bluuebunny/crossref_metadata_2025 huggingface dataset:
Safe Mothers, Healthy Babies: Reproductive Health in the Twentieth Century
Authors: Kotelchuck Milton
Published: September 2009

The decline of infant and maternal mortality represents one of the greatest public health achievements of the 20th century. From 1900 through 2000, infant mortality in the United States declined dramatically from estimated 10,000–15,000 deaths to 690 deaths per 100,000 births; similarly, maternal mortality declined from an estimated 600–900 deaths to under ten deaths per 100,000 births. Reductions in both morbidity and mortality have improved the lives of parents and children and have altered expectations for women. Public health actions to improve sanitation, maternal hygiene, nutrition, and prenatal care played a central role in the transformation of reproductive health in the 20th century. This chapter describes decade by decade the evolving concepts and debates about the causes of infant and maternal mortality, the initiatives to ameliorate them, the institutionalization of the major public health advances, and the resulting epidemiologic transformations in the United States.
Saving Babies and Mothers: Pioneering Efforts to Decrease Infant and Maternal Mortality
Authors: Wolf Jacqueline H.
Published: September 2009

This chapter examines the efforts of late-19th and early-20th century reformers to lower infant and maternal mortality in the United States. Earlier fatalistic attitudes toward infant and maternal mortality shifted to the view that all premature deaths were inexcusable, prompting assertive state toward setting and maintaining minimal living standards. The chapter focuses in particular on the efforts to lower infant death from diarrhea via dual campaigns, one to encourage mothers to breastfeed and the other to regulate the dairy industry. It also discusses the successful work of home-birth and lying-in dispensaries to lower the maternal mortality rate by providing free obstetric care to the poor and training physicians in the art of obstetrics.
The More Things Change: A Historical Perspective on the Debate over Vitamin Advertising in the United States
Authors: Apple Rima D.
Published: September 2009

Vitamin supplements have been popular from the time the micronutrients were discovered in the early 20th century. Popular news media and advertisements promoted vitamins as crucial for two critical concerns: vitamin supplements insured that the diet contained sufficient quantities of critical micro-nutrients; and vitamins—whether as a dietary supplement or as an ingredient in cosmetics—could enhance beauty. While health professionals and medical practitioners recognized the critical value of vitamins, they often saw the growth of the vitamin industry as a threat to the general population's health and well-being. Over the century the themes of beauty and insurance were re-interpreted and reinforced through successive eras, reverberating in the contemporary promotion of the cancer fighting potential and beautifying effects of anti-oxidants.
Family Planning: A Century of Change
Authors: Darroch Jacqueline E.
Published: September 2009

As the 20th century dawned, American women typically became biologically capable of conceiving children at age fifteen, were married at age twenty-two, and had an average of 3.6 children during their reproductive lives. In contrast, for women born during the last third of the 1900s experienced menarche at age thirteen, first engaged in sexual intercourse at age seventeen, and had an average of 2.1 children. These changes during the 20th century reflect the technologic changes in family-planning methods available to American women and men increasing couples' ability to successfully control the number and timing of children, increased women's control over fertility, and gave rise to alternative medical provider networks for women's reproductive-health care. This chapter summarizes key changes in family planning over the last century and provides an overview of changes in contraceptive technology and in the provision of reproductive health and contraceptive services.
Teaching Birth Control on Tobacco Road and Mill Village Alley: Race, Class, and Birth Control in Public Health
Authors: Schoen Johanna
Published: September 2009

In the 1930s, public health professionals launched birth control programs as part of their infant and maternal health measures. In addition to reducing infant and maternal mortality rates, offering birth control to poor women also seemed attractive for economic and eugenic reasons. Public health birth control services simultaneously offered women reproductive control and provided control over poor women's reproduction. Although clients recognized the race and class prejudices behind many family planning programs, they took advantage of the services offered, and bargained with authorities over the conditions of contraceptive advice. Women's lack of access to contraceptive services, their poverty, their race, and gender significantly influenced their decision to participate in contraceptive field trials or take advantage of birth control programs.
Changing the Face of America: Water Fluoridation and Oral Health
Authors: Burt Brian A. , Tomar Scott L.
Published: September 2009

