US.
>
> The Institute of Medicine Report, not official policy but our highly
> regarded medical research part of
> our National Academy of Sciences, released their report "Unequal
Treatment:
> Confronting Racial and
> Ethnic Disparities in Health Care" this spring, a report on differential
> treatment in the health care sector,
> also with differential outcomes, attributable not to lack of insurance,
but
> to differences in health care.
> We realize that health treatment disparities are an important part of --
but
> clearly not the only factor in
> health disparities.
>
> In short, I didnt make this up, and it is not lobbying, although it is
> certainly advocacy for more equity in health --
> in US health care, in health policy, in social & economic policy. The
goal
> is part of official US DHHS policy goals,
> however unrealistic it might seem to you -- or to others in the UK or EU.
>
> In the US, I would be the first to admit, we have some gaps between our
> ideals and our policy & practice.
>
> Barbara
>
> Barbara Krimgold
> Center for the Advancement of Health
> 2000 Florida Ave. NW, Suite 210
> Washington, DC 20009
> Tel: 202-387-2829 ext. 109
> Fax: 202-387-2857
>
> [log in to unmask] <mailto:[log in to unmask]>
>
>
>
> -----Original Message-----
>
> -----Original Message-----
> From: Oliver,AJ [mailto:[log in to unmask]]
> Sent: Wednesday, August 14, 2002 11:19 AM
> To: [log in to unmask]
> Subject: Re: SES and the doctor-patient communication
>
>
> Dear Barbara,
>
> I don't mean to sound awkward, but isn't the goal of "eliminating health
> disparities by race/ethnicity, gender and income/socioeconomic status"
> verging on the ridiculous.
>
> What sort of disparities? (e.g access, utilisation or outcome? Did you
mean
> 'health' or 'health care')
>
> How can they possibly be eliminated by 2010? (there's hardly any proven,
> effective policies to reduce disparities in health)
>
> And won't at least some of the disparities possibly be equitable (i.e.
> arising from choice)?
>
> Perhaps its just me, but I see the creation of equitable societies as
rooted
> in ethics and social science rather than lobbying.
>
> Adam
>
> -----Original Message-----
> From: Barbara Krimgold [mailto:[log in to unmask]]
> Sent: Wed 8/14/2002 2:53 PM
> To: [log in to unmask]
> Cc:
> Subject: Re: SES and the doctor-patient communication
>
>
> You might look at work in the US around Race and Unequal
Treatment,
> in particular the recent study of the US Institute of Medicine,
> "Unequal Treatment:
> Confronting Racial and Ethnic Disparities in Health Care." In the
> US, we
> have a goal, in our governmental health document, Healthy People
> 2010,
> of eliminating health disparities by race/ethnicity, gender and
> income/
> socioeconomic status. Since the US does not always collect data
by
> class/SES, much of our literature -- literally hundreds of studies
> of
> differential treatment for cancer and cardiovascular disease,
etc --
> uses race as a proxy for class (plus other discriminatory
treatment)
> and documents unequal treatment by race.
>
> This might provide a comparison to your work in the EU on
> doctor-patient
> communication by SES, the "white coat" phenomenon etc.
>
> If you find this idea of interest, you can find the study on the
IOM
> website,
> www.nas.edu. Look under www.nas.edu/health and you will find the
> executive summary of the report which you can read or order
online,
> if you find it of interest.
>
> Best regards,
>
> Barbara Krimgold
> Center for the Advancement of Health
> 2000 Florida Ave. NW, Suite 210
> Washington, DC 20009
> Tel: 202-387-2829 ext. 109
> Fax: 202-387-2857
>
> [log in to unmask]
>
>
>
>
>
> -----Original Message-----
> From: Jan De Maeseneer [mailto:[log in to unmask]]
> Sent: Wednesday, August 14, 2002 6:14 AM
> To: [log in to unmask]
> Subject: Fw: SES and the doctor-patient communication
>
>
>
>
>
> ----- Original Message -----
> From: Jan De Maeseneer <mailto:[log in to unmask]>
> To: [log in to unmask]
> Sent: Friday, August 02, 2002 4:25 PM
> Subject: SES and the doctor-patient communication
>
>
> Dear Mr. Oliver,
>
> I work as a PhD and assistent at the University of Ghent.
In
> february this year I received a scholarship for a project about the
> influence of the socio-economic status of patients on the doctor-patient
> communication. The aim is to review the literature and to use the Eurocom
> Study-database to perform a quantitative study on this subject.
> Unfortunately, little has been published concerning this particular part
of
> inequalities in health.
> I performed a thourough search using Pubmed and journal
> databases, now I am writing this email to several people who I think might
> have interesting articles or other links that could help me.
> Would you be so kind as to consider my question?
> Any tips can be send to my private email:
> [log in to unmask]
>
> Thank you for your cooperation!
>
> Dr. StC)phanie De Maesschalck
>
> Vakgroep Huisartsgeneeskunde
> en Eerstelijnsgezondheidszorg.
>
> Department of General Practice and Primary Health Care.
> U.Z. - 1K3
> De Pintelaan 185
> B-9000 Gent
>
>
> Tel: ++32 9 240 35 42
> Fax: ++32 9 240 49 67
> e-mail: [log in to unmask]
>
>
>
=========================================================================
Date: Wed, 14 Aug 2002 19:33:40 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: Northern Ireland: Developing better services: modernising
hospitals - extension of consultation period
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Apologies for the inevitable cross posting
Dear Colleagues
The Minister for Health, Social Services and Public Safety ( An Roinn =
Sl=E1inte, Seirbhs=EDs=ED S=F3isialta agus S=E1bh=E1ilteachta Poibl=ED) =
in Northern Ireland Bairbre de Br=FAn, has extended the consultation =
period for Developing Better Services: Modernising Hospitals and =
Reforming Structures.
The deadline for receipt of responses is now 31st October.
The consultation paper sets out a model for future hospitals services =
and gives options for the changes in the administrative structures of =
the Health and Personal Social Services. It also makes an initial =
assessment of the equality implications of the changes and sets out the =
resources required and estimated timescale for implementation=20
The consultation paper is available on the DHSSPS website at:
http://www.dhsspsni.gov.uk/publications/2002/betterservices.html
I've attached foreward below.
Best wishes=20
David McDaid
LSE Health and Social Care
Foreward by Bairbre de Br=FAn
I commissioned a review of acute hospital services in August 2000, and =
asked the review group to make recommendations on the future profile of =
hospital services, taking account of issues of accessibility, safety, =
clinical standards and quality of services. The review was set up =
against a background of many years of under-funding of health services, =
which has undermined and weakened their capacity to deliver the quality =
of service demanded of a modern hospital system. My objective was to =
develop an agenda for a major, and long overdue, modernisation of the =
acute hospital system. The Executive has recognised the need to boost =
health and social care expenditure and has invested an additional =A3523 =
million in healthcare since the establishment of the Assembly. Of this, =
80% has been required merely to maintain existing services.=20
While this additional and much needed expenditure is welcome, extra =
spending alone is not the answer. To provide a modern hospital system =
that will meet the needs of all our people, well into the future, will =
require a fundamental change in the way services are delivered and =
administered. Otherwise we will see services continue to decline and =
fall behind standards elsewhere. In this paper I am setting out how I =
consider our hospital services need to be modernised and the decisions =
required to take these changes forward. My proposals are not about =
reducing acute services. Rather they aim to build upon the firm =
foundations of current services, to ensure that everyone will have =
prompt access to high quality acute care, delivered close to their homes =
wherever possible.
I would expect my proposals to bring about a new, modern and more =
effective hospital service, a service that is set up and resourced to =
meet the needs of the expected numbers of patients that it serves; =
deliver a world-class service with much improved outcomes, in areas such =
as cancer and heart disease; eliminate the problem of people waiting for =
admission and delayed discharges; meet peak demands without postponing =
normal activity; and substantially reduce waiting times, bringing them =
down to a maximum of three months for non-urgent cases, with priority =
cases treated much sooner.
Delivering quality care also demands organisational structures that are =
fit for purpose and equal to the challenges facing a modern health =
service. The need for organisational reform has been evident for some =
time, but the issues are complex. Before coming to decisions, I would =
like to consult as widely as possible on the options set out in this =
paper for structural change. I also want to take account of the emerging =
principles/criteria from the Executive's recently announced Review of =
Public Administration.
The acute hospitals review, now in its final stages, should not be seen =
in isolation. It is directly linked to work that I have commissioned =
covering: Investing in Health, which is the Executive's strategy for =
improving the health and well-being of the population; Building the Way =
Forward in Primary Care, a new approach to primary care; Best Practice, =
Best Care, which sets out proposals for improving the quality of =
services; and Review of Community Care - First Report, which is the =
first stage of a review of community care. Taken together, these =
initiatives form the main components of a unified and coherent approach =
to improving health and social services. I intend to bring them together =
in a new Regional Strategy, which will be published next year.
The Executive's 2002-2005 Programme for Government commits it to =
developing proposals for a modern acute hospital service, with the =
declared expectation of taking decisions on the way forward in the =
course of 2002. This is a challenging agenda for change, which will not =
be delivered overnight. However, we now have a robust strategy that will =
deliver a modern, caring, quality hospital and health care system. A =
system capable of delivering high-quality care and treatment
today, and well into the 21st century.
=========================================================================
Date: Wed, 14 Aug 2002 19:39:54 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: Northern Ireland: HEALTH ACTION ZONES TO CONTINUE
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Dear Colleagues
I've attached recent press release from Northern Ireland Department of =
Health, Social Services and Public Safety confirming continuing funding =
for Health Action Zones in Northern Ireland.
Best wishes
David McDaid
LSE Health and Social Care
Also available at=20
http://www.ni-executive.gov.uk/press/hss/020719c-hss.htm
HEALTH ACTION ZONES TO CONTINUE - DE BR=DAN=20
Minister for Health Social Services and Public Safety, Ms Bairbre de =
Br=FAn, has announced that the Health Action Zones in North and West =
Belfast and Armagh and Dungannon are to continue to be funded for a =
further 3 years to 2005.=20
Ms de Br=FAn said: "Investing for Health, the recently published public =
health strategy, emphasises the need to address inequalities in health =
by tackling the wider determinants of health through effective =
partnership working including community participation. The Health Action =
Zone approach is absolutely in tune with our aspirations for Investing =
for Health."=20
The Health Action Zones ( HAZ) in North and West Belfast and Armagh and =
Dungannon were established as a pilot initiative for three years in =
1999. The Zones were introduced with the aim of bringing organisations =
together to pool resources and expertise, to target health inequalities =
where there is evidence of disadvantage by implementing locally agreed =
strategies for improving health. Two further Zones were announced last =
year - one in each of the Northern and Western Health and Social =
Services Board areas.=20
The Minister continued: "While the first two Health Action Zones have =
made a real and positive contribution to tackling inequalities, problems =
still exist and need to be tackled - the real impact on health can only =
be seen in the longer term. Health Action Zones have an important =
contribution to make in bringing together key agencies and the community =
to plan jointly and tackle issues efficiently.=20
" Health Action Zones are developing the integrated approach advocated =
in Investing for Health. Their activities at a local level will =
contribute to the achievement of the objectives of not only of this =
Strategy but to other key Government priorities."=20
Commenting on the announcement, Richard Black, Chairman of the North and =
West Belfast Health Action Zone said: "We have learned a great deal in =
the first phase of our development, taken a few risks, made mistakes as =
well as delivered an ambitious programme.=20
"Developing and growing the partnership has been a key focus and has =
required a huge level of commitment and investment in terms of time and =
energy from all partners. Like all successful partnerships we have =
learned to listen, explore real difficulties faced by members and engage =
in opportunities for working closely together to address common goals.=20
"It has been a period of growing together that has challenged the =
Council Members to grasp the possibilities and genuinely commit to =
working together at the highest level. This has at times been inspiring. =
"We have examined our strategic priorities and identified the areas of =
common interest where need is greatest and where mutual co-operation =
will have the greatest impact."=20
Dr Jane Wilde , Chairperson of the Armagh and Dungannon Health Action =
Zone commented: "The HAZ partnership is building a cohesive community =
voice in an area which is deeply fragmented. This announcement provides =
a welcome vote of confidence to our partners in the Health Action Zone =
who are working tirelessly together to make a difference to the lives of =
local people in Armagh and Dungannon. We are seeing substantial evidence =
of the rewards to be gained by encouraging and supporting the community =
to improve their health and wellbeing."=20
Ms de Br=FAn concluded by saying: "I am pleased to be able to announce =
the continuation of support to the Health Action Zones in North and West =
Belfast and Armagh and Dungannon. This will enable them to run alongside =
the new Investing for Health Partnerships to assist on a practical level =
and play a key role in the successful implementation of Investing for =
Health both at a local level and in terms of the positive learning they =
can bring to others."=20
NOTES TO EDITORS:=20
The first two Health Action Zones in the North and West Belfast and =
Armagh and Dungannon districts were established in 1999 to tackle health =
improvement in a holistic way, brining together the main statutory, =
voluntary agencies and the community.=20
North and West Belfast HAZ has 3 main areas for action -=20
* Making sure that children up to the age of 12 years have a better =
start in life.=20
* Improving services for young people.=20
* Addressing health and social inequality through a community =
development approach.
