The weighting of an international health status index

The major purpose of this paper is to suggest possible weights for a global index of health status. The indicators for the global index are taken from the World Health Organization's definition of health as physical, mental and social well-being. These indicators are combined with mortality indicators to arrive at a finalized index. Survey methodology is used to make initial estimates of the weighting of appropriate indicators, based upon a sample of international health scholars. Preliminary results indicate that mortality is weighted 40%, physical health (morbidity and disability) 25%, mental health 15%, and social health 20%. These results are intended as a starting point for future research.     

WHO on Health and Economic Productivity

The current issue of the World Health Organization's annual flagship publication, titled The World Health Report 1999: Making a Difference, is the first issued under Gro Harlem Brundtland, WHO's Director-General, who assumed the office in 1998. In her preface to the 121-page report Dr. Brundtland identifies four major challenges to be addressed in order to improve the world's health: the need to reduce the burden of excess mortality and morbidity suffered by the poor; the need to counter potential threats to health resulting from economic crises, unhealthy environments, or risky behavior; the need to develop more effective health systems; and finally the need to invest in expanding the knowledge base that made possible the twentieth-century revolution in health. Chapter 1 of the report discusses health and development; subsequent chapters address the problems of emerging epidemics and infectious diseases and of maternal and child disability and mortality; health systems development; and the challenges of rolling back malaria and combating the tobacco epidemic. Chapter 1 consists of two parts: the first documents the twentieth-century revolution in human health, the second discusses the inadequately explored problem of the relationship between health and economic productivity. This second section of Chapter 1 is reproduced below in full, with the permission of WHO. (The endnotes were renumbered.)     

Responding to social service and health care needs of aging women veterans

This is a study about aging women veterans who served in the military during the 1940s, 1950s and 1960s. The Veterans Administration (VA) represents a formal network of health and support services that offers a wide range of benefits for veterans. However, older women veterans may not be aware of, or benefit from, all that may be available to them. The purpose of this study was to learn about aging women veterans' knowledge and utilization of services and benefits available through the VA. Telephone interviews were conducted in April 1998 with 220 women veterans in Massachusetts who were age 60 + years. There was generally strong identification with veterans' organizations among the women surveyed. These women veterans were likely to receive medical care-a major benefit available through the VA. The benefits veterans were least likely to know about included services that may be particularly relevant and helpful to an aging veteran, such as long-term care and home adaptation services. Strategies are suggested to enhance outreach efforts to aging veterans.     

Region of Birth and Disability Among Recent U.S. Immigrants: Evidence from the 2000 Census

This study aimed to test the “healthy immigrant” hypothesis and assess health heterogeneity among newly arrived working-age immigrants (18–64 years) from various regions of origin. Using the 5% sample of the 2000 U.S. Census (PUMS), we found that, compared with their native-born counterparts, immigrants from all regions of the world were less likely to report mental disability and physical disability. Immigrants from selected regions of origin were, however, more likely to report work disability. Significant heterogeneity in disabilities exists among immigrants: Those from Eastern Europe and Southeast Asia reported the highest risk of mental and physical disability, and those from East Asia reported the lowest risk of physical disability. Furthermore, Mexican immigrants reported the lowest risk of mental disability, and Canadian immigrants reported the lowest risk of work disability. Socioeconomic status and English proficiency partially explained these differences. The health advantage of immigrants decreased with longer U.S. residence.     

Responding to Social Service and Health Care Needs of Aging Women Veterans

ABSTRACT

This is a study about aging women veterans who served in the military during the 1940s, 1950s and 1960s. The Veterans Administration (VA) represents a formal network of health and support services that offers a wide range of benefits for veterans. However, older women veterans may not be aware of, or benefit from, all that may be available to them. The purpose of this study was to learn about aging women veterans' knowledge and utilization of services and benefits available through the VA. Telephone interviews were conducted in April 1998 with 220 women veterans in Massachusetts who were age 60 + years.

There was generally strong identification with veterans' organizations among the women surveyed. These women veterans were likely to receive medical care—a major benefit available through the VA. The benefits veterans were least likely to know about included services that may be particularly relevant and helpful to an aging veteran, such as long-term care and home adaptation services. Strategies are suggested to enhance outreach efforts to aging veterans.     