During the early- to mid-1900s, dental caries (i.e., tooth decay), frequently associated with uncomfortable treatment and tooth loss, was one of life's less pleasant certainties. However, the dental health outlook for Americans growing up during the later part of the 1900s was quite different. Substantial improvements in oral health were the result of many factors, including rising standards of living, better treatment technology, and more positive attitudes toward oral health. However, the widescale exposure of Americans to fluoride also played a crucial role. The concept of water fluoridation as tool for oral health began with studies which revealed that routine exposure to fluoride reduced the incidence and severity of dental caries. By the start of the 21st century, more than half of the U.S. population had access to fluoridated water. This chapter traces the historical development of fluoride as a tool for preventing dental caries.
Dietary Policy, Controversy, and Proof: Doing Something versus Waiting for the Definitive Evidence
Authors: Garrety Karin
Published: September 2009

The view that a healthy diet was low in fats and high in carbohydrates became mainstream and widely accepted during the second half of the 20th century. But discussions about diet, disease, and health take place in a highly politicized arena, and this diet was the subject of considerable controversy. This chapter examines the period from the 1940s, when awareness of the increasing incidence of CHD began to grow, to 1985, the year the National Cholesterol Education Program (NCEP) began its effort to sell the anti-fat, anti-cholesterol message to the nation. This campaign marked a victory for advocates of fat reduction over skeptics who continued to question the efficacy of low fat diets as a means of preventing disease.
The First Surgeon General’s Report on Tobacco: Science and the State in the New Age of Chronic Disease
Authors: Brandt Allan M.
Published: September 2009

The Surgeon General's Report of 1964 marks a watershed in the history of public health. Following its publication, both the science and the practice of public health were visibly transformed. This chapter traces the clinical and epidemiological progress in knowledge about smoking and health harm, and the institutional history of the Report. In establishing cigarette smoking as the preeminent public health issue of the second half of the 20th century, the federal government established new responsibilities and authority for science and health in the consumer culture. Surgeons General since have used the authority of their office to shape the policy context of subsequent tobacco regulation.
Applied Longitudinal Data Analysis
Authors: Singer Judith D. , Willett John B.
Published: September 2009

Change is constant in everyday life. Infants crawl and then walk, children learn to read and write, teenagers mature in myriad ways, and the elderly become frail and forgetful. Beyond these natural processes and events, external forces and interventions instigate and disrupt change: test scores may rise after a coaching course, drug abusers may remain abstinent after residential treatment. By charting changes over time and investigating whether and when events occur, researchers reveal the temporal rhythms of our lives. This book is concerned with behavioral, social, and biomedical sciences. It offers a presentation of two of today's most popular statistical methods: multilevel models for individual change and hazard/survival models for event occurrence (in both discrete- and continuous-time). Using data sets from published studies, the book takes you step by step through complete analyses, from simple exploratory displays that reveal underlying patterns through sophisticated specifications of complex statistical models.
Exploring Longitudinal Data on Change
Authors: Singer Judith D. , Willett John B.
Published: September 2009

This chapter describes exploratory analyses that can help researchers learn how different individuals in their sample change over time. These analyses serve two purposes: to identify important features of data and to prepare researchers for subsequent model-based analyses. Section 2.2 addresses the within-person question: How does each person change over time? It does this by exploring and summarizing empirical growth records, which list each individual's outcome values over time. Section 2.3 addresses the between-person question: How does individual change differ across people? This is done by exploring whether different people change in similar or different ways. Section 2.4 shows how to ascertain descriptively whether observed differences in change across people (interindividual differences in change) are associated with individual characteristics. These between-person explorations can help identify variables that may ultimately prove to be important predictors of change. Section 2.5 concludes by examining the reliability and precision of exploratory estimates of change and comments on their implications for the design of longitudinal studies.
Introducing the Multilevel Model for Change
Authors: Singer Judith D. , Willett John B.
Published: September 2009

This chapter introduces the multilevel model for change, demonstrating how it allows researchers to address within-person and between-person questions about change simultaneously. Although there are several ways of writing the statistical model, a simple and common approach is adopted that has much substantive appeal. It specifies the multilevel model for change by simultaneously postulating a pair of subsidiary models—a level-1 submodel that describes how each person changes over time, and a level-2 model that describes how these changes differ across people.
Doing Data Analysis with the Multilevel Model for Change
Authors: Singer Judith D. , Willett John B.
Published: September 2009

This chapter delves deeper into the specification, estimation, and interpretation of the multilevel model for change. Following introduction of a new data set, it presents a composite formulation of the model that combines the level-1 and level-2 submodels together into a single equation. The new composite model leads naturally to consideration of alternative methods of estimation. The chapter not only describes two new methods—generalized least squares (GLS) and iterative generalized least squares (IGLS) within each, it distinguishes further between two types of approaches, the full and the restricted. The remainder of the chapter focuses on real-world issues of data analysis.
Treating TIME More Flexibly
Authors: Singer Judith D. , Willett John B.
Published: September 2009