Armagh and Dungannon HAZ programmes focus on:=20
* Rurality=20
* Housing=20
* Young people
The second phase of HAZ were announced last year. The Northern Board =
Zone focuses on a number of Housing Executive estate areas or =
neighbourhoods which have health and well-being issues in common. The =
other, in the Western Health Board area, aims to tackle poverty and =
older peoples issues.=20
Each HAZ receives core funding from DHSSPS of =A3150k per year for =
infrastructure costs.=20
Investing for Health is the recently published public health strategy. =
It contains a framework for action to improve health and well-being and =
reduce health inequalities which is based on partnership working amongst =
Departments, public bodies, local communities, voluntary bodies District =
Councils and the social partners.=20
Each HSS Board is working to establish an Investing for Health =
Partnership at Board area level to develop long term local =
cross-sectoral health improvement plans to address the identified health =
and well being needs of their local populations to meet the strategic =
aims and objectives of Investing for Health.
=========================================================================
Date: Thu, 15 Aug 2002 08:49:44 -0400
Reply-To: Dennis Raphael <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: Dennis Raphael <[log in to unmask]>
Subject: letter to editor
Mime-Version: 1.0
Content-type: text/plain; charset=us-ascii
Content-Disposition: inline
Dear Editor of the Toronto Star:
http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&c=Article&cid=1026144236487&call_page=TS_Health&call_pageid=968867505381&call_pagepath=Life/Health
The Toronto Star story on the increasing prevalence of diabetes among Ontarians
is indeed a wake-up call (Number of diabetics rises 31%, report says, August
15). However one significant piece of the puzzle was not mentioned by your
reporter. In the report it is noted that the prevalence rate of diabetes is
almost 400% greater among low income women as that seen among high income women.
Similarly, the rate for low income males is 40% higher, and among lower middle
income men 50% higher than well-off men , still significant figures. Diabetes
therefore appears --like heart disease -- to be an affliction of the poor and
insecure. Will governments -- and instititions like the Diabetes and Heart and
Stroke Foundation -- raise the issue of the increasing incidence of poverty in
addtion to the usual exhorations about changing lifestyles as means of
preventing these diseases?
Dennis Raphael, PhD
Associate Professor and Undergraduate Program Director
School of Health Policy and Management
Atkinson Faculty of Liberal and Professional Studies
York University
4700 Keele Street
Toronto, Ontario M3J 1P3
tel: 416-736-2100, ext. 22134
fax: 416-736-5227
email: [log in to unmask]
=========================================================================
Date: Fri, 16 Aug 2002 17:26:13 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: New Book: Engendering International Health: The Challenge of
Equity
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
FYI
David Mcdaid
LSE Health and Social Care
Engendering International Health
The Challenge of Equity
edited by Gita Sen, Asha George, and Piroska =D6stlin
Engendering International Health presents the work of leading
researchers on gender equity in international health. Growing economic
inequalities reinforce social injustices, stall health gains, and deny
good health to many. In particular, deep-seated gender biases in health
research and policy institutions combine with a lack of well-articulated
and accessible evidence to downgrade the importance of gender
perspectives in health. The book's central premise is that unless public
health changes direction, it cannot effectively address the needs of
those who are most marginalized, many of whom are women.
The book offers evidence and analysis for both low- and high-income
countries, providing a gender and health analysis cross-cut by a concern
for other markers of social inequity, such as class and race. It details
approaches and agendas that incorporate, but go beyond, commonly
acknowledged issues relating to women's health; and it brings gender and
equity analysis into the heart of the debates that dominate
international health policy.
Gita Sen is Sri Ratan Tata Chair Professor at the Indian Institute of
Management, Bangalore, India, and Adjunct Lecturer at the Harvard School
of Public Health. Asha George is a doctoral candidate at the Institute
of Development Studies, University of Sussex, and a Research Fellow at
the Harvard Center for Population and Development Studies. Piroska
=D6stlin is a Senior Researcher at the Karolinska Institute in Stockholm
and a Research Associate at the Harvard Center for Population and
Development Studies.
Contributors
Jill Astbury, Maggie Bangser, Nancy Breen, Maureen Butter, Jane
Cottingham, Asha George, Kara Hanson, Pamela Hartigan, Aditi Iyer,
Claudia Garcia Moreno, Cynthia Myntti, Piroska =D6stlin, Janet Price, =
Gita
Sen, Jacqueline Sims, Rachel Snow, Hilary Standing, Rachel Tolhurst.
6 x 9, 510 pp., 21 illus., paper ISBN 0-262-69273-2, cloth ISBN
0-262-19469-4
Basic Bioethics series
A Bradford Book
______________________
David Weininger
Associate Publicist
The MIT Press
5 Cambridge Center, 4th Floor
Cambridge, MA 02142
617 253 2079
617 253 1709 fax
http://mitpress.mit.edu
=========================================================================
Date: Sat, 17 Aug 2002 00:03:00 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: New Publication: Can Patient Self-Management Help Explain The SES
Health Gradient?
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Dear Colleagues
I've attached below a press Release from RAND Health on a new =
publication.
Best wishes
David McDaid
LSE Health and Social Care
Education Helps to Overcome Health Disparities
----------------------------------------------
Lower socioeconomic status has for some time been strongly linked with =
poorer health. A new study finds that education can be key--more =
important in influencing health than income, age, race, and gender.
More info at http://www.rand.org/rnb/0802/healtheducation.html
Goldman DP, Smith JP. Can Patient Self-Management Help Explain The SES =
Health Gradient? Proceedings of the National Academy of Sciences United =
States of America, Vol. 99, No. 16, August 6 2002, pp. 10929-10934.=20
There are large differences in health outcomes by socioeconomic status =
(SES) that cannot be explained fully by traditional arguments, such as =
access to care or poor health behaviors. We consider a different =
explanation--better self-management of disease by the more educated. We =
examine differences by education in treatment adherence among patients =
with two illnesses, diabetes and HIV, and then assess the subsequent =
impact of differential adherence on health status. One unique component =
of this research is that for diabetes we combine two different =
surveys--one cohort study and one randomized clinical trial--that are =
usually used exclusively by either biomedical or/and social scientists =
separately. For both illnesses, we find significant effects of adherence =
that are much stronger among patients with high SES. After controlling =
for other factors, more educated HIV+ patients are more likely to adhere =
to therapy, and this adherence made them experience improvements in =
their self-reported general health. Similarly, among diabetics, the less =
educated were much more likely to switch treatment, which led to =
worsening general health. In the randomized trial setting, intensive =
treatment regimens that compensated for poor adherence led to better =
improvements in glycemic control for the less educated. Among two =
distinct chronic illnesses, the ability to maintain a better health =
regimen is an important independent determinant of subsequent health =
outcomes. This finding is robust across clinical trial and =
population-based settings. Because this ability varies by schooling, =
self-maintenance is an important reason for the steep SES gradient in =
health outcomes.
=========================================================================
Date: Sat, 17 Aug 2002 06:33:02 -0400
Reply-To: Dennis Raphael <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: Dennis Raphael <[log in to unmask]>
Subject: Re: New Publication: Can Patient Self-Management Help Explain The
SES Health Gradient?
Comments: To: "Mcdaid,D" <[log in to unmask]>
Mime-Version: 1.0
Content-type: text/plain; charset=us-ascii
Content-Disposition: inline
This is "blaming the victim" taken to the most sosphisticated levels! Doesn't
explain the higher incidence of the disease in the first place though!
Dennis R.
=========================================================================
Date: Mon, 19 Aug 2002 11:13:28 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: New Discussion Papers released by Commission on Future of Health
Care in Canada
MIME-Version: 1.0
Content-Type: multipart/related;
boundary="----_=_NextPart_001_01C24769.0FDDB840";
type="multipart/alternative"
This is a multi-part message in MIME format.
------_=_NextPart_001_01C24769.0FDDB840
Content-Type: multipart/alternative;
boundary="----_=_NextPart_002_01C24769.0FDDB840"
------_=_NextPart_002_01C24769.0FDDB840
Content-Type: text/plain;
charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Dear Colleagues
A number of discussion papers on various aspects of the future of the =
Candian health care systems have been released by the Commission chaired =
by Roy Romanov this month., which may be of interest to some of you.
Titles below. Also links and info on contents of each DP. All freely =
available on-line. Info on the papers and links below
Best wishes
David McDaid
LSE Health and Social Care
More info below
Titles:
DP 9: Options for Raising Revenue for Health Care. Melissa Rode, Michael =
Rushton
DP 10: Funding and Production of Health Services: Outlook and Potential =
Solutions. Jean-Luc Migue
DP 11: The Conditions For A Sustainable Public Health System In Canada =
Louis Imbeau, Kina Chenard, Adriana Dudas
DP 12: Constitutional Jurisdiction Over Health And Health Care Services =
In Canada. Howard Leeson
DP 13: Strengthening the Foundations: Modernizing the Canada Health Act. =
Colleen Flood, Sujit Choudhry
DP 14: Influences on the "Health Care Technology Cost-Driver" Steve =
Morgan, Jerry Hurley
DP 15: Paying to Play? Government Financing and Health Care Agenda =
Setting Katherine Fierlbeck
Discussion Paper No. 9: Options for Raising Revenue for Health Care
Release Date: 2 August 2002
Meliss Rode, Michael Rushton, University of Regina
http://www.healthcarecommission.ca/Suite247/Common/GetMedia_WO.asp?MediaI=
D=3D934&Filename=3D9_Rode_E.pdf
Authors Rode and Rushton recommend a transfer of "tax room" to the =
provinces to ensure the stable funding of health care, and its =
providers, flowing from that level of government. "Since it is already =
likely the case that provinces rely more on corporate taxes than is =
efficient in a federation, and since it is difficult to use the personal =
income tax as a major instrument of income redistribution if devolved in =
a significant way to the provinces, sales taxes are the most promising =
avenue for change," says the paper. As a result, it concludes that =
Canada should follow the model used by the European Union and transfer =
the federal Goods and Services tax (GST) to the provinces.
Discussion Paper No. 10: Funding and Production of Health Services: =
Outlook and Potential Solutions
Release Date: 2 August 2002
Jean-Luc Migue, The Fraser Institute
http://www.healthcarecommission.ca/Suite247/Common/GetMedia_WO.asp?MediaI=
D=3D935&Filename=3D10_Migue_E.pdf
This paper, from a senior scholar at The Fraser Institute, begins with =
an examination of all the possible sources of funding for the Canadian =
health care system and ends with an argument in favour of the health =
savings account (or the tax credit) as the only way to assure consumer =
choice, cost-saving incentives and sustainability. "The unconditional =
assurance of obtaining health care, including for the most well-off, =
encourages people to adopt unhealthy behaviour and inflates costs," =
writes the author.
Discussion Paper No. 11: The Conditions For A Sustainable Public Health =
System In Canada
Release Date: 2 August 2002
Louis Imbeau, Kina Chenard, Adriana Dudas, Laval University
http://www.healthcarecommission.ca/Suite247/Common/GetMedia_WO.asp?MediaI=
D=3D936&Filename=3D11_Imbeau_E.pdf <<ole0.bmp>>=20
This paper notes that the "sustainability of the health system depends =
on the financial, organizational and epistemic capacity to respond =
adequately to the health needs of current generations without =
compromising the system's ability to meet the needs of future =
generations". This capacity is being influenced by two competing agendas =
- one supporting more privatization in health care and the other a =
stronger federal role vis-=E0-vis the provinces. The paper argues that =
this dynamic only weakens the health system and diminishes its capacity =
to respond to current and future health needs.
Discussion Paper No. 12: Constitutional Jurisdiction Over Health And =
Health Care Services In Canada
Release Date: 2 August 2002
Howard Leeson, University of Regina
http://www.healthcarecommission.ca/Suite247/Common/GetMedia_WO.asp?MediaI=
D=3D937&Filename=3D12_Leeson_E.pdf <<ole1.bmp>>=20
This paper examines the various questions related to the origin and =
exercise of constitutional jurisdiction over health care in Canada. In =
particular it examines four questions:
What are the constitutional bases for the federal and provincial roles =
in the provision of health care in Canada?=20
What is the constitutional basis for the exercise of the federal =
spending power as it relates to health?=20
Does the Charter of Rights and Freedoms affect the distribution of =
jurisdiction with respect to health care and the delivery of health =
care?=20
Insofar as Canadian health policy increasingly involves broader =
definitions of "health" each year, how might the interrelationship of =
broader parameters and overlapping jurisdictions affect health care =
policy in the future?
Conclusions related to the economic powers will play an increasingly =
important role in health care -- globalization, power over patents, =
privatization, and the fiscal role of the federal government.
Overall the paper concludes that it is unlikely that there will be =
formal constitutional change in the area of health care. It is also =
probable that the courts will tread carefully in this area as well. If =
there is change needed in the exercise of jurisdiction, it will probably =
be brought about by political agreement, enshrined in some form of =
semi-permanent contract or arrangement.
