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Health care systems in developed countries must respond to diverse populations especially given increasing population movements. These groups make different claims upon the state and may have different health care needs and expectations. But policy-makers and professionals often seem blind to this diversity. To ensure the wellbeing of its whole population, a state must respond to subgroups in terms of their health status and access to health services. The chapters in this book discuss countries and population groups that illustrate different responses to claimant groups and different ways of delivering health services. The chapters consider inherent population diversity (age, sex), citizenship issues (e.g. migrants, asylum seekers), and ethnic and indigenous groups (Roma in Europe, New Zealand Maori, Australian Aborigines). Are there barriers to people receiving equitable health care? Should mainstream health services be more responsive to the needs of different people, or should alternative health services be set up? The book provides a breadth of perspectives from which to draw conclusions on how to meet the needs of societies characterized by diversity.

This book offers a prospective on the global response to one of the greatest moral, legal, and public health challenges of the twenty-first century — achieving the human right to health as enshrined in the United Nations Declaration of Human Rights (UDHR) and other legal instruments. The book aims to bring clarity to many of the complex clinical, ethical, economic, legal, and socio-cultural questions raised by injury and disease including the deeper determinants of health, such as poverty. Including an examination of the profound inequalities in health, which have resulted in millions of people condemned to unnecessary suffering and hastened deaths, this is much more than a primer on the right to health, it is a thoughtful account of its parameters together with strategies to achieve it, and discussion of why the right is so essential. Country-specific case studies provide context for analysing the right to health and assessing whether, and to what extent, this right has influenced critical decision-making that makes a difference in people’s lives. Thematic chapters also look at the specific challenges involved in translating the right to health into action. The book highlights the urgency to build upon the progress made in securing the right to health for all, offering a timely reminder that all stakeholders must redouble their efforts to advance the human right to health.

This book documents the lived experiences of HIV-positive gay men who are presently middle aged, long-term survivors of HIV/AIDS. Through the use of ethnography and life history interviews, the book delineates the resiliencies that these fifteen long-term survivors have demonstrated in coping with a life-threatening disease throughout the course of their adult lives. Interwoven with the academic literature, historical events, and artistic expressions from the popular media, the book narrates the life stories of these gay men who are members of the “AIDS Generation”. Their stories span the period from the early days of the epidemic to the present, including their lives as boys and young men negotiating their sexuality, first learning their serostatus, and their life experiences during this time. Next, this book describes the medical, psychological, social strategies and behaviors the men of this generation engaged in to survive the AIDS epidemic, and how these men of the AIDS Generation are confronting and navigating through this period of middle aged adulthood and into older adulthood with new physical, emotional, and social struggles. The book examines how approaches to survival inform and are informed by the broad body of literature on resilience and health, which may be applicable to the lives of those newly infected with HIV and others who are living with chronic health conditions, as well as providing insight to their caregivers and policy makers.

Alcohol has always been an issue in public health but it is currently assuming increasing importance as a cause of disease and premature death worldwide. This book provides an interdisciplinary source of information that links together the usually separate fields of science, policy, and public health. This volume highlights the importance of bringing scientific knowledge to bear in order to strengthen and develop alcohol public policy. The book looks at the historical evolution of alcohol consumption in society, key early studies of alcohol and disease, and the cultural and social aspects of alcohol consumption. It then goes on to cover the chemistry and biology of alcohol, patterns of consumption, gender and age-related issues, alcohol and injury, alcohol and cancer and non-malignant disease, and various current therapeutic aspects. The book concludes with a section on alcohol policy, looking at issues of poverty, the availability of alcohol and alcohol control measures.

Alcohol: No Ordinary Commodity - Research and Public Policy Second Edition is a collaborative effort by an international group of addiction scientists to improve the linkages between addiction science and alcohol policy. It presents the accumulated scientific knowledge on alcohol research that has a direct relevance to the development of alcohol policy on local, national, and international levels. It provides an objective analytical basis on which to build relevant policies globally, and informs policy makers who have direct responsibility for public health and social welfare. By locating alcohol policy primarily within the realm of public health, this book draws attention to the growing tendency for governments, both national and local, to consider alcohol misuse as a major determinant of ill health, and to organize societal responses accordingly. The scope of the book is comprehensive and international. The authors describe the conceptual basis for a rational alcohol policy and present new epidemiological data on the global dimensions of alcohol misuse. The core of the book is a critical review of the cumulative scientific evidence in seven general areas of alcohol policy: pricing and taxation; regulating the physical availability of alcohol; modifying the environment in which drinking occurs; drink-driving countermeasures; marketing restrictions; primary prevention programs in schools and other settings; and treatment and early intervention services. The final chapters discuss the current state of alcohol policy in different parts of the world and describe the need for a new approach to alcohol policy that is evidence-based, realistic, and coordinated.