This chapter demonstrates how to apply the multilevel model to complex data sets. Section 5.1 begins by illustrating what to do when the number of waves is constant but their spacing is irregular. Section 5.2 illustrates what to do when the number of waves per person differs as well; it also discusses the problem of missing data, the most common source of imbalance in longitudinal work. Section 5.3 demonstrates how to include time-varying predictors in your data analysis. Section 5.4 concludes by discussing why and how to adopt alternative representations for the main effect of TIME.
Modeling Discontinuous and Nonlinear Change
Authors: Singer Judith D. , Willett John B.
Published: September 2009

This chapter introduces strategies for fitting models in which individual change is explicitly discontinuous or nonlinear. Section 6.1 begins by describing ways of incorporating abrupt discontinuities into the individual change trajectory. Section 6.2 shows how transformation of either the outcome or TIME can lead to a multilevel model for linear change based on the transformed variable(s). Section 6.3 extends this basic idea by specifying trajectories that are polynomial functions of TIME. Section 6.4 concludes by surveying several models for individual change in which the outcome is an explicit nonlinear function of the growth parameters.
Describing Continuous-Time Event Occurrence Data
Authors: Singer Judith D. , Willett John B.
Published: September 2009

This chapter presents strategies for describing continuous time event data. Section 13.1 identifies salient properties of continuous-time data and redefines the survivor and hazard functions as required. Section 13.2 estimates these functions using a pair of simple strategies—called the discrete-time and actuarial methods—that require the continuous event times to be grouped into intervals. Section 13.3 introduces a superior approach—the Kaplan–Meier method—that does not require the artificial grouping of data but that yields estimates of only the survivor, not the hazard, function. The remainder of the chapter offers solutions to the core conundrum embedded in continuous-time event data: the inability to estimate the hazard function well.
Fitting Cox Regression Models
Authors: Singer Judith D. , Willett John B.
Published: September 2009

This chapter describes the conceptual underpinnings of the Cox regression model and demonstrates how to fit it to data. Section 14.1 begins by developing the Cox model specification itself, demonstrating why it is a sensible representation. Section 14.2 describes how the model is fit. Section 14.3 examines the results of model fitting, showing how to interpret parameters, test hypotheses, evaluate goodness-of-fit, and summarize effects. Section 14.4 concludes by presenting strategies for displaying results graphically.
Extending the Cox Regression Model
Authors: Singer Judith D. , Willett John B.
Published: September 2009

This chapter begins by describing how to include time-varying predictors in the Cox regression model. It then introduces two methods for relaxing the proportionality assumption. Section 15.2 presents the stratified Cox regression model, which stipulates that while the effects of each predictor are identical across strata, the baseline hazard functions can differ. Section 15.3 presents an alternative strategy that closely mirrors the approach used in discrete time: the inclusion of interactions with time as predictors in the model. Section 15.4 introduces a range of regression diagnostics useful for examining the underlying assumptions of the Cox model. Section 15.5 discusses what to do when modeling “competing risks”—multiple events that compete to terminate an individual's lifetime. Section 15.6 concludes by describing what to do when you have not observed the beginning of time for everyone in your sample and there are so-called late entrants to the risk set.
Racial And Ethnic Minorities
Authors: Allen Carol Easley , Easley Cheryl E.
Published: September 2009

This chapter describes the impact of social injustice on the health of racial and ethnic minorities, the roots and underlying issues of this social injustice, specific implications of social injustice for racial and ethnic minorities, and an agenda of what needs to be done. This agenda includes ensuring cultural confidence among health professionals and institutions, increasing recruitment and retention of minority youth into health professions, attending to clear health communication to address health literacy problems, reducing poverty and addressing factors that create poverty, addressing racial discrimination, and performing research.
Women
Authors: Rees Stacey J. , Chavkin Wendy
Published: September 2009

This chapter describes how social injustice affects the health of women and the underlying causes and roots of social injustice against women. It discusses what needs to be done, including increasing access to quality health care, strengthening prevention programs that promote women's health, undertaking gender-sensitive initiatives that address sexually transmitted diseases and sexual and reproductive health issues, promoting research and disseminating information on women's health, and increasing resources and monitoring follow-up for women's health.
Children
Authors: Rosenbaum Sara , Yoder Chung-Hi H.
Published: September 2009

This chapter deals primarily with the impact of social injustice on children in the United States, emphasizing children's rights in a legal context. It covers the legal status of children in society, the impact of social injustice on children's health, underlying factors and roots of this social injustice, and what needs to be done. The chapter concludes that the well-being of children depends on many investments, such as adequate family income, safe housing neighbors, and caregivers whose own lives are sufficiently supported to be able to invest time in and nurture their children. It also includes boxes on how the United States compares with other developed countries, and saving children's lives in developing countries.
Older People
Authors: Estes Carroll L. , Wallace Steven P.
Published: September 2009