Discussion Paper No. 13: Strengthening the Foundations: Modernizing the =
Canada Health Act
Release Date: 14 August 2002
Colleen Flood, Sujit Choudhry University of Toronto
<<ole2.bmp>> This paper's authors recommend ways to make the Canada =
Health Act relevant in today's context. The paper argues for a continued =
prohibition against extra-billing and user fees, but suggests ways in =
which the federal Act can be amended to encourage innovation and =
evidence-based reform in the delivery of care. The authors are =
definitive that there "is no evidence that a greater role for private =
financing would improve either efficiency or equity in Medicare".
http://www.healthcarecommission.ca/Suite247/Common/GetMedia_WO.asp?MediaI=
D=3D946&Filename=3D13_Flood_E.pdf
Discussion Paper No. 14: Influences on the "Health Care Technology =
Cost-Driver"
Release Date: 14 August 2002
<<ole3.bmp>> Steve Morgan, University of British Columbia, Jeremiah =
Hurley, McMaster University
http://www.healthcarecommission.ca/Suite247/Common/GetMedia_WO.asp?MediaI=
D=3D947&Filename=3D14_Morgan_E.pdf
New technologies, and consumer demand for them, will definitely affect =
the cost of health care delivery in the future. Demographic shifts and a =
push from the genetic sciences (e.g. genetic testing) will also increase =
pressure to respond medically with new technology and pharmaceuticals. =
This paper cautions that this situation requires a careful assessment of =
benefits, efficiencies and outcomes, before new technologies, and their =
costs, are embraced by the system and its health care providers.
Discussion Paper No. 15: Paying to Play? Government Financing and Health =
Care Agenda Setting
Release Date: 14 August 2002
Katherine Fierlbeck, Dalhousie University
http://www.healthcarecommission.ca/Suite247/Common/GetMedia_WO.asp?MediaI=
D=3D953&Filename=3D15_Fierlbeck_E.pdf
Two overarching issues inform the relationship between governments =
regarding health care: first, what kind of change is desirable? And =
second, how is it possible politically to achieve such change? The =
objective of Canadian public health care is, of course, the health of =
the Canadian public: yet patients are also taxpayers and citizens, and =
as such often have contradictory expectations. This paper holds that =
change in federal-provincial relations regarding health care is =
necessary; that it is timely; and that each level of government can be =
persuaded to make these changes. It also argues that Canada must aim for =
a balance between federal involvement and provincial autonomy.
------_=_NextPart_002_01C24769.0FDDB840
Content-Type: text/html;
charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 3.2//EN">
<HTML>
<HEAD>
<META HTTP-EQUIV=3D"Content-Type" CONTENT=3D"text/html; =
charset=3Diso-8859-1">
<META NAME=3D"Generator" CONTENT=3D"MS Exchange Server version =
6.0.5762.3">
<TITLE>New Discussion Papers released by Commission on Future of Health =
Care in Canada</TITLE>
</HEAD>
<BODY>
<!-- Converted from text/rtf format -->
<BR>
<P><FONT SIZE=3D2 FACE=3D"Arial">Dear Colleagues</FONT>
</P>
<P><FONT SIZE=3D2 FACE=3D"Arial">A number of discussion papers on =
various aspects of the future of the Candian health care systems have =
been released by the Commission chaired by Roy Romanov this month., =
which may be of interest to some of you.</FONT></P>
<P><FONT SIZE=3D2 FACE=3D"Arial">Titles below. Also links and info on =
contents of each DP. All freely available on-line. Info on the papers =
and links below</FONT></P>
<P><FONT SIZE=3D2 FACE=3D"Arial">Best wishes</FONT>
</P>
<P><FONT SIZE=3D2 FACE=3D"Arial">David McDaid</FONT>
<BR><FONT SIZE=3D2 FACE=3D"Arial">LSE Health and Social Care</FONT>
</P>
<P><FONT SIZE=3D2 FACE=3D"Arial">More info below</FONT>
</P>
<P><FONT SIZE=3D2 FACE=3D"Arial">Titles:</FONT>
</P>
<P><FONT FACE=3D"Times New Roman">DP 9:<SPAN LANG=3D"en-gb"> Options for =
Raising Revenue for Health Care. Melissa Rode, Michael =
Rushton</SPAN></FONT>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">DP 10: Funding =
and Production of Health Services: Outlook and Potential Solutions. =
Jean-Luc Migue</FONT></SPAN>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">DP 11: The =
Conditions For A Sustainable Public Health System In =
Canada</FONT></SPAN><SPAN LANG=3D"en-us"> <FONT FACE=3D"Times New =
Roman">Louis Imbeau, Kina Chenard, Adriana Dudas</FONT></SPAN><SPAN =
LANG=3D"en-gb"></SPAN>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">DP 12: =
Constitutional Jurisdiction Over Health And Health Care Services In =
Canada. Howard Leeson<BR>
</FONT></SPAN><SPAN LANG=3D"en-us"></SPAN>
<BR><SPAN LANG=3D"en-us"><FONT FACE=3D"Times New Roman">DP =
13:</FONT></SPAN><SPAN LANG=3D"en-gb"> <FONT FACE=3D"Times New =
Roman">Strengthening the Foundations: Modernizing the Canada Health Act. =
Colleen Flood, Sujit Choudhry</FONT></SPAN>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">DP 14: =
Influences on the “Health Care Technology Cost-Driver” Steve =
Morgan, Jerry Hurley</FONT></SPAN>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">DP 15: Paying to =
Play? Government Financing and Health Care Agenda Setting Katherine =
Fierlbeck</FONT></SPAN><SPAN LANG=3D"en-us"></SPAN>
</P>
<BR>
<P><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">Discussion Paper =
No. 9: Options for Raising Revenue for Health Care<BR>
Release Date: 2 August 2002<BR>
</FONT></SPAN><SPAN LANG=3D"en-us"><FONT FACE=3D"Times New Roman">Meliss =
Rode, Michael Rushton, University of Regina</FONT></SPAN>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman"><A =
HREF=3D"http://www.healthcarecommission.ca/Suite247/Common/GetMedia_WO.as=
p?MediaID=3D934&Filename=3D9_Rode_E.pdf">http://www.healthcarecommission.=
ca/Suite247/Common/GetMedia_WO.asp?MediaID=3D934&Filename=3D9_Rode_E.pdf<=
/A></FONT></SPAN>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">Authors Rode and =
Rushton recommend a transfer of “tax room” to the provinces =
to ensure the stable funding of health care, and its providers, flowing =
from that level of government. “Since it is already likely the =
case that provinces rely more on corporate taxes than is efficient in a =
federation, and since it is difficult to use the personal income tax as =
a major instrument of income redistribution if devolved in a significant =
way to the provinces, sales taxes are the most promising avenue for =
change,” says the paper. As a result, it concludes that Canada =
should follow the model used by the European Union and transfer the =
federal Goods and Services tax (GST) to the provinces.</FONT></SPAN></P>
<P><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">Discussion Paper =
No. 10: Funding and Production of Health Services: Outlook and Potential =
Solutions<BR>
Release Date: 2 August 2002<BR>
</FONT></SPAN><SPAN LANG=3D"en-us"><FONT FACE=3D"Times New =
Roman">Jean-Luc Migue, The Fraser Institute</FONT></SPAN>
<BR><SPAN LANG=3D"en-us"><FONT FACE=3D"Times New Roman"><A =
HREF=3D"http://www.healthcarecommission.ca/Suite247/Common/GetMedia_WO.as=
p?MediaID=3D935&Filename=3D10_Migue_E.pdf">http://www.healthcarecommissio=
n.ca/Suite247/Common/GetMedia_WO.asp?MediaID=3D935&Filename=3D10_Migue_E.=
pdf</A></FONT></SPAN>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">This paper, from =
a senior scholar at The Fraser Institute, begins with an examination of =
all the possible sources of funding for the Canadian health care system =
and ends with an argument in favour of the health savings account (or =
the tax credit) as the only way to assure consumer choice, cost-saving =
incentives and sustainability. “The unconditional assurance of =
obtaining health care, including for the most well-off, encourages =
people to adopt unhealthy behaviour and inflates costs,” writes =
the author.</FONT></SPAN></P>
<P><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">Discussion Paper =
No. 11: The Conditions For A Sustainable Public Health System In =
Canada<BR>
Release Date: 2 August 2002<BR>
</FONT></SPAN><SPAN LANG=3D"en-us"><FONT FACE=3D"Times New Roman">Louis =
Imbeau, Kina Chenard, Adriana Dudas, Laval University</FONT></SPAN>
<BR><SPAN LANG=3D"en-us"><FONT FACE=3D"Times New Roman"><A =
HREF=3D"http://www.healthcarecommission.ca/Suite247/Common/GetMedia_WO.as=
p?MediaID=3D936&Filename=3D11_Imbeau_E.pdf">http://www.healthcarecommissi=
on.ca/Suite247/Common/GetMedia_WO.asp?MediaID=3D936&Filename=3D11_Imbeau_=
E.pdf</A></FONT><FONT FACE=3D"Arial" SIZE=3D2 COLOR=3D"#000000">
<IMG SRC=3D"No%20AttachName" alt=3D"ole0.bmp"></FONT></SPAN><SPAN =
LANG=3D"en-gb"></SPAN><SPAN LANG=3D"en-gb"></SPAN><SPAN =
LANG=3D"en-gb"></SPAN>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">This paper notes =
that the “sustainability of the health system depends on the =
financial, organizational and epistemic capacity to respond adequately =
to the health needs of current generations without compromising the =
system’s ability to meet the needs of future generations”. =
This capacity is being influenced by two competing agendas - one =
supporting more privatization in health care and the other a stronger =
federal role vis-=E0-vis the provinces. The paper argues that this =
dynamic only weakens the health system and diminishes its capacity to =
respond to current and future health needs.</FONT></SPAN></P>
<P><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">Discussion Paper =
No. 12: Constitutional Jurisdiction Over Health And Health Care Services =
In Canada<BR>
Release Date: 2 August 2002<BR>
</FONT></SPAN><SPAN LANG=3D"en-us"><FONT FACE=3D"Times New Roman">Howard =
Leeson, University of Regina</FONT></SPAN>
<BR><SPAN LANG=3D"en-us"><FONT FACE=3D"Times New Roman"><A =
HREF=3D"http://www.healthcarecommission.ca/Suite247/Common/GetMedia_WO.as=
p?MediaID=3D937&Filename=3D12_Leeson_E.pdf">http://www.healthcarecommissi=
on.ca/Suite247/Common/GetMedia_WO.asp?MediaID=3D937&Filename=3D12_Leeson_=
E.pdf</A></FONT><FONT FACE=3D"Arial" SIZE=3D2 COLOR=3D"#000000">
<IMG SRC=3D"No%20AttachName-2" alt=3D"ole1.bmp"></FONT></SPAN>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">This paper =
examines the various questions related to the origin and exercise of =
constitutional jurisdiction over health care in Canada. In particular it =
examines four questions:</FONT></SPAN></P>
<P><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">What are the =
constitutional bases for the federal and provincial roles in the =
provision of health care in Canada? </FONT></SPAN>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">What is the =
constitutional basis for the exercise of the federal spending power as =
it relates to health? </FONT></SPAN>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">Does the Charter =
of Rights and Freedoms affect the distribution of jurisdiction with =
respect to health care and the delivery of health care? =
</FONT></SPAN></P>
<P><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">Insofar as =
Canadian health policy increasingly involves broader definitions of =
“health” each year, how might the interrelationship of =
broader parameters and overlapping jurisdictions affect health care =
policy in the future?</FONT></SPAN></P>
<P><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">Conclusions =
related to the economic powers will play an increasingly important role =
in health care -- globalization, power over patents, privatization, and =
the fiscal role of the federal government.</FONT></SPAN></P>
<P><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">Overall the paper =
concludes that it is unlikely that there will be formal constitutional =
change in the area of health care. It is also probable that the courts =
will tread carefully in this area as well. If there is change needed in =
the exercise of jurisdiction, it will probably be brought about by =
political agreement, enshrined in some form of semi-permanent contract =
or arrangement.</FONT></SPAN></P>
<BR>
<P><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">Discussion Paper =
No. 13: Strengthening the Foundations: Modernizing the Canada Health =
Act<BR>
Release Date: 14 August 2002<BR>
</FONT></SPAN><SPAN LANG=3D"en-us"><FONT FACE=3D"Times New =
Roman">Colleen Flood, Sujit Choudhry University of Toronto</FONT></SPAN>
<BR><SPAN LANG=3D"en-us"><FONT FACE=3D"Arial" SIZE=3D2 =
COLOR=3D"#000000">
<IMG SRC=3D"No%20AttachName-3" alt=3D"ole2.bmp"></FONT></SPAN><SPAN =
LANG=3D"en-gb"></SPAN><SPAN LANG=3D"en-gb"></SPAN><SPAN =
LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">This paper’s authors =
recommend ways to make the Canada Health Act relevant in today’s =
context. The paper argues for a continued prohibition against =
extra-billing and user fees, but suggests ways in which the federal Act =
can be amended to encourage innovation and evidence-based reform in the =
delivery of care. The authors are definitive that there “is no =
evidence that a greater role for private financing would improve either =
efficiency or equity in Medicare”.</FONT></SPAN></P>
<P><SPAN LANG=3D"en-us"><FONT FACE=3D"Times New Roman"><A =
HREF=3D"http://www.healthcarecommission.ca/Suite247/Common/GetMedia_WO.as=
p?MediaID=3D946&Filename=3D13_Flood_E.pdf">http://www.healthcarecommissio=
n.ca/Suite247/Common/GetMedia_WO.asp?MediaID=3D946&Filename=3D13_Flood_E.=
pdf</A></FONT></SPAN>
</P>
<P><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">Discussion Paper =
No. 14: Influences on the “Health Care Technology =
Cost-Driver”<BR>
Release Date: 14 August 2002<BR>
</FONT></SPAN><SPAN LANG=3D"en-us"></SPAN><SPAN LANG=3D"en-us"><FONT =
FACE=3D"Arial" SIZE=3D2 COLOR=3D"#000000">
<IMG SRC=3D"No%20AttachName-4" alt=3D"ole3.bmp"></FONT><FONT =
FACE=3D"Times New Roman">Steve Morgan, University of British Columbia, =
Jeremiah Hurley, McMaster University</FONT></SPAN>
<BR><SPAN LANG=3D"en-us"><FONT FACE=3D"Times New Roman"><A =
HREF=3D"http://www.healthcarecommission.ca/Suite247/Common/GetMedia_WO.as=
p?MediaID=3D947&Filename=3D14_Morgan_E.pdf">http://www.healthcarecommissi=
on.ca/Suite247/Common/GetMedia_WO.asp?MediaID=3D947&Filename=3D14_Morgan_=
E.pdf</A></FONT></SPAN>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">New =
technologies, and consumer demand for them, will definitely affect the =
cost of health care delivery in the future. Demographic shifts and a =
push from the genetic sciences (e.g. genetic testing) will also increase =
pressure to respond medically with new technology and pharmaceuticals. =
This paper cautions that this situation requires a careful assessment of =
benefits, efficiencies and outcomes, before new technologies, and their =
costs, are embraced by the system and its health care =
providers.</FONT></SPAN></P>
<P><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">Discussion Paper =
No. 15: Paying to Play? Government Financing and Health Care Agenda =
