Policy relevant determinants of health: an international perspective

Background: International comparisons can provide clues to understanding some of the important policy-related determinants of health, including those related to the provision of health care services. An earlier study indicated that the strength of the primary care infrastructure of a health services system might be related to overall costs of health services. The purpose of the current research was to determine the robustness of the findings in the light of the passage of 5–10 years, the addition of two more countries, and the findings of other research on the possible importance of other determinants of country health levels. Methods: Thirteen industrialized countries, all with populations of at least 5 million, were characterized by the relative strength of their primary care infrastructure, the degree of national income inequality, and a major manifestation of a behavioral determinant of health that is amenable to policy intervention (smoking), using international data sets and ...

Closing the gap in a generation: health equity through action on the social determinants of health

Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others.

Counting the cost of child mortality in the World Health Organization African region

Background: Worldwide, a total of 6.282 million deaths occurred among children aged less than 5 years in 2013. About 47.4 % of those were borne by the 47 Member States of the World Health Organization (WHO) African Region. Sadly, even as we approach the end date for the 2015 Millennium Development Goals (MDGs), only eight African countries are on track to achieve the MDG 4 target 4A of reducing under-five mortality by two thirds between 1990 and 2015. The post-2015 Sustainable Development Goal (SDG) 3 target is "by 2030, end preventable deaths of new-borns and children under 5 years of age". There is urgent need for increased advocacy among governments, the private sector and development partners to provide the resources needed to build resilient national health systems to deliver an integrated package of people-centred interventions to end preventable child morbidity and mortality and other structures to address all ...

Inclusion Health: Education and Training for Health Professionals: END of STUDY REPORT

The concept of Inclusion Health is founded on the premise that not all UK citizens have access to the highest standards of healthcare. Meeting the health needs of a small group of socially excluded individuals and their communities remains a challenge. This population has poorer predicted health outcomes and a shorter life expectancy than the average population. The National Inclusion Health programme for England was launched in March 2010 as a cross-government programme led by the Department of Health. It provides a framework for driving improvements in health outcomes for socially excluded groups. The rationale for setting up this framework is to increase the understanding and visibility of the health needs and health outcomes of socially excluded groups. The framework will also ensure that the services which support this population continue to improve, including continuity of care and building capability and capacity. One key activity within the framework is to ...

Integrating health care and housing to promote healthy aging.

In recent decades, the influence between health status and social conditions has been broadly studied; one of the conditions that has been strongly linked to health status has been housing.

Population ageing and the increase of chronic conditions are two of the drivers that have made that housing conditions become an important factor influencing health.

Many different proposals have been made regarding home care, most of them trying to take hospital care to patient’s home; in this post, some different aspects are discussed, mainly related to what Medicare could do in order to improve housing conditions and its influence in patient’s health: (I) increasing the emphasis on vulnerable population covered by Medicare’s Publicly Assisted Housing Programme, (II) tackling elderly falls as a main health problem and striving to reach the Health People 2020 goal of a 10 percent reduction in the rate of emergency-department visits due to ...

Enhancing primary healthcare delivery in the inner-city community in Toronto, Canada

A very participatory evaluation process with broad involvement of all stakeholders, including patient and community members, led to consensus on priorities and gaps in services; prioritization of an innovative, patient-centred, model of health and social care led to development of an integrative Family Health team working from a social determinants of health lens; multiple partnerships support long-term sustainability and educational collaboration; supportive leadership and internal champions created momentum for change and mitigated internal and external barriers to change; active and ongoing engagement of patients, community and health team members in program design and implementation.

St. Michael’s Hospital, Department of Family & Community Medicine-Family Health Team

The St. Michael’s Hospital Academic Family Health Team (SMHAFHT) is a large, primary care teaching clinic, affiliated with the University of Toronto, and nestled within the downtown core of Toronto. The Family Health Team provides services to the inner-city community of Toronto through 6 clinical sites located conveniently in these neighbourhoods. We serve the poorest communities in Toronto - people who are marginalized, underhoused and with significant health comorbidities who are significantly impacted by many social determinants of health that negatively affect the quality of one’s life, such as poverty, inadequate housing and inequitable access to health and social care services. 

In identifying the significant impact that social determinants of health have on our community, and in consideration of the research which supports the importance of interprofessional (IP) care and education, our department undertook a visioning and planning process to evolve and ‘re-purpose’ the way we deliver care, how ...