This chapter addresses social injustice in relation to the health of older people. It covers the impact of social injustice on the health of older people; the roots and underlying causes of this social injustice, including the graying of the socioeconomic status-health gradient, the biomedicalization of aging, and globalization; and finally, what needs to be done. The chapter concludes that rights for older people must be defined as basic human rights, and that social justice for older people must begin with the assertion of the human right to health.
Lesbian, Gay, Bisexual, And Transgender/Transsexual Individuals
Authors: Lombardi Emilia , Bettcher Talia
Published: September 2009

This chapter describes the impact of social injustice on the health of lesbian, gay, bisexual, and transgender/ transsexual individuals, including the impact of violence, HIV/AIDS, mental health and substance abuse, and cardiovascular disease and cancer. It addresses the underlying factors and roots of this social injustice and what needs to be done, in terms of legislative and other policies, roles of health care facilities and organizations, educational measures, and research.
Forced Migrants: Refugees And Internally Displaced Persons
Authors: Toole Michael
Published: September 2009

This chapter addresses social injustice in relation to forced migrants (refugees and internally displaced persons). It addresses the effects of social injustice on the health of refugees and internally displaced persons, including the impact of violence and various direct and indirect impacts on health. It describes roots and underlying issues, including poor health as a risk factor for conflict and international responses to homelessness, as well as what needs to be done. The chapter concludes that the plight of homeless people can be addressed only if the international community is serious about addressing the root causes of poverty, poor governance, exploitation, and inequities between rich and poor countries.
Nutrition
Authors: Brown J. Larry
Published: September 2009

This chapter addresses social injustice as it relates to nutrition and the relationship between poor nutritional status and adverse health outcomes. It describes the impact of social injustice on nutrition and roots and underlying factors, as well as what needs to be done. A box describes obesity in relation to social injustice. The chapter concludes that government policy that invests in all households and narrows disparities in income and wealth will end not only hunger, but also the many other adverse health outcomes that result from social injustice.
Chronic Diseases
Authors: Yach Derek
Published: September 2009

This chapter describes social injustice in relation to chronic diseases, including cardiovascular disease, diabetes mellitus, cancer, chronic respiratory diseases, and aging and risk factors. It considers how social injustice influences chronic diseases in terms of social class and chronic disease risks and outcomes, cumulative exposure to risks, comorbidity, and access to quality medical care. It looks at roots and underlying issues, including macroeconomic influences, urban and rural factors, and generally weak chronic disease policies and programs in developing countries. It describes what needs to be done, including institution of comprehensive prevention, health promotion, and treatment policies, as well as emphasizing prevention and health promotion, strengthening capacity and mobilizing resources, developing global norms that benefit developing countries, reorienting health services to address chronic disease, and promoting broader societal changes.
Assaultive Violence And War
Authors: Mercy James A.
Published: September 2009

This chapter addresses social injustice in relation to assaultive violence and war. It considers social injustice as a cause of violence and the influence of cultural forms of injustice, including hate-motivated violence, and gender inequality, and the influence of institutional forms of social injustice, including political repression and unfair distribution of justice. Boxes in the chapter describe the relationship between war and public health and also genocide. The chapter gives suggestions on what needs to be done, including increasing the cost of injustice, deconcentrating poverty, reducing social distance, redefining harmful cultural norms, and strengthening democratic institutions.
Occupational Safety And Health
Authors: Taylor Andrea Kidd , Murray Linda Rae
Published: September 2009

This chapter addresses social injustice in relation to occupational safety and health. It provides an historic overview and discussion of the scope of the problem, a discussion of income inequalities in the United States, and various ways in which social injustice impacts on occupational safety and health. A box in the chapter describes the adverse impacts of economic globalization. The chapter describes what needs to be done, including educating workers, empowering communities, preventing discrimination, promoting workplace democracy and environmental justice, improving surveillance and research, reforming OSHA and workers' compensation, and promoting the role of organized labor.
Strengthening Communities And The Roles Of Individuals In Community Life
Authors: Aronson Robert E. , Lovelace Kay , Hatch John W. , Whitehead Tony L.
Published: September 2009

This chapter addresses strengthening communities and the roles of individuals in community life as ways of reducing social injustice. It describes how social injustice can be addressed through community transformation and provides principles to guide the work of community transformation. The chapter puts forward an agenda for action, including specific measures of what needs to be done.
Researching Critical Questions On Social Justice And Public Health: An Ecosocial Perspective
Authors: Krieger Nancy
Published: September 2009