Honesty and comfort levels in mothers when screened for perinatal depression and anxiety

PurposeTo evaluate the degree of honesty and level of comfort reported by women when questioned about their emotional wellbeing during the perinatal period; to investigate if honesty and comfort are associated with perinatal depression or perinatal anxiety; and to examine the reasons why women may not always respond honestly.MethodsQualitative and quantitative data from 1597 women from the cross-sectional perinatal mental health substudy (part of the Australian Longitudinal Study on Women’s Health) were analysed using a mixed methods approach.ResultsWhen questioned by their health practitioner about their emotional wellbeing in the perinatal period, 20.7% of women indicated they had not always responded honestly. Reasons for not being honest reflected four main themes: normalizing of symptoms/coping; negative perceptions (self-and others); fear of adverse repercussions; and fear of involvement of health services (trust and confidentiality). The 38.9% of women who did not feel comfortable when questioned by their health practitioner about their emotional wellbeing were four times more likely to report perinatal depression (odds ratio = 4.09; 95% confidence interval = 2.55, 6.57) and nearly twice as likely to report perinatal anxiety (odds ratio = 1.90; 95% confidence interval = 1.24, 2.94) than other women.ConclusionsWomen who are most likely to need mental health care during the perinatal period are also those least likely to be honest about their mental health. A non-judgemental, open and reassuring approach by clinicians may help to reduce the stigma and fears contributing to lack of honest responses, and improve early diagnosis and treatment of mental health problems.     

Major Socioeconomic Driving Forces of Improving Population Health in China: 1978–2018

China's post-Cultural-Revolution reform generated rapid economic growth. But it also brought about major negative changes, especially in the early stage, which jeopardized population health and mortality gains. Nonetheless, improvements continued. China had achieved the Millennium Development Goal target 4 of reducing under-5 mortality by two-thirds well before the target year of 2015. Life expectancy continued to rise and reached 76.6 years by 2018, notably higher than the world average and that recorded in many countries with similar per capita GDP. By describing China's recent economic growth, the rebuilding of nationwide health insurance systems, the development of medical financial assistance, and poverty alleviation programs, this paper shows how these improvements were achieved. Vulnerability to health and mortality risks has been reduced; the availability of, and people's access to, health insurance have increased; and better medical treatments and health services have become available and accessible. These macro-socioeconomic determinants have played the central role in achieving further population health and mortality progress in China in the past four decades.     

Recent trends in multiple-caused mortality 1968 to 1982: Age and cohort components

Declines in mortality at advanced ages have been observed recently in the United States. These declines have been related to a reduction in the risk of major circulatory diseases, such as stroke and heart disease. In this paper we examine the contribution of two additional major factors in those declines. The first is the effect of conditions associated with circulatory diseases. This effect can be examined by using multiple-cause mortality data in which all conditions reported by the physician on the death certificates are recorded. The second is the contribution of cohort mortality differentials to temporal changes. If major cohort differentials are identified, we may be able to determine if recent declines in mortality are likely to continue-and to what levels. Such insights would be useful both in improving projections of the size and age structure of the U.S. elderly population and its entitlement groups and in helping to identify future patterns of needs for preventive and other health services.     

Experienced health in older women with rheumatoid arthritis

This study explored how older women with chronic illness and disability experience their own health. Data were collected in in-depth interviews with ten older women with rheumatoid arthritis. Data analysis and interpretation was carried out within a phenomenological- hermeneutic frame of understanding, which revealed five major themes: health as coping with everyday life, health as freedom, health as absence of inconvenience, health as togetherness and health as mental well-being. For older people with chronic illness and disability, good health found expression in general well-being. It was perceived as a state of equilibrium that the respondents sought to maintain through their own active choices.     

Reproducing inequalities: Luck, wallets, and the enduring effects of childhood health

In this article, I argue that research on social stratification, on intergenerational transmission of inequalities, and on the theory of factor payments and wage determination will be strengthened by studying the role played by early childhood health. I show that the inclusion of such a factor requires researchers to integrate theories in each of these fields with new theories linking early childhood health conditions and events that occur at later stages in the life course of individuals, particularly physical and mental health as well as disability and mortality. The empirical evidence I gather shows that early childhood health matters for the achievement of or social accession to, adult social class positions. Even if the magnitude of associations is not overwhelming, it is not weaker than that found between adult social accession and other, more conventional and better-studied individual characteristics, such as educational attainment. It is very likely that the evidence presented in this article grossly underplays the importance of early childhood health for adult socioeconomic achievement.     