Priorities for action on the social determinants of health: Empirical evidence on the strongest associations with life expectancy in 54 low-income countries, 1990–2012

The WHO Commission on the Social Determinants of Health set out an impressive collection of policy proposals on the social determinants of health. However, a serious weakness for securing implementation is the difficulty for policymakers in identifying priorities for action. The objective of this study is to determine a small set of the most influential determinants using existing data and an empirical approach.

There is no evidence that national income, public spending on healthcare and education, secondary schooling, terms of international trade, employment, debt service and relief, out-of-pocket expenditures, agricultural ex- or imports, lifestock production, foreign investment, urbanization or environmental degradation are robustly associated with population health. Results provide support for the relevance of some proposed policies. The findings can inform priorities for future research and policy action on the social determinants of health.

Community health center provider ability to identify, treat and account for the social determinants of health: a card study

The social determinants of health (SDH) are conditions that shape the overall health of an individual on a continuous basis. As momentum for addressing social factors in primary care settings grows, provider ability to identify, treat and assess these factors remains unknown. Community health centers care for over 20- million of America´s highest risk populations. This study at three centers evaluates provider ability to identify, treat and code for the SDH.

The results suggest simple methods of identification may be sufficient. The addition of searchable codes and reimbursements may improve the way social factors are addressed for individuals and populations. 

Providing primary health care through integrated microfinance and health services in Latin America

The simultaneous burdens of communicable and chronic non-communicable diseases cause significant morbidity and mortality in middle-income countries. Integrating health-related services with microfinance has been shown to improve health knowledge, behaviors, and access to appropriate health care. However, limited evidence is available on effects of fully integrating clinical health service delivery alongside microfinance services through large scale and sustained long-term programs, so this study analyze descriptive reports and administrative data for measures related to improving access to primary health services and management of chronic diseases. 

Individual determinants of integrated care for indigent patients: an experimental study in Brussels: Pierre Smith

In metropolitan area, socially deprived patients with chronic disease undergo the fragmentation of health and social care services because of their complex needs. Integration of health and social care would benefit these patientes, however, it is not feasible or appropriate to integrate all the services for all vulnerable patients. This study aims at identifying the indicidual determinants of deprived patients´preferences in integration of health and social care. 

Community Care for People with Complex Care Needs: Bridging the Gap between Health and Social Care

Introduction: A growing number of people are living with complex care needs characterized by multimorbidity, mental health challenges and social deprivation. Required is the integration of health and social care, beyond traditional health care services to address social determinants. This study investigates key care components to support complex patients and their families in the community.

Methods: Expert panel focus groups with 24 care providers, working in health and social care sectors across Toronto, Ontario, Canada were conducted. Patient vignettes illustrating significant health and social care needs were presented to participants. The vignettes prompted discussions on i) how best to meet complex care needs in the community and ii) the barriers to delivering care to this population.

Results: Categories to support care needs of complex patients and their families included i) relationships as the foundation for care, ii) desired processes and structures of care, and iii) barriers and workarounds for desired ...

The impact of cash transfers on social determinants of health and health inequalities in sub-Saharan Africa: a systematic review

Cash transfers (CTs) are now high on the agenda of most governments in low-and middle- income countries. Within the field of health promotion, CTs constitute a healthy public policy initiative as they have the potential to address the social determinants of health and health inequalities. A systematic review was conducted to synthesise the evidence on CTs´impacts on social determinants of health and health inequalities in sub-Saharan Africa, and to identify the barriers and facilitators of effective CTs.

Determinants of enrollment decision in the community-based health insurance, North West Ethiopia: a case-control study

Health security is increasingly being recognized as an integral part of poverty reduction effort. Many lower and middle-income countries (LMICs) have not been able to fulfill equitable healthcare needs of their citizens.
The aim of this study was to identify the determinants for enrollment decision in the community-based health insurance program among informal economic sector-engaged societies, North West Ethiopia.

Why the biopsychosocial model needs to be the underpinning philosophy in rehabilitation pathways for patients recovering from COVID-19

The pandemic caused by COVID-19 has left many consequences, both social and health, on a social and individual level. In the face of individual sequelae, the need to address this need for care with an integrative approach becomes more important.The pandemic caused by COVID-19 has left many consequences, both social and health, on a social and individual level. In the face of individual sequelae, the need to address this need for care with an integrative approach becomes more important.

"For patients recovering from COVID-19, it will be impossible to separate the person and their personal circumstances from COVID-19, and to regard physical, psychological and social factors as independent entities. For this reason, we argue that the BPS model is needed with even more reason than before, and that it should be the philosophy of care to underpin rehabilitation in the recovery from COVID-19".