This chapter describes researching critical questions on social justice and public health from an ecosocial perspective. It discusses a proposal for a public health research agenda that advances issues of social justice and includes four components: theory, monitoring, etiology, and prevention. The chapter draws on ecosocial theory and the proposition that social justice is the foundation of public health.
Promoting Equitable And Sustainable Human Development
Authors: Jolly Richard
Published: September 2009

This chapter describes how social injustice can be reduced by promoting equitable and sustainable human development. It covers requirements for greater social justice in public health. It describes the Millennium Development Goals for poverty reduction and it describes priority actions required of developed countries. The chapter also describes ways in which social injustice can be reduced globally and how sustainable human development can be facilitated. The chapter concludes that actions required for ending social injustice as it affects health go far beyond those of the health sector, and that priority actions extend to many aspects of economic and social policy, nationally and internationally.
More than Ramps
Authors: Iezzoni Lisa I. , O'Day Bonnie L.
Published: September 2009

Nearly 20% of Americans live today with some disability, and this number will grow as the “baby boomers” age. Despite this, the U.S. health care system is ill equipped to provide optimal, safe, and efficient care to this population. Significant barriers still block people with disabilities from receiving high quality health care. This book examines these barriers then proposes solutions to make health care accessible and welcoming to people with disabilities, focusing on adults who are blind, deaf, hard of hearing, or who have difficulties using their legs, arms, or hands. The book draws upon stories told by persons with these conditions and reviews of national surveys, governmental policies, and current practices. Some barriers are obvious, such as examining tables that are too high. Other problems arise from faulty communication between patients and health care professionals, including misconceptions among clinicians about the daily lives, preferences, values, and abilities of patients with disabilities. Yet others relate to restrictive health insurance policies. Finding patient-centered solutions to these many impediments will take more than simply building ramps. The first part of the book examines broad social and health insurance policies affecting people with disabilities. The second part discusses current barriers to health care, while the third proposes ways to overcome these hurdles and improve care. Using universal design principles, these solutions recognize that creating safe and accessible health care for people with disabilities will benefit virtually everyone at some point in their lives.
Health Insurance and Accessing the Health Care System
Authors: Iezzoni Lisa I. , O'Day Bonnie L.
Published: September 2009

Approximately 15% of Americans lack health insurance, and many have insurance policies with limited benefits, inadequate to meet their needs. This chapter examines the health insurance coverage of persons with disabilities, focusing primarily on working-age adults (the vast majority of elderly adults have Medicare). Since most working-age Americans obtain health insurance coverage through their employment, the chapter explores the consequences of leaving the workforce—or being unemployed—especially when individuals apply for Social Security Disability Insurance and must then await Medicare coverage. It also reviews basic concerns relating to benefits design, particularly policies (such as medical necessity requirements) that might have special implications for persons with disabilities.
Clinical Competence and Technical Communication
Authors: Iezzoni Lisa I. , O'Day Bonnie L.
Published: September 2009

This chapter explores communication between patients with disabilities and clinicians about “technical” matters—the purportedly objective “facts” that guide clinical decision making, such as discussions about symptoms, signs, therapeutic options, and treatment side effects. It discusses concerns that clinicians may have inadequate scientific knowledge about many disabling conditions, and they therefore make decisions based on their personal views of patients' quality of life rather than objective medical evidence. Conflicts can arise when clinicians fail to appreciate the value persons with disabilities place on their lives. The chapter also discusses problems making clinical information, such as recommendations for treatments and warnings about side effects, accessible to persons with impaired vision or hearing. Failure to accommodate patients' communication needs can compromise patients' safety.
Improving Patient-Clinician Communication
Authors: Iezzoni Lisa I. , O'Day Bonnie L.
Published: September 2009

This chapter offers suggestions for improving open and effective patient-clinician communication. The first step involves training clinicians to recognize communication barriers. All members of health care organizations, from senior leadership to front-line office assistants, require training to enhance awareness of potential communication barriers and strategies for accommodating communication needs. The chapter reviews various approaches for improving communication, as well as training clinicians to improve their interview and interaction skills with patients with disabilities. Training should include efforts to increase sensitivity to stigmatizing attitudes and other social barriers experiences by persons with disabilities. The chapter also discusses clinicians with disabilities.
Globalization and Tobacco
Authors: Yach Derek , Wipfli Heather , Hammond Ross , Glantz Stanton
Published: September 2009