Setting</FONT></SPAN>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">Release Date: 14 =
August 2002</FONT></SPAN>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">Katherine =
Fierlbeck, Dalhousie University</FONT></SPAN>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman"><A =
HREF=3D"http://www.healthcarecommission.ca/Suite247/Common/GetMedia_WO.as=
p?MediaID=3D953&Filename=3D15_Fierlbeck_E.pdf">http://www.healthcarecommi=
ssion.ca/Suite247/Common/GetMedia_WO.asp?MediaID=3D953&Filename=3D15_Fier=
lbeck_E.pdf</A></FONT></SPAN>
<BR><SPAN LANG=3D"en-gb"><FONT FACE=3D"Times New Roman">Two overarching =
issues inform the relationship between governments regarding health =
care: first, what kind of change is desirable? And second, how is it =
possible politically to achieve such change? The objective of Canadian =
public health care is, of course, the health of the Canadian public: yet =
patients are also taxpayers and citizens, and as such often have =
contradictory expectations. This paper holds that change in =
federal-provincial relations regarding health care is necessary; that it =
is timely; and that each level of government can be persuaded to make =
these changes. It also argues that Canada must aim for a balance between =
federal involvement and provincial autonomy.</FONT></SPAN></P>
<BR>
</BODY>
</HTML>
------_=_NextPart_002_01C24769.0FDDB840--
------_=_NextPart_001_01C24769.0FDDB840
Content-Type: image/bmp;
name="ole0.bmp"
Content-Transfer-Encoding: base64
Content-Description: ole0.bmp
Content-Location: No%20AttachName
Qk1aAAAAAAAAADoAAAAoAAAAAQAAAAgAAAABAAEAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAA////
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
------_=_NextPart_001_01C24769.0FDDB840
Content-Type: image/bmp;
name="ole1.bmp"
Content-Transfer-Encoding: base64
Content-Description: ole1.bmp
Content-Location: No%20AttachName-2
Qk1aAAAAAAAAADoAAAAoAAAAAQAAAAgAAAABAAEAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAA////
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
------_=_NextPart_001_01C24769.0FDDB840
Content-Type: image/bmp;
name="ole2.bmp"
Content-Transfer-Encoding: base64
Content-Description: ole2.bmp
Content-Location: No%20AttachName-3
Qk1aAAAAAAAAADoAAAAoAAAAAQAAAAgAAAABAAEAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAA////
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
------_=_NextPart_001_01C24769.0FDDB840
Content-Type: image/bmp;
name="ole3.bmp"
Content-Transfer-Encoding: base64
Content-Description: ole3.bmp
Content-Location: No%20AttachName-4
Qk1aAAAAAAAAADoAAAAoAAAAAQAAAAgAAAABAAEAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAA////
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
------_=_NextPart_001_01C24769.0FDDB840--
=========================================================================
Date: Mon, 19 Aug 2002 11:48:22 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: NICE to set up Citizens Council in England and Wales
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Dear Colleagues
For information press release plus questions and answers issued by the =
National Institute for Clinical Excellence in England and Wales today, =
on setting up a new Citizen's council made up of individuals with no =
connection to health care. According to NICE although the advice of the =
council will not be binding, NICE judgements will take the Council's =
views into account.
Best wishes=20
David McDaid
LSE Health and Social Care
Pres release available on line at=20
http://www.nice.org.uk/article.asp?a=3D35549
NICE 2002/044 A
Issued: 19 August 2002=20
The National Institute for Clinical Excellence (NICE) is establishing =
the country's first Citizens Council to advise its decision-makers. A =
recruitment campaign to find 30 ordinary members of the public in =
England and Wales who will consider issues from a public perspective =
starts today.=20
Speaking about the formation of the Citizens Council, Chairman of NICE, =
Professor Sir Michael Rawlins said:=20
" The primary role of NICE is to improve patient care. We are doing it =
in two key ways, firstly by the appraisal of individual technologies to =
encourage the NHS to uptake those that are clinically and cost =
effective, and secondly by the development of clinical guidelines on the =
management of individual conditions. The involvement of patients and =
carers in NICE's decision-making has always been extremely important, =
but it has been a long-term aim of ours to involve the wider public in =
our work. The Kennedy report following the Bristol Inquiry only served =
to reinforce the importance of involving the public in NHS =
decision-making. The establishment of a Citizens Council is designed to =
provide a backdrop of public opinion against which we and the =
independent groups that advise us can make their recommendations".=20
NICE has appointed an independent specialist company, with a track =
record in recruiting and running Citizens juries, to recruit 30 members =
of the public from diverse sections of the community to join the =
Council.=20
" We are seeking people with diverse backgrounds who have fresh and =
inquiring minds and, above all, good commonsense values," said Ruth =
Turner of Vision 21, the company conducting the recruitment campaign. =
"It is not even necessary that people will have taken part in anything =
similar before. We will be selecting people on the basis of their =
potential, rather than their track record."=20
Andrew Dillon, NICE Chief Executive, added: "This is a really exciting =
development for the Institute and the NHS. We expect this Council to =
provide NICE with advice that reflects the public's perspective on what =
are often challenging issues. The Council will not include people who =
work in the NHS or in private medicine. Similarly those working in the =
Department of Health, the National Assembly for Wales health teams, the =
healthcare industries or in groups or organisations supporting patient =
or industry groups, for example lobbying organisations, will be =
excluded. We want the Council to be a forum where ordinary members of =
the public are able to have their say."
Application packs can be obtained either by telephoning 0161 839 0385, =
e-mailing Ruth Turner <mailto:[log in to unmask]> or by visiting =
the NICE <http://www.nice.org.uk/> web site.
Notes for editors
The Citizens Council is an innovation to reflect public opinion in the =
guidance that NICE publishes about the clinical and cost effectiveness =
of treatments and care for the NHS. Challenging value questions will be =
addressed by a 30 strong group of men and women drawn from all walks of =
life.
NICE has prepared, for the public, the answers to some common questions =
and answers on the Citizens Council. These are available from Nice and =
will be published on its web site. Large print versions are also =
available. The questions and answers are provided below for your =
reference.
Some questions and answers about NICE's Citizens Council
1. How do I apply for membership of the Council?
If you live in England or Wales you can apply to become a member of the =
Citizens Council. NICE is keen to be as inclusive as possible and if you =
have a disability, or have special needs, such as childcare, we are keen =
to ensure they should not stop you from taking part.=20
Telephone: Vision 21 on 0161 839 0385,=20
E-mail: [log in to unmask] <mailto:[log in to unmask]>
Web:=20
www.nice.org.uk <http://www.nice.org.uk/>
The closing date for applications is Friday 20 September 2002.
2. Who won't be on the Council?
Because groups such as NHS employees, suppliers to the NHS, or patient =
groups already have a strong voice in making their opinions known in the =
decisions NICE makes, we would decline applications from anyone in those =
groups. In addition we would decline applications from those who work in =
lobbying organisations. We are anxious to give a voice to people who =
normally find it difficult to have their opinions heard.
3. What is the Citizens Council?
The Citizens Council will help NICE find out what members of the public =
think about key issues informing the development of the guidance NICE =
issues on the treatments and care that people can expect in the NHS.
We know that although the guidance we issue about the treatment and care =
that should be used within the NHS is based on evidence there are key =
values and judgments on which are decisions are made. We want =
representatives of the public from all parts of the community to give =
their views and opinions and provide a backdrop against which we, and =
the independent Committees that advise us, can produce our guidance.
We already have the experts to provide the technical input and we are =
now creating an opportunity for a 30-strong group of people, drawn from =
all groups in the population, to have their say. This will be the =
Citizens Council.
Council members will be from all age groups, social circumstances, =
ethnic background and ability, forming a cross-section of opinion. They =
will be paid (=A3150 a day when on Council business), meet twice a year =
in 3-day sessions, and deliberate on questions put to them by the Board =
of NICE. Their meetings will be open to the public.
4. Why does NICE want a Citizens Council?
Establishing the Council is:
* First, the fulfilment of a principle established in the NHS =
Modernisation Plan and a long-term aim of NICE, to involve the wider =
public in its work
* Second, as a response to the Kennedy report following the Bristol baby =
deaths, which recommended more public involvement in making NHS =
decisions=20
* And third, to provide a backdrop of public opinion against which NICE =
and the independent groups that advise it can make their =
recommendations.
5. What will the Council do?
As a sub-committee of the NICE Board, it will develop questions that =
concern the judgments that surround the work of NICE. The Council will =
consider the questions and make a report to NICE. NICE will then use =
these opinions to inform its work and the work of the independent groups =
and experts who develop NICE guidelines and appraisals for the NHS.
6. What are the values Council members will bring?=20
We want to put a rationale behind the use of resources. In doing so we =
want to know what ordinary people, who are using, have used or most =
certainly will use the NHS, think about key parts of the way our =
decisions are made. In developing their opinions they will bring parts =
of themselves and their backgrounds to the table - these are their =
values.
7. Are there some examples of how the Citizens Council might be useful?
NICE deals with some challenging issues. Here are three examples.
* We were asked to look at where the products that help people stop =
smoking might add value to the NHS and patients - we recommended that =
these products should be available only to people who have demonstrated =
a real willingness to give up smoking.
* Similarly we were asked to look at where the new anti obesity products =
could add value to the NHS and patients. We recommended that these drugs =
should be available only to people who were classed as clinically obese =
and who had already demonstrated they could lose weight by their own =
efforts.=20
* During an appraisal, we didn't feel comfortable that we had enough =
evidence to make a blanket recommendation for a particular drug. And so =
we said that it should, effectively, be used in a nationwide clinical =
trial to get more evidence, and that the Department of Health should =
negotiate a more cost-effective deal with the manufacturers.
We think we got those decisions about right and that the wider public =
would agree with us.
However, as technology advances, some decisions can only get more =
difficult - for example, decisions about the care people in the NHS can =
expect; decisions about some new treatments referred to by the press as =
'lifestyle' products; or decisions about very expensive drugs that may =
help someone who is very ill to live just a few weeks longer.=20
The Citizens Council will:
* keep us in touch with public opinion=20
* tell us their views on issues that could challenge the independent =
groups that advise us=20
* provide a perspective on technical issues such as the levels of =
evidence we should consider
* and be there to give us non-technical common-sense advice.
8. What kind of people can sit on the Citizens Council?
The Citizens Council will be made up of 30 members of the public drawn =
from a different range of backgrounds and coming from all parts of =
England and Wales.=20
9. How will Council members be chosen?
The recruitment of Council members is being carried out at arm's length =
from NICE by Vision 21 -an independent specialist company. Vision 21 =
will identify people on the basis of the likelihood that they will be =
able to make a contribution, rather than on their track record of being =
involved in similar bodies. Council members will have responded to =
advertisements and widespread publicity.
A separate sheet giving the timetable for recruitment and guidance on =
how to apply is available with the application form from Vision 21 or =
from the NICE website.
10. What kind of background is needed to be a Council member?
The selection process is designed to ensure that as wide a cross-section =
of society as possible is included. It is not necessary for applicants =
to have had experience of sitting on committees. Selection will be on =
the basis of a person's potential - regardless of their background or =
circumstances. The only people prevented from being Council members are =
those with a connection with the NHS or other groups and companies =
working within health.
11. How much time will be involved?
Once selected, Council members will be asked to attend an introductory =
meeting lasting up to 2 days. This is designed to allow them to meet =
other Council members and to let them know what to expect when taking =
part in a Council meeting. The Council will then meet twice a year and =
each meeting will last up to 3 days.
12. What other support will be available?
The Citizens Council organisers will make every effort to provide =
support to Councillors who need it. For example, when necessary, =
cr=E8che facilities will be provided for young children of Council =
members or carers will be arranged for dependants of Councillors. All =
the venues selected for the Council meetings will have disabled access =
and hearing loops. Support staff will be on hand throughout meetings to =
explain things when necessary.
13. Will Councillors get paid?
Yes, they will be paid =A3150 per day when on Council business and all =
their travelling and accommodation expenses will be taken care of. Where =
special facilities need to be provided, such as a cr=E8che or a signer, =
NICE will pay.