A Community Resource Navigator Model: Utilizing Student Volunteers to Integrate Health and Social Care in a Community Health Center Setting

While unmet social needs are major drivers of health outcomes, most health systems are not fully integrated with the social care sector to address them. 

This case study describes the development and implementation of a model utilizing student volunteer community resource navigators to help patients connect with community-based organizations. The authors then detail initial implementation outcomes and practical considerations for future work.

Policy by Pilot? Learning From Demonstration Projects for Integrated Care; Comment on “Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study”

Analysis of policy implementation for chronic disease in Belgium highlights the difficulties of launching experiments for integrated care in a health system with fragmented governance. It also entreats us to consider the inherent challenges of piloting integrated care for chronic disease. Sociomedical characteristics of chronic disease –political, social, and economic aspects of improving outcomes – pose distinct problems for pilot projects, particularly because addressing health inequity requires collaboration across health and social sectors and a long-term, life-course perspective on health. Drawing on recent US experience with demonstration projects for health service delivery reform and on chronic disease research, I discuss constraints of and lessons from pilot projects. The policy learning from pilots lies beyond their technical evaluative yield. Pilot projects can evince political and social challenges to achieving integrated chronic disease care, and can illuminate overlooked perspectives, such as those of community-based organizations (CBOs), thereby potentially extending the terms of policy ...

Integrated Health and Social Care in the United States: A Decade of Policy Progress

Over the last decade in the United States (US), the burden of chronic disease, health care costs, and fragmented care delivery have increased at alarming rates. To address these challenges, policymakers have prioritized new payment and delivery models to incentivize better integrated health and social services. This paper outlines three major national and state policy initiatives to improve integrated health and social care over the last ten years in the US, with a focus on the Medicaid public insurance program for Americans with low incomes.

From Patient-centered to Person-centered: The pharmacist's role and value in community-integrated care transformation

Patient-centered care lies at the center of the Joint Commission of Pharmacy Practitioners Pharmacists’ Patient Care Process (PPCP) and recognizes the pharmacist’s responsibility for the patient’s drug-related and health needs, concerns, and expectations as well as prioritizing the patient’s interests before all others. Person-centered care more explicitly expands the pharmacist’s understanding of the patient to a person with rights, knowledge, and experiences that extend outside of disease, illness, and pharmacotherapy. The Social Care Framework developed by the National Academies of Science, Engineering, and Medicine provides a roadmap to how pharmacists can provide community-integrated care that is consistent with person-centeredness. Doing so can expand the pharmacist’s role and value in a time of community-integrated care transformation.

Operational Framework for Primary Health Care

The World Health Assembly in resolution WHA72.2 (2019) requests the Director-General inter alia “to develop, in consultation with, and with the involvement of more expertise from, Member States, and in time for consideration by the Seventy-third World Health Assembly, an operational framework for primary health care, to be taken fully into account in the WHO general programmes of work and programme budgets in order to strengthen health systems and support countries in scaling-up national implementation efforts on primary health care”. This operational framework builds on an initial draft that was prepared as part of a technical series to support the Global Conference on Primary Health Care (Astana, 25 and 26 October 2018). It was then revised following expert review, public consultation, civil society consultation, key informant interviews and consultations with Member States.

This operational framework, the related Vision for primary health care in the 21st Century, and associated technical ...

Integrated person- and people-centred primary care for diabetes in low- and middle-income countries: The nurses' perspective on patient needs

The aim of this study was to identify what nurses working in primary care settings perceive as necessary to support the life needs of people with type 2 diabetes. Articulate these needs with the needs expressed by people with diabetes in a previous study. This study demonstrates nurses' important contribution to analysing and designing people-centred care in their community. 

2nd International Summit on Public Health and Preventive Medicine

2nd International Summit on Public Health and Preventive Medicine (ISPHPM2024), a premier event focusing on the latest developments in the field of public health and preventive medicine which is going to be held in Prague, Czech Republic during May 27-29, 2024.

The 2023 edition of ISPHPM conference took place in Brussels in May 2023 with a fabulous set of speakers, it was a huge success. This year's event will bring together healthcare professionals, researchers, and experts from around the world to discuss the latest advancements in public health. Join us for a day of education, networking, and knowledge exchange. This event will provide a valuable opportunity for the attendees to learn from each other’s work, exchange ideas, create networks and build collaborations.

Come join us for a 3 day event that promises to be both informative and inspiring!