This chapter reviews the evolving economic and social system sustaining the growing tobacco epidemic in order to identify how globalization is affecting the industry, governments, and tobacco control advocates. It is divided into four main sections. The first section recalls key historical events that led to the worldwide prominence of tobacco use and the global rise of tobacco-related death and disease. The second section examines scientific evidence regarding the health effects of active and passive smoking and reviews the globalization of the public health response to the tobacco epidemic. The third section describes the Framework Convention on Tobacco Control (FCTC) negotiating process and final treaty text. The fourth section analyzes some of the remaining major challenges resulting from working within a global system, in particular, those challenges associated with developing coherent domestic and international policies and the permanent need to anticipate the unintended consequences of national and global regulations. The chapter concludes by identifying new directions and resources for global tobacco control and predicting some of the main challenges that lie ahead.
The Rapid Shifts in Stages of the Nutrition Transition: The Global Obesity Epidemic
Authors: Popkin Barry M. , Mendez Michelle
Published: September 2009

This chapter examines the types of shifts in food availability, dietary intake patterns, and obesity that have taken place in developing countries during a period of rapid globalization and urbanization. The effects of globalization and urbanization on dietary and activity patterns and nutritional status in developing countries are complex. These forces are associated with potentially beneficial dietary shifts, such as increases in energy sufficiency and reduced micronutrient deficiency, but also appear to promote potentially obesogenic shifts, such as increased intakes of edible oils, animal foods, and caloric sweeteners. While there have been substantial reductions in undernutrition in this period of rapid development and social change, being overweight has become an increasing problem.
Structural Adjustment Programs and Health
Authors: Breman Anna , Shelton Carolyn
Published: September 2009

This chapter reviews literature comparing empirical, theoretical, and normative articles on the relationship between structural adjustment programs (SAPs) and health. The first section discusses the debate, the role-players, their main arguments, and trends in the debate. The second section presents a framework illustrating the causal arguments for how structural adjustment may affect health outcomes and discusses methodological issues in empirical estimations of this relationship. The third section summarizes and analyzes the empirical evidence, and finally draws conclusions from the review.
Promoting Public Health in the Twenty-First Century: The Role of the World Health Organization
Authors: Bonita Ruth , Irwin Alec , Beaglehole Robert
Published: September 2009

One of the paradoxes of globalization is that an increasingly interconnected and interdependent world is simultaneously marked by widening health gaps between privileged and less advantaged groups, both between and within countries. Ambitious development and health objectives, most prominently the Millennium Development Goals (MDGs), have been set by the global community to promote a fairer distribution of the benefits of progress. But gains toward the targets are too slow, particularly in the countries with the greatest needs. This chapter assesses WHO's capacity to lead in meeting these challenges. It begins with a review of key stages of WHO's history, then surveys the current state of global public health. Finally, it explores strategic directions set by WHO's current leadership to respond and help shape a healthier, more equitable future for all.
Military Spending: Global Health Threat or Global Public Good?
Authors: Hyatt Jr. Raymond R.
Published: September 2009

This chapter examines the specific tradeoffs between military spending and social welfare spending (the well-known guns vs. butter tradeoff) and the effects of expenditures in military budgets for recently expanding peacekeeping operations. The analysis confirms the negative relationship between mortality and the allocation of resources to military programs by the state. Citizens in countries with higher allocations to military programs have worse mortality outcomes. Greater percentages of state resources allocated to military programs are associated with higher infant mortality rate (IMRs) and lower overall life expectancy at birth (LEB) for the average citizen. The most basic aspect of freedom—the opportunity to live a life of choice—is restricted as resources are allocated away from domestic programs.
Medical Education: Teaching Doctors to Be Trustworthy
Authors: Cohen Jordan J.
Published: September 2009

Physician trustworthiness is the best protection against error-prone modern healthcare. This chapter discusses how medical education can nurture and sustain trustworthiness in future physicians using appropriate admissions criteria, explicit learning objectives, and rewards and sanctions for professional behaviors. It argues institutions should also be clear in articulating expectations, commitment, and values from students and faculty through an approach similar to the Compact Between Teachers and Learners of Medicine, which is a model compact designed by the Association of American Medical Colleges (AAMC). Other initiatives the AAMC is developing to improve education include the Institute for the Improvement of Medical Education and measures of professionalism for peer evaluation.
Trust in Vaccines
Authors: McCORMICK MARIE C.
Published: September 2009