The options in antenatal and neonatal care are legion. Preferences still tend to be subjective. In spite of much publicity that has raised public expectation, an up-to-date thorough evaluation of antenatal and neonatal screening has been lacking. This book sets out the principles and theory of screening using single and multiple markers. It emphasizes the need to examine screening approaches in a quantitative manner and aims to help enable choices to be based on objective evidence of efficacy safety, and cost — essential in determining public health policy. Technical advances have sometimes been introduced uncritically and without adequate assessment. It has been assumed, perhaps naively, that the early detection of abnormality will invariably be a good thing. In this book, there is no such assumption that new tests or technical procedures are useful. They are only considered as a legitimate medical option if they can and have been shown to lead to improvements in outcome. Each disorder is defined and the screening procedure which is designed to identify the disorder critically evaluated. Priority is given to the screening of disorders which lend themselves to effective intervention and practical guidance is provided on how screening should be conducted. Most chapters include a discussion of problem areas and research needs. There are twenty-three chapters from leading experts from Europe and North America. The book bridges different disciplines concerned with screening, and aims to improve the understanding of the subject and delivery of preventive medical services.

This book examines the critical role of anthropology in four crucial public health domains: (1) anthropological understandings of public health problems such as malaria, HIV/AIDS, and diabetes; (2) the anthropological design of public health interventions in areas such as tobacco control and elder care; (3) anthropological evaluations of public health initiatives such as Safe Motherhood and polio eradication; and (4) anthropological critiques of public health policies, including neoliberal health care reforms. Anthropologists provide crucial understandings of public health problems from the perspectives of the populations in which the problems occur. On the basis of such understandings, anthropologists may develop and implement interventions to address particular public health problems, often working in collaboration with local participants. Anthropologists also work as evaluators, examining the activities of public health institutions and the successes and failures of public health programs. Anthropological critiques may focus on major international public health agencies and their workings, as well as public health responses to the threats of infectious disease and other disasters. Through twenty-four case studies from around the world, the book provides an argument for the imperative of anthropological perspectives, methods, information, and collaboration in the understanding and practice of public health.

This book focuses on areas of public health practice in which the systematic application of epidemiologic methods can have a large and positive impact. It describes how best to apply traditional epidemiologic methods for determining disease etiology to “real-life” problems in public health and health services research. This book bridges the gap between theoretical epidemiology and public health practice, and covers a number of topics not addressed elsewhere. This edition contains a new chapter on the development and use of systematic reviews and one on epidemiology and the law. Each chapter includes one or more case studies intended to illustrate major points from the chapter and to provide a basis for teaching exercises. All of the chapters are authored by leading experts in the fields of epidemiology and public health, and all are fully revised and updated.

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.

Although asbestos was once considered a miracle mineral, today even the word itself has ominous implications for all strata of our society. Incorporated in the past into over 3,000 different industrial and consumer products, as well as in building materials and military equipment, opportunities for exposure continue to be ever present in our environment. Thousands of workers and servicemen in a wide variety of trades have been disabled or have died consequent to the health effects of asbestos, and many more can be expected to be affected in years to come. Litigation continues, and financial awards have bankrupted many Fortune 500 companies and numerous smaller companies. While one might implicate our forefathers in this widespread, relentless medical catastrophe, only in recent decades has science appreciated the complexities of the problem and the long disease latencies. The characteristics and discovery of the unique fibrous minerals known as asbestos are considered in this book. A discussion of the major uses of these materials in the past follows. The epidemiology of the diseases asbestos cause and the risk associated with exposure are then discussed. Individual asbestos-associated diseases are considered in detail from clinical, pathologic, and pathogenic perspectives in the context of approaches to diagnosis and treatment. The authors also explore the history of regulatory efforts based on governmental actions, and the complex story of litigation related to asbestos-associated diseases. Finally, projections for the future worldwide occurrence of asbestos-related diseases are calculated.