14. Why pay the Council Members?
Each member of the Council will receive =A3150 per day when on Council =
business and we will pay all travel and overnight expenses too. We will =
also provide special facilities such as cr=E8ches for young children of =
Council members. Naturally we will pay the costs of the places we use to =
hold the meetings and pay the travelling expenses of the expert =
witnesses. We are also paying the expert organisation to run the =
meetings. NICE will not be involved in the meetings.
Without making these payments:
* how else could we balance the Council with an opinion from a single =
mum on a Council estate, if not by paying expenses and providing =
childcare?
* how else could we include a self-employed person if we were not to =
offer a fee for their time?=20
* how else could we be sure that geography plays no part in preventing =
people from taking part if we are not prepared to meet travel and =
accommodation costs?'
15. How long will members serve on the Council?
Appointments will be for up to 3 years only. Some people will serve for =
a year, some for 2 years and some for 3 years.
16. Who decides what topics come before the Council?
A special sub-committee of NICE's Board, in consultation with the rest =
of NICE, will decide the questions to be put to the Citizens Council.=20
17. How will meetings be run?
An independent organisation, Vision 21, will run the meetings and =
produce reports summarising the Council 's views, which will be sent to =
NICE. Expert witnesses will give evidence on the issues under =
consideration and Council members will be able to ask them questions. =
There are likely to be sessions where Council members are asked to form =
smaller groups and consider particular topics - with the support of =
Vision 21 staff.=20
18. Who else might be at the meetings?
All Council meetings will be open to members of the public and to the =
press and the media, and so anyone from these groups might attend.=20
19. What powers does the Council have?
The Council's advice will be used to help NICE and the indepenedent =
Committees that advise it to consider their judgments in in the light of =
the views of representatives of the general public. NICE is not bound by =
the Council's advice but it is committed to this type of input - =
otherwise it wouldn't have set it up the Council in the first place.
=========================================================================
Date: Tue, 20 Aug 2002 09:44:23 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: Adressing health inequalities
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Dear Colleagues
I've attached below information on a viewpoint paper published in this =
weeks Lancet by Adam Oliver, Andrew Healey and Julian Le Grand which is =
available freely on-line. Their viewpoint argues that before adopting a =
policy on health inequalities firstly a strong ethical framework is =
required to determine which inequalities are inequitable, and following =
this secondly to assess proposed policies for their value for money.=20
They argue that "It would be undesirable for any society if =
health-inequality policy took precedence over all other considerations, =
and if health inequalities--even when they are deemed inequitable--were =
addressed at all costs. Ethics and social science, rather than agenda =
setting and lobbying, should take centre stage in this international =
policy debate."
Details below
Best wishes
David McDaid
LSE Health and Social Care
Addressing health inequalities
A J Oliver, A T Healey, J LeGrand
Lancet 2002; 360: 565-67=20
Available at=20
http://www.thelancet.com/journal/vol360/iss9332/full/llan.360.9332.editor=
ial_and_review.22134.1
=========================================================================
Date: Tue, 20 Aug 2002 10:09:33 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: Inequalities in Prescribing of Secondary Preventative Therapies
for Ischaemic Heart Disease in Ireland
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Dear Colleagues=20
I attach information from a paper in the latest edition of the Irish =
Medical Journal, which is freely available on line, which argues that =
there are geographical varaiations in access to secondary preventative =
therapies across Ireland.
Best wishes
David McDaid
LSE Health and Social Care
K Bennett, J Feely, D Williams
Inequalities in Prescribing of Secondary Preventative Therapies for =
Ischaemic Heart Disease in Ireland
Irish Medical Journal June 2002 95(6)
Available on-line at
http://www.imj.ie/news_detail.php?nNewsId=3D2398&nVolId=3D93
Abstract
The study aim is to quantify the variation in prescribing rates of =
secondary preventative therapies for Ischaemic Heart Disease (IHD) =
across regions, age and gender. Patients receiving any prescriptions for =
a nitrate during a one year period (September 1999-August 2000) were =
considered using a national primary care prescribing database. Age-sex =
standardised prescribing rates of four secondary preventative therapies =
for IHD (Ace inhibitors, beta-blockers, aspirin, statins) were =
calculated for each region. Wide variations between regions were =
observed with significantly higher variability for Ace inhibitors =
compared with aspirin (F-ratio=3D22.8, p<0.001). Men were more likely to =
prescribed these therapies and the elderly were less likely (except Ace =
inhibitors). The study suggests that access to secondary preventative =
therapy is not equitable across regions, gender and age in Ireland. The =
wide variability may be due to uncertainty in prescribing secondary =
preventative therapies and/or variability in clinical need between =
regions.=20
=========================================================================
Date: Tue, 20 Aug 2002 10:28:31 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: Measuring Total Health Inequality: Adding Individual Variation to
Group-Level Differences
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Dear Colleagues
A new paper is now available from the International Journal for Equity =
in Health. The journal is freely accessable via Biomed Central (you may =
need to register first to access)
I have attached details of the paper below
Best wishes
David McDaid
LSE Health and Social Care
Measuring Total Health Inequality: Adding Individual Variation to =
Group-Level Differences=20
Emmanuela Gakidou, Gary King
International Journal for Equity in Health 2002, 1:3 (12 August 2002)
Available at
http://www.biomedcentral.com/content/pdf/1475-9276-1-3.pdf
Abstract (Provisional)
Background
Studies have revealed large variations in average health status across =
social, economic, and other groups. No study exists on the distribution =
of the risk of ill-health across individuals, either within groups or =
across all people in a society, and as such a crucial piece of total =
health inequality has been overlooked. Some of the reason for this =
neglect has been that the risk of death, which forms the basis for most =
measures, is impossible to observe directly and difficult to estimate.
Methods
We develop a measure of total health inequality aE" encompassing all =
inequalities among people in a society, including variation between and =
within groups aE" by adapting a beta-binomial regression model. We apply =
it to children under age two in 50 low- and middle-income countries. Our =
method has been adopted by the World Health Organization and is being =
implemented in surveys around the world; preliminary estimates have =
appeared in the World Health Report (2000).
Results
Countries with similar average child mortality differ considerably in =
total health inequality. Liberia and Mozambique have the largest =
inequalities in child survival, while Colombia, the Philippines and =
Kazakhstan have the lowest levels among the countries measured.=20
Conclusions
Total health inequality estimates should be routinely reported alongside =
average levels of health in populations and groups, as they reveal =
important policy-related information not otherwise knowable. This =
approach enables meaningful comparisons of inequality across countries =
and future analyses of the determinants of inequality.
=========================================================================
Date: Tue, 20 Aug 2002 14:37:33 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: Scotland: new clinical effectiveness body
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Dear Colleagues
The Scottish Executive has just published its response to the =
consultation on integrating Scotland's three clinical effectiveness =
bodies (the Clinical Standards Board for Scotland, Health Technology =
Board for Scotland, and Scottish Health Advisory Service) into one body =
the Quality and Standards Board for Scotland.
I attach an excerpt from press release below - the full release =
including response to all points raised from the 145 responses can be =
found at
http://www.scotland.gov.uk/pages/news/2002/08/SEhd158.aspx
All the best
David McDaid
LSE Health and Social Care
News Release: SEhd158/2002
The Executive published its response today to the consultation on =
integrating Scotland's three clinical effectiveness bodies, agreeing to =
establish one body - the Quality and Standards Board for Health in =
Scotland. Health Minister Malcolm Chisholm stressed that the new body =
will be independent and will respond to public concerns. The new body =
will integrate the three existing organisations: the Clinical Standards =
Board for Scotland, Health Technology Board for Scotland, and Scottish =
Health Advisory Service. Mr Chisholm said:
"The new body will focus on improving the quality of patient care and =
the health of patients. It will have a particular emphasis on the =
quality of care and the patient journey for vulnerable groups. "I =
recognise that there have been concerns raised through the consultation =
process and these will be passed to the new Board and I expect their =
strategic plan to address these issues.
"We are committed to moving ahead and establishing the Quality Standards =
Board for Health in Scotland quickly. I expect to announce the Chairman =
of the new Board in September and appointments to the board will follow =
shortly afterwards. "While our existing arrangements have worked well =
and Scotland has a deserved international reputation for its =
leading-edge work on clinical quality, the expectations of patients and =
the public are changing. We need to continue to develop a =
patient-focussed service and a culture of openness and honesty where =
patients and staff work together in partnership.=20
"We are doing away with unnecessary bureaucracy and duplication to =
ensure that there are no distractions from the task of improving the =
quality of health care to patients in Scotland.
"I am determined that this new body will be fully independent, and able =
to respond to the concerns of patients and the public. I will expect it =
to lead the drive to improve services, identify problems where they =
occur and find solutions."
The Executive has also accepted the concerns that a Departmental Quality =
Strategy Group could be taken to have an overall supervisory role. This =
was not what the Executive intended. The title of this new Group will be =
changed to convey its advisory and consultative role within the =
Department. It will not oversee the Board.
The Quality Standards Board for Health in Scotland will be established =
as a special health board.
A total of 145 responses were received from NHS, professional and =
patient organisations during the consultation process.
=========================================================================
Date: Tue, 20 Aug 2002 20:00:17 -0400
Reply-To: Dennis Raphael <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: Dennis Raphael <[log in to unmask]>
Subject: European Health Policy Article
Comments: To: [log in to unmask], Health Promotion on the Internet
<[log in to unmask]>, [log in to unmask]
Comments: cc: [log in to unmask]
Mime-Version: 1.0
Content-type: text/plain; charset=us-ascii
Content-Disposition: inline
http://www.ehfg.org/virtual/newsletter/NL7.pdf
The latest issue of the European Health Forum's
"Issues in European Health Policy" contains the article
"Canada's looking to the USA for Policy Ideas Threatens
Citizens' Cardiovascular Health."
=========================================================================
Date: Wed, 21 Aug 2002 12:58:27 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: CMO Report: Health in Scotland 2001
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Dear Colleagues
The Chief Medical Officer in Scotland has just published the annual =
report on Health in Scotland. I've outlined chapter information below =
and attached the text of letter to the First Minister
Best wishes
David McDaid
LSE Health and Social Care
Chapter 1 - Health Determinants
Chapter 2 - Focusing on Priority Health Topics
Chapter 3 - Working in Partnership to Improve Life Circumstances
The report is available at
http://www.scotland.gov.uk/library5/health/his01-00.asp
Letter to First Minister McConnell below
Report of the Chief Medical Officer on the state of Scotland's health =
for the year ended 31 December 2001.
To Jack McConnell MSP, First Minister
Dear Sir
The background theme to this annual report is "Working Together". This =
key theme applies to multidisciplinary teams of health professionals and =
cross sectoral work across the health service, local authorities and the =
Executive. As in past reports this review of health in Scotland during =
the year 2001 details the double burden of disease facing our country at =
the start of the 21st century. One element of this challenge is the =
growing burden of chronic disease. The other is that of new and =
re-emerging infectious diseases. Cancer, coronary heart disease and =
stroke together account for around 60% of all deaths in Scotland every =
year. They, together with diabetes, are increasingly amenable to both =
prevention through healthier lifestyle and earlier diagnosis and more =
successful management by the healthcare system. Patients increasingly =
look to the services of complex multidisciplinary teams as much as to =
the skill and commitment of individual clinicians. This report surveys =
the way in which Scotland's health professionals are working together =
through NHSScotland to provide the programmes and care packages to =
tackle these problems. The real challenge however is to plan and provide =
for the future of Scotland's health, to get upstream of these potential =
problems by a concerted effort to promote positive health. This demands =
that the health serviceworks together with partners in local authorities =
and across the Executive to tackle the underlying causes of poor health. =
These are well known and include poverty and social exclusion, tobacco, =
drugs, excessive use of alcohol, poor diet, obesity and lack of =
exercise. The year 2001 saw a welcome commitment to make a step change =
in Scotland's health status and this report sets out the background to =
this essential programme of investment in Scotland's future health and =
wellbeing. We now need a period of sustained, focused action involving =
individual Scots, their communities and their voluntary and public
services working together on health and its determinants.
This report has been produced by and reflects the work of many =
colleagues in the Scottish Executive Health Department, in the NHS, in =
the Scottish Medical Schools, the Health Education Board for Scotland, =
the Scottish Centre for Infection and Environmental Health, the Public =
Health Institute for Scotland and this year includes contributions from =
the Directors of Public Health for Highland, Forth Valley and Grampian. =
They all work together daily for Scotland's health. My thanks are =
therefore due to all who have contributed to the preparation of this =
report and in particular to Dr Elizabeth Stewart and Miss Sandra =
Campbell, the co-editors and to Miss Sheena Cant, who so patiently and =
skilfully compiled the text and tables.
Yours faithfully
Dr E M Armstrong
Chief Medical Officer
=========================================================================
Date: Wed, 21 Aug 2002 17:48:53 +0100
Reply-To: Jane sandall <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: Jane sandall <[log in to unmask]>
Subject: LAST CALL FOR APPLICATIONS FOR PHIL STRONG PRIZE
Comments: To: [log in to unmask], [log in to unmask],
[log in to unmask], [log in to unmask],
Medical Sociology News <[log in to unmask]>,
[log in to unmask], [log in to unmask], Mark Newman
<[log in to unmask]>
Comments: cc: [log in to unmask], Nicky Gibson
<[log in to unmask]>, Catherine Exley <[log in to unmask]>
MIME-Version: 1.0
Content-Type: multipart/alternative;
boundary="----=_NextPart_000_005C_01C2493B.03D230C0"
This is a multi-part message in MIME format.