Improvements in immunizations have been perceived as one of the greatest medical advances. However, recently, there has been increasing mistrust of the effects of vaccines on children. This chapter delineates how this decline in trust occurred, including sections on changes in policy, adverse events, myths, misinformation, and incomplete science. It describes ways that physicians can enhance the patient-physician relationship by increasing patient trust in vaccines and immunizations, through better communication and flexibility.
Trust in the Trenches: Developing the Patient-Physician Dyad in Medical Genetics
Authors: Pauker Susan P.
Published: September 2009

Genetic medicine is unique in that it involves the patient, living and deceased relatives, and future generations. Because of this complexity, medical genetics can bring patients and doctors face to face with sudden and painfully difficult decisions. Despite the controversy, the medical genetics specialty has the potential to build trust in the patient-physician relationship in difficult situations. This chapter identifies some of the difficult decisions patients face when meeting with a medical geneticist. These difficulties can be compounded by confidentiality and informed consent issues. Physicians can avoid some of these situations by building trust with sensitive and accurate communications.
Healthier Societies: An Introduction
Authors: Heymann Jody , Hertzman Clyde
Published: September 2009

This introductory chapter calls attention to the emphasis that individuals and nations currently place on the treatment of illnesses and injuries at the expense of addressing the conditions that give rise to them. In most countries, there is far more political pressure to invest in medical care services for those who are already sick and injured than to invest in the programs and policies that could prevent those injuries and illnesses. Many adults believe that it is too late for them to take steps that would help prevent their own health problems, and even if convinced of the importance of addressing social determinants of health, have no idea how to move policy makers. This book is designed to address the knowledge gaps behind the barriers to approaching health from a societal perspective. The chapter also contains a detailed summary of the book's contents.
Biological Pathways Linking the Social Environment, Development, and Health
Authors: Hertzman Clyde , Frank John
Published: September 2009

This chapter begins by presenting an overview of current knowledge regarding the biological pathways by which socioeconomic, psychosocial, and developmental experiences affect human biology over the life course. The goal is to understand not only how systematic differences in health status emerge among groups of people whose life experiences differ from one another, but also how the variations are translated into differential risks of conditions such as coronary heart disease and Alzheimer's disease. The chapter then offers a conceptual framework for comprehensively integrating and accommodating the rapidly growing body of evidence on the biological pathways that contribute to this process, which the book has termed “biological embedding”. Finally, the chapter identifies key research opportunities and challenges in furthering our understanding of this field.
A Life Course Approach to Health and Human Development
Authors: Hertzman Clyde , Power Chris
Published: September 2009

This chapter expands on the idea that the health status of populations cannot be adequately understood without recognizing health-determining influences across the life course. It begins by discussing socioeconomic gradients in health and development in childhood and young adulthood, and their effects in later life. It then presents three models (latency, cumulative, and pathways) that explain the possible connections between long-term exposure to various circumstances and their manifestation as different health and well-being outcomes, and explores the evidence illustrating each relationship. Finally, it discusses policy implications, concluding that health policies should be based on the understanding that problems emerging today may be related to life experiences that occurred years or decades earlier, and that the range of social and economic policy decisions made today will affect future health profiles.
Food, Nutrition, and Population Health: From Scarcity to Social Inequalities
Authors: Dubois Lise
Published: September 2009

Nutrition is an important determinant of population health, and social inequalities create nutritional inequalities even in industrialized countries where a wide variety of high-quality food is available. This chapter describes the effects of food and nutrition on different health outcomes at the population level. It begins with a presentation of food- and nutrition-related diseases in developed countries, as well as childhood nutritional needs and their long-term consequences. It then examines the relationship between social inequalities, nutrition, and health, and highlights the growing problem of poverty and food insecurity within industrialized countries. The chapter concludes with a discussion of nutrition policies that are important in order to diminish nutritional and related health inequalities within and between nations.
Role of Geography in Inequalities in Health and Human Development
Authors: Dunn James R. , Frohlich Katherine L. , Ross Nancy , Curtis Lori J. , Sanmartin Claudia
Published: September 2009

While the empirical evidence for the effect of geography on health is compelling, to make further progress it is necessary to revisit the scientific basis for asking questions about the influence of places on health. This chapter addresses this conceptual question. It first reviews existing evidence on location and health, then offers two perspectives from the past—one from sociology and one from epidemiology—that clarify the motivations for studying place effects and that help to chart a path forward. It concludes with a discussion of the challenges and possibilities for future study on the connections between location, social environment, and health, as well as the potential policy implications.
Social Welfare Models, Labor Markets, and Health Outcomes
Authors: Vogel Joachim , Theorell Töres
Published: September 2009