This book draws from the social sciences, the natural sciences, and the health sciences to introduce the principles and methods applied in environmental health. It presents an overview of the basic sciences needed to understand environmental health hazards, including toxicology, microbiology, health physics, injury analysis, and relevant psychosocial concepts. It also presents a basic approach to risk assessment and risk management. The first part of the book concentrates on broad issues, providing frameworks for the investigation and management of environmental health problems. The middle section deepens the discussion of routes of exposure (air quality, water and sanitation, food and agricultural issues). The final section addresses environmental health from sustainable development themes (settlements and urbanization, energy, industry, and global concerns). The final chapter focuses on ethical issues and action planning.

Environmental chemical hazards are a highly contentious topic in modern life. Nearly every nation on earth has faced its own environmental crises, and also shares perspectives on the possibility of global catastrophes. Of the many global concerns we face, the environmental issue is unique in many ways. The greatest of these is the fundamental scientific nature of the issue, and the extent to which our opinions are formed based on high-level scientific inquiry and assessment. The two key fields of study on this issue, environmental epidemiology and exposure assessment, are still given separate names because of their separate historical roots and scientific traditions, but are seen increasingly as inseparable aspects of the same basic investigation. In this book, the authors assert that important advances in the quantification of environmental risks can only come through a true synthesis of the two fields. They have built a common biologic model of exposure, physiologic response and disease, a synthesis of the various existing models which serves to both simplify and improve the application of environmental epidemiology and exposure assessment to current and future environmental chemical risks. When exposure assessor and epidemiologist agree from the start on the model for their study, the conceptual framework for the study they design and the analyses they carry out are much more likely to yield useful exposure-risk information. An explicit biologic model of the apparent processes linking exposure to disease should form the basis for any study seeking to quantify risk from environmental chemicals.

This book presents a systematic analysis of how BSE policy was made in the UK and EU, 1986%#x2013;2004. The main focus is on the role of scientific expertise, advice, and evidence in policy-making processes, and its use by officials and ministers as a political resource. The central argument is that highly political and highly problematic policy decisions were often misrepresented as based on, and only on, sound science. Those tactics required the selective highlighting of scientific uncertainties. Since many of the most crucial policy-sensitive uncertainties were concealed or discounted, research to diminish those uncertainties was not undertaken. Since the claim had been that it was impossible for BSE-contaminated food to cause a human spongiform encephalopathy, when such cases emerged in 1996, the policy-making regime was comprehensively undermined and a crisis ensued. The BSE policy saga is used to develop and refine a general analytical framework with which science-based policy governance can be analysed, providing resources with which the book specifies the conditions under which such policy-making may achieve and reconcile scientific and democratic legitimacy.

The third edition of this book reviews the global burden of cancer, causes of cancer, and current priorities and future directions in cancer epidemiology and prevention research. The book maintains the structure of previous editions with seventy-two chapters organized into five major sections: Basic Concepts; The Magnitude of Cancer; The Causes of Cancer; Cancer by Tissue of Origin, and Cancer Prevention and Control. The introductory chapters under Basic Concepts highlight the advances in genomic and molecular biology that have applications in morphologic classification of malignant tumors, and in the elucidation of critical genetic events that result in malignant transformation and tumor invasion. The section on the Magnitude of Cancer reviews global patterns of cancer incidence and mortality in relation to country of residence, age, gender, race and ethnicity, and socioeconomic status. The section on The Causes of Cancer reviews the spectrum of environmental, lifestyle and genetic risk factors that are associated with the origin of human cancers. Chapters on Cancer by Tissue of Origin review systematically the demographic, environmental, and host factors that impact the origin and progression of cell-and organ-specific neoplasms. The concluding section, Cancer Prevention and Control, addresses methods and applications for translating epidemiologic, laboratory, and clinical research observations into preventive interventions. Special emphasis is provided on measuring the impact of behavioral interventions on health-promoting practices, as well as governmental policies that regulate environmental carcinogens.