------=_NextPart_000_005C_01C2493B.03D230C0
Content-Type: text/plain;
charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Apologies for cross-posting
=20
Phil Strong Memorial Prizes
The BSA Medical Sociology Study Group are pleased to announce the Phil =
Strong Memorial Prizes available for the Academic year 2002-3. It is =
anticipated that there will be one or two prizes to the value of =A31000 =
in total. The purpose of the prizes is to contribute to the advancement =
of medical sociology by supporting post-graduate research in medical =
sociology leading to a higher degree.=20
Applicants must show that they are working in the field of Medical =
Sociology and that they are registered for a higher degree at a British =
University or other recognised British research institution, with a =
named supervisor who is a member of the BSA.
Applications must be submitted to arrive no later than 31st August 2002. =
The draw for the this year's prizes will be made at the Medical =
Sociology Study Group's AGM at their Annual Conference to be held at the =
University of York from 27-29 September 2002.=20
For further details on how to apply please go to: =
http://www.britsoc.org.uk/about/philstr02.htm
or contact the BSA office:
Phil Strong Prizes
British Sociological Association
Unit 3F/G
Mountjoy Research Centre
Stockton Road
Durham, DH1 3UR.
Tel: +44(0)191 383-0839
Fax: +44(0)191 383-0782
http://www.britsoc.org.uk/
------=_NextPart_000_005C_01C2493B.03D230C0
Content-Type: text/html;
charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML><HEAD>
<META content=3D"text/html; charset=3Diso-8859-1" =
http-equiv=3DContent-Type>
<META content=3D"MSHTML 5.00.2919.6307" name=3DGENERATOR>
<STYLE></STYLE>
</HEAD>
<BODY bgColor=3D#ffffff>
<DIV><FONT face=3DArial size=3D2>
<DIV><FONT face=3DArial size=3D5>Apologies for =
cross-posting</FONT></DIV>
<DIV><FONT size=3D5> </FONT></DIV>
<DIV><FONT face=3DArial size=3D2><FONT color=3D#ff0000><FONT =
size=3D4><SPAN=20
style=3D"FONT-FAMILY: 'Times New Roman'; FONT-SIZE: 11pt; =
mso-bidi-font-size: 7.5pt"><STRONG>Phil=20
Strong Memorial Prizes</STRONG><?xml:namespace prefix =3D o ns =3D=20
"urn:schemas-microsoft-com:office:office"=20
/><o:p></o:p></SPAN></FONT></FONT></DIV>
<P align=3Djustify class=3DMsoNormal style=3D"MARGIN: 5pt 0in 12pt =
0.25in">The BSA=20
Medical Sociology Study Group are pleased to announce the Phil =
Strong=20
Memorial Prizes available for the Academic year 2002-3. It is =
anticipated that=20
there will be one or two prizes to the value of =A31000 in total. The =
purpose of=20
the prizes is to contribute to the advancement of medical sociology by=20
supporting <B style=3D"mso-bidi-font-weight: normal">post-graduate</B> =
research in=20
<B style=3D"mso-bidi-font-weight: normal">medical sociology</B> leading =
to a=20
higher degree. <BR><B style=3D"mso-bidi-font-weight: =
normal"><BR></B>Applicants=20
must show that they are working in the field of Medical Sociology and =
that they=20
are registered for a higher degree at a British University or other =
recognised=20
British research institution, with a named supervisor who is a member of =
the=20
BSA.<BR><B style=3D"mso-bidi-font-weight: normal"><BR></B>Applications =
must be=20
submitted to arrive no later than <B style=3D"mso-bidi-font-weight: =
normal">31st=20
August 2002</B>. The draw for the this year's prizes will be made at the =
Medical=20
Sociology Study Group's AGM at their Annual Conference to be held at the =
University of York from 27-29 September 2002. <BR><B=20
style=3D"mso-bidi-font-weight: normal"><BR></B><SPAN style=3D"COLOR: =
red">For=20
further details on how to apply please go to: <A=20
href=3D"http://www.britsoc.org.uk/about/philstr02.htm">http://www.britsoc=
.org.uk/about/philstr02.htm</A></SPAN></P>
<P class=3DMsoNormal style=3D"MARGIN: 5pt 0in 12pt 0.25in"><SPAN=20
style=3D"COLOR: red">or contact the BSA office:<BR>Phil Strong =
Prizes<BR>British=20
Sociological Association<BR>Unit 3F/G<BR>Mountjoy Research =
Centre<BR>Stockton=20
Road<BR>Durham, DH1 3UR.<o:p></o:p></SPAN></P>
<P class=3DMsoBodyTextIndent2><SPAN style=3D"FONT-FAMILY: 'Times New =
Roman'">Tel:=20
+44(0)191 383-0839<BR>Fax: +44(0)191 383-0782<o:p></o:p></SPAN></P>
<P class=3DMsoNormal><SPAN style=3D"FONT-SIZE: 11pt; mso-bidi-font-size: =
12.0pt"><A=20
href=3D"http://www.britsoc.org.uk/">http://www.britsoc.org.uk/</A><o:p></=
o:p></SPAN></P></FONT></FONT></DIV></BODY></HTML>
------=_NextPart_000_005C_01C2493B.03D230C0--
=========================================================================
Date: Wed, 21 Aug 2002 18:40:58 -0400
Reply-To: Dennis Raphael <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: Dennis Raphael <[log in to unmask]>
Subject: Final SDOH Conference program
Comments: To: [log in to unmask]
Comments: cc: [log in to unmask], [log in to unmask],
[log in to unmask], [log in to unmask],
[log in to unmask], [log in to unmask]
Mime-Version: 1.0
Content-type: text/plain; charset=us-ascii
Content-Disposition: inline
The final conference program including details of the pre-conference workshop on
social determinants of health is now available at:
http://www.socialjustice.org/conference/program.htm
Dennis R
=========================================================================
Date: Thu, 22 Aug 2002 14:03:00 -0400
Reply-To: [log in to unmask]
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: Jack Elinson <[log in to unmask]>
Subject: Re: media suffering from tunnel vision
Comments: To: King David <[log in to unmask]>
In-Reply-To: <AF0D6BAD4280D511A2690050BA219EF218F46A@BPCTHYDE>
MIME-Version: 1.0
Content-Type: TEXT/PLAIN; charset=US-ASCII
OK. Do it!
=========
On Wed, 27 Mar 2002, King David wrote:
> Colleagues, What do you think about starting an 'international social
> determinants of health week' (or something with a bit of a snappier title)?
> The aim would be to counteract the myth, perpetuated by some state agencies
> and the popular media that health is solely a product of individual
> behaviour and the number of doctors and hospitals in your locality. Everyone
> involved in 'Health' would be encouraged to focus upstream, if only for a
> week. Those involved in Public Health and Health Promotion would be
> encouraged to take to the streets to engage with the public and discuss
> factors - other than individual behaviour - which impact on their health and
> to gauge what public support there is for the programmes and interventions
> they are engaged in presently. The week could be supplemented with media
> campaigns, perhaps incorporating the expertise of socially aware PR agencies
> e.g. adbusters http://www.adbusters.org/ . The 'week' would counteract the
> numerous 'awareness' days and weeks that perpetuate bio medical behaviour
> change approaches and begin to gain a popular mandate for action on social
> determinants of health... any comments?
>
> David King
> Health Promotion Service
> Barnet Primary Care Trust
> Hyde House
> The Hyde
> London NW9 6QQ
>
> email: [log in to unmask]
> tel: (020) 8201 4860 (w)
> tel: 07973 739 158 (m)
>
>
> -----Original Message-----
> From: Dennis Raphael [mailto:[log in to unmask]]
> Sent: 24 March 2002 00:39
> To: [log in to unmask]
> Subject: media suffering from tunnel vision
>
>
> Mar 20, 2002
> Media suffering from tunnel vision
>
> Daily stories about a shortage of health care funding and miraculous
> medical
> discoveries may be symptomatic of a serious malady afflicting the news media
> speculates Michael Hayes. "Tunnel vision," suggests the Simon Fraser
> University
> health geographer and associate director of the institute for health
> research
> and education. Hayes specializes in population health research and leads a
> collaborative project called Telling stories: news media, health literacy
> and
> public policy.The three year project, funded by a $175,000 grant from the
> Social Sciences and Humanities Research Council, will generate empirical
> analysis of health literacy in Canadian news media. Faculty from SFU's
> school
> of communication (Bob Hackett and Donald Gustein) and the University of
> Calgary,
> B.C. 's provincial health officer and the Institute of Media, Policy and
> Civil
> Society are collaborating on the study.
>
> Hayes' group recently gathered some telling evidence in a pilot project
> aimed
> at testing the study's methodology and content analysis tools. "We found
> that
> an overwhelming number of health stories in major newspapers deal
> obsessively
> with shortages in healthcare services and funding, and medical
> discoveries,"
> says Hayes. "The
> last 30 years of federal health policy-making have been based on evidence
> that
> factors outside the health care system are fundamental to determining and
> maintaining a population's health. Yet very few of the stories we analysed
> dealt with health determinants such as housing, nature of work, poverty or
> income distribution."
>
> The pilot project analysed 500 health stories published collectively over a
> year in five major newspapers: The Globe and Mail, National Post, Toronto
> Star,
> Montreal Gazette and Vancouver Sun. "We know that the news media
> significantly
> impact public opinion. Research shows that risk factors for mortality as
> presented in the media often
> don't jive at all with the empirical evidence," says Hayes. He adds this
> kind
> of reporting feeds public pressure for short term, immediate solutions to
> health
> care shortages. Policy makers need to second the news media's help in
> shifting
> public opinion if we are to focus on early developmental and life long
> factors
> that influence health outcomes over the life course, says Hayes.
>
> The SFU professor's collaborative study will gather empirical evidence on
> the
> extent to which the news media set the public agenda on health and what
> influences their decision-making. The group's research will culminate in
> workshops aimed at stimulating health reporting and public discourse that
> better addresses the broad spectrum of determinants affecting population
> health.
>
> Hayes notes that this study is unique in its focus and broad-based,
> interdisciplinary approach. "One study published recently analysed health
> reporting in Dutch newspapers, but there has been no empirical
> analysis of the media's portrayal of health issues in Canada," notes Hayes.
> "This project also brings together academic researchers and media analysts
> from
> non profit groups to uncover and share information."
>
> Hayes also has a $521,000 grant over three years to analyse and correlate
> information from a variety of databases about the distribution of health
> status
> in the Lower Mainland. Using 26 population health determinants, the study
> will
> integrate information from municipal, regional and provincial databases to
> create a big picture of health status in the metropolitan Vancouver region.
> The
> Canadian Institute for Health Information is funding this project through
> its
> Canadian Population Health Initiative.
>
> -30 -
>
> CONTACT
> Michael Hayes, 604.268.6648, [log in to unmask]
> Carol Thorbes, Media & PR, 604.291.3035
>
=========================================================================
Date: Thu, 22 Aug 2002 15:43:18 -0400
Reply-To: Barbara Krimgold <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
Comments: RFC822 error: <W> Incorrect or incomplete address field found and
ignored.
From: Barbara Krimgold <[log in to unmask]>
Subject: Re: media suffering from tunnel vision
Comments: To: Jack Elinson <[log in to unmask]>
Comments: cc: "[log in to unmask], [log in to unmask],
Dennis [log in to unmask]" <[log in to unmask]>
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
A really awesome idea! Barbara Krimgold
-----Original Message-----
From: Jack Elinson
To: [log in to unmask]
Sent: 8/22/02 2:03 PM
Subject: Re: media suffering from tunnel vision
OK. Do it!
=========
On Wed, 27 Mar 2002, King David wrote:
> Colleagues, What do you think about starting an 'international social
> determinants of health week' (or something with a bit of a snappier
title)?
> The aim would be to counteract the myth, perpetuated by some state
agencies
> and the popular media that health is solely a product of individual
> behaviour and the number of doctors and hospitals in your locality.
Everyone
> involved in 'Health' would be encouraged to focus upstream, if only
for a
> week. Those involved in Public Health and Health Promotion would be
> encouraged to take to the streets to engage with the public and
discuss
> factors - other than individual behaviour - which impact on their
health and
> to gauge what public support there is for the programmes and
interventions
> they are engaged in presently. The week could be supplemented with
media
> campaigns, perhaps incorporating the expertise of socially aware PR
agencies
> e.g. adbusters http://www.adbusters.org/ . The 'week' would counteract
the
> numerous 'awareness' days and weeks that perpetuate bio medical
behaviour
> change approaches and begin to gain a popular mandate for action on
social
> determinants of health... any comments?
>
> David King
> Health Promotion Service
> Barnet Primary Care Trust
> Hyde House
> The Hyde
> London NW9 6QQ
>
> email: [log in to unmask]
> tel: (020) 8201 4860 (w)
> tel: 07973 739 158 (m)
>
>
> -----Original Message-----
> From: Dennis Raphael [mailto:[log in to unmask]]
> Sent: 24 March 2002 00:39
> To: [log in to unmask]
> Subject: media suffering from tunnel vision
>
>
> Mar 20, 2002
> Media suffering from tunnel vision
>
> Daily stories about a shortage of health care funding and miraculous
> medical
> discoveries may be symptomatic of a serious malady afflicting the news
media
> speculates Michael Hayes. "Tunnel vision," suggests the Simon Fraser
> University
> health geographer and associate director of the institute for health
> research
> and education. Hayes specializes in population health research and
leads a
> collaborative project called Telling stories: news media, health
literacy
> and
> public policy.The three year project, funded by a $175,000 grant from
the
> Social Sciences and Humanities Research Council, will generate
empirical
> analysis of health literacy in Canadian news media. Faculty from
SFU's
> school
> of communication (Bob Hackett and Donald Gustein) and the University
of
> Calgary,
> B.C. 's provincial health officer and the Institute of Media, Policy
and
> Civil
> Society are collaborating on the study.