Inequalities in material living standards can be regulated by various institutions and methods, including tax and transfer programs through the public sector; individual, family, and community norms and actions (social networks); and the labor market. All three factors will likely play a role in any country, but the nature and strength of their roles will vary. The nations belonging to the European Union encompass several different configurations of labor market conditions, welfare state arrangements, and family arrangements, termed welfare production models in this chapter. This chapter explores the link between welfare production strategies and living conditions, focusing on health status. It compares institutional variation between groups of EU member states, and conducts a longitudinal analysis of health outcomes and the labor market in Sweden.
Changing Trends in Economic Well-being in OECD Countries: What Measure Is Most Relevant for Health?
Authors: Osberg Lars , Sharpe Andrew
Published: September 2009

This chapter's aim is to determine how best to measure economic well-being in order to understand better the relationship between economic well-being and health. It argues that an index of a society's economic well-being should include four components: current effective per capita consumption flows, net societal accumulation of stocks of productive resources, income distribution, and economic security. The chapter develops such an index for selected OECD countries and compares trends in economic well-being according to this index to trends in GDP per capita—the most commonly used measure of economic well-being. It concludes with a discussion of why the connection between health and economic well-being might be stronger than the relationship between health and GDP per capita.
Taking Different Approaches to Child Policy
Authors: Kozyrskyj Anita L. , Curtis Lori J. , Hertzman Clyde
Published: September 2009

This chapter examines the question of whether research evidence regarding early childhood development and population health has actually contributed to the development of policies that affect children's health and well-being. To explore the role that research played in the development of child policy, it examines recently implemented child policies in three countries: the National Children's Agenda in Canada, the State Children's Health Insurance Program in the United States, and the Early Childhood Education and Care Policy in Norway. It contextualizes each of these policies with a discussion of family policy and social attitudes towards family and children in each country. The chapter concludes that while research evidence played a central role in the development of each of these policies, the political, cultural, and historical environment, along with the core social values of the population, shaped policy specifics.
Noise
Authors: Maxwell Lorraine E.
Published: September 2009

This chapter examines the nonauditory effect of noise on children, that is, the effect of noise apart from hearing loss. Noise sources can be external (e.g., roads, trains, aircraft) or internal (e.g., resulting from poor acoustic designs for classrooms, normal classroom activities, and ambient sources such as HVAC systems). Both acute and chronic noisy conditions influence learning. Noise affects communication between teachers and students, motivation, attention, memory, and thus academic achievement. A noisy school environment can be a source of stress for both children and teachers. Most efforts to reduce noise are directed at the classroom. Careful school design and modification can alleviate noisy conditions in and around the building.
Ergonomics for Students and Staff
Authors: Bennett Cheryl , Woodcock Andree , Tien Diane
Published: September 2009

This chapter reviews three pressing ergonomic concerns in schools—furniture, information and communications technology (ICT), and school bags—to illustrate the role of ergonomics in promoting the long-term health of the next generation and in making school environments safer. General physical fitness, posture, back pain, and back care are related to furniture, information and communication technology, and school bags. Ergonomic practices are often cost effective; many can be implemented through education, procedural changes, or adjustments to existing equipment or furniture.
Animal Safety
Authors: Paulson Jerome A. , Harvey Chinonye
Published: September 2009

The presence of animals in school settings is common, and the balance of benefits and risks remains controversial. Some experts argue that animals have no place in schools, whereas others contend that animal contact is beneficial. Animals in school settings raise three major health and safety concerns: infectious diseases, allergies, and bites. This chapter presents evidence that addresses both the benefits and the risks of animals in schools, and makes recommendations to maximize the benefits and minimize the risks of animal contact in the school setting.
Injury Prevention
Authors: West Sandra S. , Jackson Hope , Geller Robert J. , Frumkin Howard
Published: September 2009

This chapter focuses on all the other kinds of injuries that may occur throughout schools—on the walkways, in hallways, in general classrooms, and in specialized settings such as vocational arts shops, biology and chemistry labs, and theaters. The first part focuses on general classroom hazards, and the next part focuses on specialized classrooms. The chapter then discusses the control of injuries in schools, reviews relevant regulations, describes the elements of effective school safety programs, and offers practical strategies to enhance safety.
Indoor Air Quality
Authors: Axelrad Robert
Published: September 2009

This chapter discusses indoor air quality (IAQ) in schools. IAQ in schools can have an important impact on health. Four factors determine IAQ in schools: sources of indoor air pollution; heating, ventilating, and air-conditioning systems; pollutant pathways; and the people themselves. The EPA's Tools for Schools program can be used to identify IAQ problems. These problems may be mitigated and managed with a variety of strategies including controlling sources and exposures and educating teachers, staff, and students.