Since its initial publication in 1982, Cancer Epidemiology and Prevention has served as the premier reference work for both students and professionals working to understand the causes and prevention of cancer in humans. Now revised for the first time in more than a decade, this fourth edition provides an updated and comprehensive summary of the global patterns of cancer incidence and mortality, current understanding of the major causal determinants, and a rationale for preventive interventions. In this edition, special attention has been paid to molecular epidemiologic approaches that address the wider role of genetic predisposition and gene-environment interactions in cancer etiology and pathogenesis.

Cancer causes a quarter of all deaths in England and Wales. There is great professional and public interest in cancer trends, but no satisfactory source to which to turn to find information about these trends and explanation of them. It is even more difficult to know where to turn for information on trends in factors causing cancer. This book presents new analyses that bring together data on cancer trends in England and Wales since 1868. Detailed consideration is given to the reasons for changes in rates of cancer, in relation to a wide range of risk factors and preventive factors. Data are presented with figures and tables describing long-term trends in more than fifty factors that may affect the risk of cancer, including AIDS, asbestos exposure, cancer screening, childbearing, diet, smoking, and ultraviolet radiation. Particular attention is given to trends in recent decades, but historical trends are also considered.

The case-control method, and to a lesser extent its case-based variants, have become a most important tool in the armamentarium of today's investigator of health problems. This book addresses a number of general and specific questions dealing with the case-control and other case-based methods, including how to design and implement a case-control study that minimizes biases; how to analyze the data to deal appropriately with confounding and to help identify interactions; how to interpret data from a case-control study; and how to use the method in a variety of problem solving situations. The book provides an exposition of the uses of a study of individual cases as well as case series in epidemiology. It describes the development of the comparative method as a basis for decision making in the health professions. The first part of the book deals with issues of design of the case control and other case based methods such as the case-crossover and case-cohort studies. In this section of the book several issues of design and analysis of case-control studies are presented within a framework for developing an information base for decision making in research and in health care. The second part of the book has a focus on the applications of the method. These include the use of case-control studies in outbreak investigations as well as other acute events such as disasters, the use of the method in health care and health services evaluation, and its use in genetic epidemiology as well as other applications.

This book is concerned with the research and policy analysis of the Global Health Equity Initiative (GHEI). It gives a truly global perspective on health equity, with contributors from each country. Reflecting the purpose of the GHEI itself, this book aims to contribute to the building of global capacity to measure, monitor, and interpret developments in health equity at national and international levels to underpin action. A conscious effort is made to focus analysis on inequities in health status, rather than access to health services, and on health inequities within countries, rather than the more often discussed inequities between countries. Insights about health equity from fields of epidemiology, demography, economics, and social science are brought to life in country studies from Bangladesh, Chile, China, Japan, Kenya, Mexico, Russia, South Africa, Sweden, Tanzania, the United Kingdom, the United States, and Vietnam. The book is organized around four key elements that structure a systematic response to inequities in health: establishing and strengthening share values, describing the health divide and analyzing causes, tackling the root causes of inequities in health, and reducing the negative consequences of ill health and building more equitable health care systems. The last part offers insights into developing the policy response to inequities in health from a global perspective.

Child labour constitutes a major public health concern, with estimates that worldwide 110 million children aged 57–14 years are engaged in labour that can be described as hazardous or intolerable. This book examines both the rights oriented and public health perspectives on child labour. A rights approach ensures that exploitative and abusive work is considered not just in terms of a labour market or health rights approach, but also in terms of human dignity and the solutions that preserve the rights of children and communities. The public health approach is steeped in the relationship between individuals and their community, seeking to identify how the presence (or absence) of government programmes and policies affects those involved. The economics perspective is also presented early in the book, to aid understanding of the causes and consequences of child labour, before the alternate public health and sociological views are presented. The book examines factors such as poverty, malnutrition, social disadvantage, gender, globalisation, and education, and look at both physical and psychological threats.

Despite children making up around a quarter of the population, the first edition of this book was the first to focus on a public health approach to the health and sickness of children and young people. It combined clinical and academic perspectives to explore the current state of health of our children, the historical roots of the speciality, and the relationship between early infant and child health on later adult health. Child public health is a rapidly developing field, and is increasingly recognised throughout the world as a major area of focus for population health. Targeting the health of children now is essential if we are to achieve a healthy population as adults. For the second edition the text has been revised and updated with new material on health for all children, global warming, child participation, systems theory, refugees, commissioning, and sustainable development.