Health care issues among lesbian, gay, bisexual, transgender and intersex (LGBTI) populations in the United States: Introduction

This supplemental issue of the Journal of Homosexuality presents research that explores a variety of health care issues encountered by lesbian, gay, bisexual, transgender and intersex (LGBTI) population groups in the United States over the 10-year period from 1993 to 2002. Topics include access to health care, utilization of care, training of medical and mental health providers, and the appropriate preparation of clinical offices and waiting areas. Authors used a variety of community-based public health research methods, including participant and provider surveys and retrospective chart reviews of patients, to develop this body of research, providing a recent-historical perspective on the complex health care and health-related needs of sexual and gender minorities. Particularly for transgender and intersex populations, the state of research describing their health care needs is in its infancy, and much remains to be done to design effective medical and mental health programs and interventions.     

分年龄组死亡率变动对人均期望寿命影响的实验研究 ——以甘肃省为例

人均期望寿命是分析、评价人口健康状况,衡量社会经济发展及医疗卫生服务水平的重要指标。从2014年开始人均期望寿命的提高被纳入卫生计生系统考核内容,受到各级政府的重视。为了有效地甄别和评价政策实施对人均期望寿命提高的贡献程度,需要精确地估计和判断各年龄组死亡率变动对人均期望寿命提高的影响。在实践中,针对某一年龄组或某一特定人群死亡率的变动以及相关政策实施对人均期望寿命的影响鲜有较为精确的定量解答或快速有效的估算办法。本研究通过数据实验方法和计算机辅助计算建立一套可以较为精确地估算某一区域内某一年龄组死亡率变动对人均期望寿命影响的计算方法和结果集,利用这种方法可以开展不同类型、不同区域内人口死亡率变动对人均期望寿命影响的快速估算。利用估算结果可以对区域内政策实施效果进行较为科学的评估或评价。文章以中国2010年人口普查数据中甘肃省各年龄组分性别死亡率数据为基础对上述研究进行实证分析和验证。     

Trends in health expectancies in Australia 1981–1993

Health expectancy indices combine the mortality and morbidity experience of a population into a single composite indicator. This paper summarizes and evaluates methods for the calculation of health expectancies and presents trends in the expectation of life with disability and handicap in Australia from 1981 to 1993. Unlike other countries for which recent health expectancy time series are available, Australian results indicate that the expectation of years with disability has increased for both males and females. Possible explanations for this are examined.     

Health Care Issues Among Lesbian,Gay, Bisexual,Transgender and Intersex (LGBTI) Populations in the United States: Introduction

ABSTRACT

This supplemental issue of the Journal of Homosexuality presents research that explores a variety of health care issues encountered by lesbian, gay, bisexual, transgender and intersex (LGBTI) population groups in the United States over the 10-year period from 1993 to 2002.

Topics include access to health care, utilization of care, training of medical and mental health providers, and the appropriate preparation of clinical offices and waiting areas. Authors used a variety of community-based public health research methods, including participant and provider surveys and retrospective chart reviews of patients, to develop this body of research, providing a recent-historical perspective on the complex health care and health-related needs of sexual and gender minorities. Particularly for transgender and intersex populations, the state of research describing their health care needs is in its infancy, and much remains to be done to design effective medical and mental health programs and interventions.     

Serious psychological distress,sex, and falls among the elderly

Serious psychological distress and falls are two major public health problems among the elderly. This study aims to test the hypothesis that although serious psychological distress can increase the risks of falls among the elderly, it tends to affect elderly women more than elderly men. Data of this study are from the 2011 California Health Survey Interviews (CHIS). We extracted a sample of 13,153 respondents aged 65 and older for this study, including 8,087 females and 5,066 males. We tested both unadjusted and adjusted interaction effects using bivariate and multivariate logistic regression analysis. Elderly women with serious psychological distress had the greatest likelihood of falls as compared to men with serious psychological distress and men and women without serious psychological distress. With respect to the covariates, limitations of physical activity and poor self-rated health status, Asian race, and older age were more likely to be associated with falls. This study provides further information on sex disparities of falls among the elderly such that serious psychological distress has a greater impact on falls for elderly women than elderly men. Thus, the findings of our studies suggest that mental health services and intervention can be useful to prevent falls for elderly women.     