>
> Hayes' group recently gathered some telling evidence in a pilot
project
> aimed
> at testing the study's methodology and content analysis tools. "We
found
> that
> an overwhelming number of health stories in major newspapers deal
> obsessively
> with shortages in healthcare services and funding, and medical
> discoveries,"
> says Hayes. "The
> last 30 years of federal health policy-making have been based on
evidence
> that
> factors outside the health care system are fundamental to determining
and
> maintaining a population's health. Yet very few of the stories we
analysed
> dealt with health determinants such as housing, nature of work,
poverty or
> income distribution."
>
> The pilot project analysed 500 health stories published collectively
over a
> year in five major newspapers: The Globe and Mail, National Post,
Toronto
> Star,
> Montreal Gazette and Vancouver Sun. "We know that the news media
> significantly
> impact public opinion. Research shows that risk factors for mortality
as
> presented in the media often
> don't jive at all with the empirical evidence," says Hayes. He adds
this
> kind
> of reporting feeds public pressure for short term, immediate solutions
to
> health
> care shortages. Policy makers need to second the news media's help in
> shifting
> public opinion if we are to focus on early developmental and life long
> factors
> that influence health outcomes over the life course, says Hayes.
>
> The SFU professor's collaborative study will gather empirical
evidence on
> the
> extent to which the news media set the public agenda on health and
what
> influences their decision-making. The group's research will culminate
in
> workshops aimed at stimulating health reporting and public discourse
that
> better addresses the broad spectrum of determinants affecting
population
> health.
>
> Hayes notes that this study is unique in its focus and broad-based,
> interdisciplinary approach. "One study published recently analysed
health
> reporting in Dutch newspapers, but there has been no empirical
> analysis of the media's portrayal of health issues in Canada," notes
Hayes.
> "This project also brings together academic researchers and media
analysts
> from
> non profit groups to uncover and share information."
>
> Hayes also has a $521,000 grant over three years to analyse and
correlate
> information from a variety of databases about the distribution of
health
> status
> in the Lower Mainland. Using 26 population health determinants, the
study
> will
> integrate information from municipal, regional and provincial
databases to
> create a big picture of health status in the metropolitan Vancouver
region.
> The
> Canadian Institute for Health Information is funding this project
through
> its
> Canadian Population Health Initiative.
>
> -30 -
>
> CONTACT
> Michael Hayes, 604.268.6648, [log in to unmask]
> Carol Thorbes, Media & PR, 604.291.3035
>
=========================================================================
Date: Fri, 23 Aug 2002 10:01:48 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: IS GOVERNMENT HEALTH POLICY BASED ON EVIDENCE OR ASSUMPTION?
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Dear Colleagues
Press Release below on an article in this weeks BMJ by Steve Cummins and =
Sally MacIntyre looking at the potential for unproven assertions to =
gradually be accepted as fact over time, and hence increase possibility =
that they will influence government policy. They take the example of =
so-called food deserts where it has been alleged that lack of income is =
the primary factor for poor diet in the UK; recently the Food Poverty =
(Eradication) Bill wqas introduced into the UK Parliament receiving =
cross party support.
Best wishes
David McDaid
LSE Health and Social Care
IS GOVERNMENT HEALTH POLICY BASED ON EVIDENCE OR ASSUMPTION?
("Food deserts" - evidence and assumption in health
policy making)
http://bmj.com/cgi/content/full/325/7361/436
The overinterpretation of a few small scale studies,
carried out up to 10 years ago, could end up being used
to determine health policy because the findings fit in with
the government's broader policy objectives, argue
researchers in this week's BMJ.
Steven Cummins and Sally Macintyre examine the
phenomena of "factoids" ? assumptions or speculations
reported and repeated so often that they are considered
true. Using the widely claimed existence of "food
deserts"? poor urban areas in the United Kingdom where
residents cannot buy affordable, healthy food ? they raise
important questions about how evidence in public health
is produced, interpreted, and reproduced when making
health policy.
Three main studies have been used as evidence that food
deserts exist in the UK, yet the authors suggest that this
research may have been overinterpreted to suit the needs
of individuals or groups, and subsequently cited in
journals, at seminars, and in the media without close
reference to the original source material.
If these three studies had concerned an issue not so
eagerly espoused by many in central and local
government and public health, and by the public too, and
if the issue had been more contentious, the authors
suspect that the studies would have been more critically
appraised.
The key problem is that the burden of proof, or demand
for evidence, may vary according to a policy's perceived
fit with current collective world views, they add.
As such, policy makers need to move away from an
unquestioning acceptance of conventional wisdom and
"expert" advice and cast a more critical and objective eye
over the facts, they conclude.
Contact:
Steven Cummins, Research Associate, MRC Social and
Public Health Sciences Unit, Glasgow, Scotland
Email: [log in to unmask]
=========================================================================
Date: Fri, 23 Aug 2002 17:26:56 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: Inequalities in Life expectancy by social class 1972-99
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]
Subject: Inequalities in Life expectancy by social class 1972-99
Further to the table we published earlier in the year, this article
includes analyses and discussion of the trends, with additional figures
presented to illustrate inequality across the whole social class =
gradient.
Inequalities across the whole social class gradient have increased to =
1999,
however the differential between men in social class I and V decreased =
for
the first time in 97-99.
In addition we explore the effect of assigning social class at different
time periods.
Angela Donkin, Peter Goldblatt and Kevin Lynch (2002) Inequalities in =
Life
expectancy by social class 1972-99, Health Statistics Quarterly 15, =
5-15.
http://www.statistics.gov.uk/downloads/theme_health/HSQ15.pdf
For the latest data on the economy and society=20
consult National Statistics at http://www.statistics.gov.uk
**********************************************************************
Please Note: Incoming and outgoing email messages
are routinely monitored for compliance with our policy
on the use of electronic communications
**********************************************************************
Legal Disclaimer : Any views expressed by
the sender of this message are not necessarily
those of the Office for National Statistics
**********************************************************************
=========================================================================
Date: Fri, 23 Aug 2002 15:38:06 -0400
Reply-To: Dennis Raphael <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: Dennis Raphael <[log in to unmask]>
Subject: Major Report on Income Inequality and Health in Canada
Comments: To: Health Promotion on the Internet <[log in to unmask]>,
[log in to unmask]
Comments: cc: [log in to unmask], [log in to unmask]
Mime-Version: 1.0
Content-type: text/plain; charset=us-ascii
Content-Disposition: inline
Are Widening Income Inequalities Making Canada Less Healthy? by James Dunn of
the University of Calgary
has been published by the Making Connection Partnership in Ontario. The
executive summary and the full report
are available at
http://www.opha.on.ca/publications/income_inequalities_exec.pdf
http://www.opha.on.ca/publications/income_inequalities.pdf
Dennis Raphael, Ph.D.
Associate Professor & Undergraduate Programme Director
School of Health Policy & Management
Atkinson Faculty of Liberal & Professional Studies
York University
4700 Keele St.
Toronto ON M3J 1P3
Ph: 416-736-2100 ext. 22134
Fax: 416-736-5227
E-mail: [log in to unmask]
=========================================================================
Date: Mon, 26 Aug 2002 08:41:05 -0400
Reply-To: Dennis Raphael <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: Dennis Raphael <[log in to unmask]>
Subject: Major Report on Income Inequality and Health in Canada
Mime-Version: 1.0
Content-type: text/plain; charset=us-ascii
Content-Disposition: inline
Apologies for duplicate messages - I have two separate but somewhat overlapping
email lists.
"Are Widening Income Inequalities Making Canada Less Healthy?" by James Dunn of
the University of Calgary
has been published by the Making Connection Partnership in Ontario. The
executive summary and the full report
are available at
http://www.opha.on.ca/publications/income_inequalities_exec.pdf
http://www.opha.on.ca/publications/income_inequalities.pdf
The full report is large and may take some time to download.
Dennis Raphael, Ph.D.
Associate Professor & Undergraduate Programme Director
School of Health Policy & Management
Atkinson Faculty of Liberal & Professional Studies
York University
4700 Keele St.
Toronto ON M3J 1P3
Ph: 416-736-2100 ext. 22134
Fax: 416-736-5227
E-mail: [log in to unmask]
=========================================================================
Date: Mon, 26 Aug 2002 13:54:01 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: Eighth wave of NICE work programme goes out for consultation
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Except from DoH press release below
full press release available at
http://tap.ukwebhost.eds.com/doh/Intpress.nsf/page/2002-0360?OpenDocument=
Best wishes
David McDaid
LSE Health and Social Care
23rd August 2002
Eighth wave of NICE Work Programme goes out for consultation
New treatments for cancer, coronary heart disease, psoriasis and asthma =
are being considered for referral to the National Institute for Clinical =
Excellence (NICE).=20
NICE was set up in 1999 to help tackle the postcode lottery of =
prescribing - where treatments are available in some areas and not =
others. It should also speed up the uptake of clinically and cost =
effective new treatments by issuing clear, evidence-based guidance to =
the NHS on the use of drugs and treatments. Where NICE recommends a =
treatment, Primary Care Trusts and Health Authorities are under a legal =
obligation to provide funding in appropriate cases.
Stakeholders, including professional and patient groups and relevant =
manufacturers, have been asked to comment on the proposals by the end of =
September. If the proposed topics are confirmed following this =
consultation, they will form part of an 8th wave of appraisals and =
clinical guidelines to be referred to NICE later this year.=20
The treatments to be looked at as part of the consultation are:
1. Iressa for non-small cell lung cancer
2. Imatinib (Glivec) for gastro-intestinal stromal tumours
3. Dual chamber pacing in elderly patients
4. Xaliproden for motor neurone disease
5. Parent training programmes, for treatment and prevention of conduct =
disorder
6. Omalizumab (Xolair) for uncontrolled asthma
7. Corticosteroids in the treatment of asthma
8. Drotecogin (Xigris) and afelimomab (Segard) for severe sepsis
9. New treatments for moderate to severe psoriasis
10. Pimecrolimus (Elidel) for atopic dermatitis=20
11. Topical steroids in atopic eczema=20
Notes for editors
=========================================================================
Date: Mon, 26 Aug 2002 14:10:15 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: Northern Ireland: Allocating prescribing resources to health and
social service boards: introduction of a weighted capitation
formula
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Dear Colleagues
The Department of Health, Social Services and Public Safety (An Roinn =
Sl=E1inte, Seirbh=EDs=ED S=F3isialta agus S=E1bh=E1ilteacha Poibl=ED) in =
Northern Ireland has recently made available on its web site the =
following report (plus annexes)
Allocating Prescribing Resources to Health & Social Services Boards: =
Introduction of a Weighted Capitation Formula=20
I attach below an excerpt from the background for more information. The =
full report is available at
http://www.dhsspsni.gov.uk/publications/2002/report_eqia_final.pdf
Best wishes
David McDaid
LSE Health and Social Care
Background
1.1 Expenditure on GP prescribing covers the costs incurred by General =
Practitioners in prescribing drugs to their patients. In 2001/02 this =
public
expenditure programme accounted for 16% (=A3274m) of the total Health =
and Social Services budget.
1.2 The distribution of the GP prescribing budget was based entirely on =
historic spend until the introduction of a weighted capitation formula =
in
1998/99. The capitation concept was first introduced by using a =
combination of the resource allocation formula in operation in Scotland =
at that time and historic spend. However, this was considered to be only =
an interim arrangement, the long-term aim being a Northern =
Ireland-specific
capitation formula. Since 1998/99 research has continued to develop a =
Northern-Ireland specific formula. In the interim, a partial Northern
Ireland-specific formula was introduced for the 1999/2000 allocations =
with movement to a full Northern Ireland formula for the 2000/01 =
allocations.
The formula has been gradually phased in and currently applies to some =
62.5% of the total GP prescribing spend. The other 37.5% continues to
be driven by historic spend.
The Capitation Formula Approach
2.1 This report describes the approach and methodology of the capitation =
based formula for the allocation of primary care resources for =
prescribing to the four Health and Social Services Boards in Northern =
Ireland. The principle of weighted capitation means that resources are =
shared out across the four HSS Boards depending on:
The relative size of the relevant population;
The relative cost of each relevant age/gender group; and
The relative level of additional need (for example, higher levels of =
illness are associated with higher levels of deprivation even within the
same age/gender grouping).
These three main components of the capitation approach will be described =
in detail below but first it is worth noting some general principles
about the weighted capitation-based methodology.=20
2.2 Whilst the weighted capitation formula is based on an analysis of =
need at small area (practice) level, the Department only uses it to =
allocate
resources to Boards. It is Boards who then have responsibility for =
allocating resources to GPs within their area and use the formula to =
inform this allocation but can also draw on local knowledge.=20
2.3 It is also worth noting that the formula is not concerned with the =
absolute level of need for prescribing resources in Northern Ireland, =
but rather the relative level across Northern Ireland. The formula is =
about equitably sharing out across the four Boards, the "pot" of money =
already allotted to the GP Prescribing Budget for Northern Ireland, =
rather than varying its size or proposing any ideal level of overall NI =
prescribing budget.
2.4 In the absence of a pure measure of need for prescribing resources, =
a utilisation-based measure is used as a proxy. The weighted capitation
approach is evidence-based, taking account of the existing use of =
prescribing resources together with key factors such as population, age, =
gender and additional health and social care needs associated with =
deprivation, which determine the resources needed to fund GP prescribing
in each HSS Board. The overall aim of the formula is to ensure equal =
resource for equal need.
=========================================================================
Date: Tue, 27 Aug 2002 09:32:50 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: Vertical and horizontal aspects of socio-economic inequity in
general practitioner contacts in Scotland
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Dear Colleagues=20
Attached information on a paper in latest issue of Health Economics =
which may be of interest to some of you.
Best wishes
David McDaid
LSE Health and Social Care
Health Economics
Volume 11, Issue 6, 2002.
Pages: 537-549
Vertical and horizontal aspects of socio-economic inequity in general =
practitioner contacts in Scotland
Matthew Sutton
http://www3.interscience.wiley.com/cgi-bin/abstract/97518195/START
Abstract
Health status varies across socio-economic groups and health status is =
generally assumed to predict health care needs. Therefore the need for =
health care varies across socio-economic groups, and studies of equity =
in the distribution of health care between socio-economic groups must =
compare levels of utilisation with levels of need. Economic studies of =
equity in health care generally assume that health care needs can be =
derived from the current health-health care relationship. They therefore =
do not consider whether the current health-health care relationship is =
(vertically) equitable and the focus is restricted to horizontal =
inequity. This paper proposes a framework for incorporating the =
implications of vertical inequity for the socio-economic distribution of =
health care. An alternative to the current health-health care =
relationship is proposed using a restriction on the health-elasticity of =
health care. The health-elasticity of general practitioner contacts in =
Scotland is found to be generally negative, but positive at low levels =
of health status. Pro-rich estimates of horizontal inequity and vertical =
inequity are obtained but neither is statistically significant. Further =
analysis demonstrates that the magnitude of vertical inequity in health =
care may be larger than horizontal inequity. Copyright =A9 2002 John =
Wiley & Sons, Ltd.
=09
=========================================================================
Date: Tue, 27 Aug 2002 16:06:18 +0100
Reply-To: "Oliver,AJ" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Oliver,AJ" <[log in to unmask]>
MIME-Version: 1.0
Content-Type: text/plain; charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
Due to one or two late withdrawals, there's a couple of spaces available =
for the following seminar.
Let me know if you want to come (registration fee is =A315).
Health Equity Network Seminar: September 19th 2002
Room S75, St Clement's Building, London School of Economics and =
Political Science
Houghton Street, London WC2A 2AE; Tel: 020 7955 6471
Health Equity in the UK from an International Perspective
In this seminar, leading experts in the analysis of cross-country =
comparisons of health inequalities-related issues will present their =
work to a multi-disciplinary, multi-sectoral audience. All presenters =
have specifically stated that they intend to present their work in a =
manner that is accessible to the non-specialist, in an effort to bring =
their findings to the forefront of the UK health inequalities policy =
debate. =20
Programme
09.00-09.30: Coffee/Registration
09.30-10.45: "Explaining cross-country differences in income-related =
inequalities in self-assessed health in the EU member states"
Chair: Ken Judge, Glasgow
Author: Eddy van Doorslaer, Erasmus=09
Discussant: Anna Coote, King's Fund =09
10.45-11.15: Coffee/Tea
11.15-12.30: "Socio-economic differences in morbidity and mortality =
among the elderly: a European overview" =09
Chair: Frank Windmeijer, UCL and IFS
Author: Anton Kunst, Erasmus
Discussant: David Blane, Imperial =09
12.30-1.30: Lunch
1.30-2.45: "Explaining income-related inequalities in physician =
utilisation in European countries"
Chair: James Raftery, Birmingham
Author: Andrew Jones, York
Discussant: Michaela Benzeval, Queen Mary =09
2.45-3.15: Coffee/Tea
3.15-4.30: "Inequity in access in five countries"
Chair: Adam Oliver, LSE
Author: Cathy Schoen, Commonwealth Fund
Discussant: Roy Carr-Hill, York
Supported by the Economic and Social Research Council
=========================================================================
Date: Wed, 28 Aug 2002 14:40:07 +0100
Reply-To: "Mcdaid,D" <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Mcdaid,D" <[log in to unmask]>
Subject: FW: Many New York Employers Plan to Scale Back Employee Health
Coverage
MIME-Version: 1.0
Content-Type: multipart/alternative;
boundary="----_=_NextPart_001_01C24E98.6C2196CC"
This is a multi-part message in MIME format.
------_=_NextPart_001_01C24E98.6C2196CC
Content-Type: text/plain;
charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]]
Dear Colleague,=20
According to a new survey in New York State, employer-sponsored health =
insurance faces an uncertain future. The combination of a weak economy, =
higher unemployment, and rising health care costs is placing pressure on =
employers to eliminate or scale back health benefits for workers, their =
dependents, and retirees. Many employers also plan to shift more health =
care costs to employees: in the next few years, three of four workers =
may see their insurance costs rise. The survey also revealed disparities =
among firms of different sizes and wage levels. Smaller firms pay higher =
insurance premiums than larger firms and receive less comprehensive =
coverage in return. Low-wage firms in New York are far less likely to =
offer health coverage than comparable firms across the nation.=20
The survey of 600 New York firms, Employer Health Coverage in the Empire =
State: An Uncertain Future, was sponsored by The Commonwealth Fund and =
conducted by the Health Research and Educational Trust. The full survey =
results, including information about premium costs, rates of coverage =
and eligibility, and enrollment patterns across the state, as well as =
employers' views on the role of government in maintaining coverage, are =
available by clicking on the link below.=20
Click here to read, download, or order the report, Employer Health =
Coverage in the Empire State: An Uncertain Future
( <http://www.cmwf.org/publist/publist2.asp?CategoryID=3D4> =
http://www.cmwf.org/publist/publist2.asp?CategoryID=3D4)=20
Visit the Fund's website (http://www.cmwf.org/) to read, order, or =
download reports from The Commonwealth Fund. You can also order reports =
by calling toll-free 1-888-777-2744 or by sending an e-mail to =
[log in to unmask]
------_=_NextPart_001_01C24E98.6C2196CC
Content-Type: text/html;
charset="iso-8859-1"
Content-Transfer-Encoding: quoted-printable
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML><HEAD>
<META HTTP-EQUIV=3D"Content-Type" CONTENT=3D"text/html; =
charset=3Diso-8859-1">
<META content=3D"MSHTML 6.00.2600.0" name=3DGENERATOR></HEAD>
<BODY>
<DIV><FONT face=3DTahoma size=3D2>-----Original =
Message-----<BR><B>From:</B>=20
[log in to unmask]
[mailto:[log in to unmask]]<BR><BR></FONT></DIV>Dear Colleague,=20
<P>According to a new survey in New York State, employer-sponsored =
health=20
insurance faces an uncertain future. The combination of a weak economy, =
higher=20
unemployment, and rising health care costs is placing pressure on =
employers to=20
eliminate or scale back health benefits for workers, their dependents, =
and=20
retirees. Many employers also plan to shift more health care costs to =
employees:=20
in the next few years, three of four workers may see their insurance =
costs rise.=20
The survey also revealed disparities among firms of different sizes and =
wage=20
levels. Smaller firms pay higher insurance premiums than larger firms =
and=20
receive less comprehensive coverage in return. Low-wage firms in New =
York are=20
far less likely to offer health coverage than comparable firms across =
the=20
nation.=20
<P>The survey of 600 New York firms, <B><I>Employer Health Coverage in =
the=20
Empire State: An Uncertain Future,</I></B> was sponsored by The =
Commonwealth=20
Fund and conducted by the Health Research and Educational Trust. The =
full survey=20
results, including information about premium costs, rates of coverage =
and=20
eligibility, and enrollment patterns across the state, as well as =
employers'=20
views on the role of government in maintaining coverage, are available =
by=20
clicking on the link below.=20
<P>Click here to read, download, or order the report, <I>Employer Health =
Coverage in the Empire State: An Uncertain Future</I><BR><A=20
href=3D" http://www.cmwf.org/publist/publist2.asp?CategoryID=3D4">(=20
http://www.cmwf.org/publist/publist2.asp?CategoryID=3D4)</A>=20
<P>Visit the Fund's website (http://www.cmwf.org/) to read, order, or =
download=20
reports from The Commonwealth Fund. You can also order reports by =
calling=20
toll-free 1-888-777-2744 or by sending an e-mail to=20
[log in to unmask] </P></BODY></HTML>
------_=_NextPart_001_01C24E98.6C2196CC--
=========================================================================
Date: Fri, 30 Aug 2002 07:15:43 -0400
Reply-To: Dennis Raphael <[log in to unmask]>
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: Dennis Raphael <[log in to unmask]>
Subject: Poster submission for SDOH Conference
Comments: To: Health Promotion on the Internet <[log in to unmask]>,
[log in to unmask]
Comments: cc: [log in to unmask], [log in to unmask]
Mime-Version: 1.0
Content-type: text/plain; charset=us-ascii
Content-Disposition: inline
Details on web submission of poster proposals for the National Conference
on the Social Determinants of Health are available at:
http://www.atkinson.yorku.ca/frschhstm.htm
-------------------------------------------------------------------------------------------------
Call for Posters
Principal Objective
To showcase the latest research on a social determinant(s) and its
relationship to
health.
Secondary Objectives
To increase our understanding of the social determinants of health through a
range
of methods and objectives - including traditional research methods, stories,
ethnographies, and lived experiences.
To profile advocacy and other efforts that have been successful in improving
the
health and well-being of Canadians.
Distribution
The posters will be erected before the conference begins (5 pm on Friday) and
stay
up for the entire conference and reception.
It is anticipated that there will be 350 people in attendance: policy makers,
researchers, community leaders and academics.
The location is in the reception area just outside the conference room.
Presenters are welcome to distribute copies of their poster to all those in
attendance.
A short description of the poster will be included in the website materials.
The poster summary may be included in the conference summary - to be posted
on
the website within 2-3 weeks following the conference.
Presentation Format
The conference secretariat (located in the Registration area) will provide a
numbered
poster board for each presentation. The number on your poster board will
correspond to the number in the final proceedings. The poster board will be 3
feet
wide x 6 feet high. Self-adhesive Velcro dots will be provided on site to
affix your
poster materials.
Submission Process
Deadline: September 15th, 2002
The poster submissions will be peer reviewed and notification will occur by
September 30th. If early acceptance is required, please request an earlier
review.
=========================================================================
Date: Fri, 30 Aug 2002 09:40:37 -0400
Reply-To: [log in to unmask]
Sender: "The Health Equity Network (HEN)"
<[log in to unmask]>
From: "Vernellia R. Randall" <[log in to unmask]>
Subject: Race/Health Update: August 2002
MIME-Version: 1.0
Content-type: text/plain; charset=iso-8859-1
Content-transfer-encoding: quoted-printable
Volume 5 No. 8
August, 2002
What's New!!
http://academic.udayton.edu/race/whatsnew.htm
Traducci=F3n disponible en website en espa=F1ol.
http://academic.udayton.edu/race/espanol.htm
Tradu=E7=E3o dispon=EDvel no website em Protuguese
http://academic.udayton.edu/race/portuguese.htm
Traduction disponible sur le website en fran=E7ais
http://academic.udayton.edu/race/fran=E7ais.htm
Syllabi
08/27/02 Gender and the Law (Syllabus)
08/27/02 Bioterrorism, Public Health and the Law (Syllabus)
**********************************
African and African Descendants World Conference Against Racism
http://tbwt.com/misc/racismconference/
NGO's follow up conference to the U.N. world conference Against
Racism aimed at (a) implementing the Durban Declaration and Programme
of Action (b) developing and iplementing strategies to address the
critical problems faced the Africans and the descendants of Africans
in the Diaspora. =A9 building a global Pan African Organization
October 02-06, 2002
Sherbourne Conference Center
Bridgetown Barbados
************************************
Race, Racism and the Law
http://academic.udayton.edu/race/
08/15/02 Reparations on "Talk America", Voice of America,
08/11/02 The Case for Black Reparations Redux
08/11/02 Ku Klux Klan and Sexualized Racism/Gendered Violence
08/13/02 Akaka Bill: Native Hawaiians and Politics as Usual
08/13/02 Restoration of Native Hawaiian Fishponds
08/06/02 Native American Grave Protection Laws and Culture
08/06/02 The First Latina/o Supreme Court Justice
08/25/02 Racism in Canada, 2002 CERD Shadow Report (Download
rft File)
08/11/02 Dimensions of the War Against Southern People in Sudan
08/11/02 Sexual Slavery in Japan During WWII
08/11/02 The Trials and Tribulations of Josephine
08/01/01 Comparing Israel to Apartheid South Africa
***************************************
Global Racism: WANTED: articles and reports about racism, racial
discrimination and law. Articles need to be in English and sent
electronically. Articles must have complete citation. Vernellia
Randall, [log in to unmask]
****************************************
Race, Health Care and the Law
http://academic.udayton.edu/health/
08/25/02 Health and Racism in Canada
08/16/02 African Americans Confront the AIDS Pandemic
************************************
If you work in the area of health care, health policy or health law
and would like to be a part of an online discussion/information group
on "Race, HealthCare and the Law, contact Professor Vernellia
Randall, [log in to unmask]
************************************=