城乡差异、就医惯性与老年人卫生服务利用

现有对城乡老年人卫生服务利用不公平的研究多忽略了长期的城乡差异所导致的隐性的农村老年人就医惯性的存在。本研究在控制了收入、医疗保障和就医可及性等因素的条件下,发现就医惯性的存在;并运用集中指数分解法发现,卫生服务的利用存在不公平,偏向于富人,而就医惯性在两种卫生服务利用中的贡献度分别为12%和5%。这种城乡固定差异造成了农村老年人在身体健康、心理健康和自我照料能力上都显著地低于城市老年人。     

Housing Satisfaction Related to Health and Importance of Services in Urban Slums: Evidence from Dhaka, Bangladesh

Quality of housing plays one of the key roles in a public health research, since inadequate housing may have direct or indirect negative impact on health. Higher satisfaction with housing was shown to be associated with higher income, higher age, a smaller family, higher education, being female and being an owner of a dwelling. The aim of our study is to identify the multiple sources of the satisfaction with housing in population of urban slums and rural areas in Dhaka, Bangladesh. We have used a combined variable “Housing Satisfaction”, containing nine items related to satisfaction with different types of housing facilities (water, electricity, toilet etc.). Ordinal as well as binary multiple logistic regression models were applied to predict housing satisfaction. Rural residents (with 90 % house ownership) were much more satisfied with their housing than urban slum dwellers. Those respondents who perceived their area as “Very bad/Bad” to reach medical care reported significantly higher levels of housing dissatisfaction. Low satisfaction with available facilities (education, health services, etc.) as well as the adjacent neighbourhood being perceived as negative for own health showed as well a strong predictive effect on housing dissatisfaction. The major findings of our study showed a complex relationship between housing satisfaction and the quality of basic facilities including the reachability of medical care. Understanding the factors which lead to satisfaction with housing and residential environment is crucial for planning successful and effective housing policies.     

Modeling and Forecasting Health Expectancy: Theoretical Framework and Application

Life expectancy continues to grow in most Western countries; however, a major remaining question is whether longer life expectancy will be associated with more or fewer life years spent with poor health. Therefore, complementing forecasts of life expectancy with forecasts of health expectancies is useful. To forecast health expectancy, an extension of the stochastic extrapolative models developed for forecasting total life expectancy could be applied, but instead of projecting total mortality and using regular life tables, one could project transition probabilities between health states simultaneously and use multistate life table methods. In this article, we present a theoretical framework for a multistate life table model in which the transition probabilities depend on age and calendar time. The goal of our study is to describe a model that projects transition probabilities by the Lee-Carter method, and to illustrate how it can be used to forecast future health expectancy with prediction intervals around the estimates. We applied the method to data on the Dutch population aged 55 and older, and projected transition probabilities until 2030 to obtain forecasts of life expectancy, disability-free life expectancy, and probability of compression of disability.     

Hungarian Medical Students’ Knowledge About and Attitude Toward Homosexual,Bisexual, and Transsexual Individuals

ABSTRACT

Discrimination that LGBTQ individuals experience in health care settings might affect their health and intention of using health care services. However, health needs of LGBTQ patients are still inappropriately addressed in the medical curriculum. First-, third-, and fourth-year medical students (N = 569) from the four Hungarian medical universities participated in a study in 2017 to assess knowledge about homosexuality, homonegativity, and their attitude as health care professionals toward sexual minorities. We found that higher levels of knowledge about homosexuality were associated with lower levels of homonegativity, upper-grade level in university, not being religious, and having close LGBTQ acquaintances. Our results suggest that it may be necessary to introduce LGBTQ themes in the medical curricula (not only in Hungary, but also in other countries) in order to improve the knowledge and attitude of medical students and thereby improve the health care of LGBTQ individuals.     

健康老龄化与卫生服务利用探析

为探讨我国健康老龄化现状与卫生服务利用的关系,提供有效卫生服务、制定合理卫生策略,采用人口学理论与流行病学技术相结合的方法,调查分析黑龙江省大庆市部分60岁及以上老年人的健康情况及卫生服务需求与利用现状。调查显示,除躯体健康较差外,部分老年人还存在一定程度的心理损伤和社会功能缺失。加大社区医疗机构投入,提高医疗服务质量,倡导老年人积极锻炼身体、与子女建立和谐的关系以及有效改善睡眠,对促进老年人健康,推进我国健康老龄化的进程具有重要的现实意义。