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Menlo Park, California, Henry J. Kaiser Family Foundation, 2012 May.  p. (U.S. Global Health Policy)This survey is the fourth in a series by the Foundation that explores the American public's views and knowledge of U.S. efforts to improve health for people in developing countries.The survey examines perceptions about foreign aid in general and U.S. spending on global health specifically, including views on the potential impact of spending, perceptions of progress in improving health in developing countries, and the visibility of global health issues in the media.The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation. It was conducted February 2 through February 12, among a nationally representative random sample of 1,205 adults ages 18 and older. The margin of sampling error for the full sample is plus or minus 3 percentage points.
[Unpublished] 2005. Presented at the First Annual International Conference of the African Science Academy Development Initiative: Improving Public Policy to Achieve the Millennium Development Goals in Africa: Harnessing Science and Technology Capacity, November 7-8, 2005, Nairobi, Kenya.  p.This document breaks down the controversy of the safety of polio immunization efforts in Nigeria. The four main points that this document discusses are: polio campaigns were suspended in several northern states; negative media discussion about safety of vaccine in national and international media; trusted community and religious leaders speak out against polio vaccine; and mistrust in oral polio vaccine leading to non-acceptance. (excerpt)
Revista Panamericana de Salud Pública / Pan American Journal of Public Health. 2002; 12(4):286-290.The benefits of immunizing against the vaccine-preventable diseases far outweigh the minimal risks of vaccination. In order to maintain or improve the strength of every national immunization program, workers at each level of the public health community—from local health workers to health department officers—should be educated about the issues surrounding vaccination, and they should be prepared to respond to public concerns. The quick response to public anxieties regarding vaccines and the rapid, honest communication of explanations and actions can help ensure the integrity of immunization programs throughout the Americas. That is according to “Guidelines for Managing Immunization Safety Concerns,” a document prepared by the Division of Vaccines and Immunization of the Pan American Health Organization (PAHO). Although immunization has been an important public health accomplishment over the past 200 years, it is not without controversy. Vaccine safety issues have been undergoing visible public debate, especially over the last 20 years. At times, immunization programs worldwide have been jeopardized by public reactions to the debate. Although vaccines are not completely effective at all times, they are one of the safest interventions in the medical armamentarium. (excerpt)
Mumbai, India, Centre for Enquiry into Health and Allied Themes [CEHAT], 2003 Jun. , 51 p.This study report is based on a need-assessment survey conducted in connection with the BMC's plant to set up a municipal general hospital in one of its ward. The study area is unique in the sense that it is the most populous ward in Greater Mumbai, and yet, it does not have a single public hospital within its limits. Data was collected from 1,035 households spread across three health-post areas around the proposed hospital site. The study was able to bring out the utility of public health care services in the area, and to find out how the population copes with their health care needs when public health care services are not available in their locality. It is to be noted that this is a predominantly lower middle class and lower class population, which resides in the study area. In spite of not having a public hospital, for ailments reported during the reference period, about 30 per cent of the patients had sought inpatient care services from the public sector outside the locality, and about 15 per cent had sought outpatient care services from BMC facilities. Though travel time and travel costs were higher, because of financial reasons the public were still seeking health care from public health care outlets outside their locality. Analysis shows that non-availability of a public hospital was forcing about 44 per cent of the households to seek inpatient care services from the private sector, even if they were interested in seeking care from the public sector. Even the outpatient care services that were currently available in the area seemed to be inadequate, as 67 per cent of the households were having their need for outpatient care services unmet. When the poorest of the poor were left with no alternative but to seek care from public health care facility in other wards, others were "managing" with the services in the private sector where out-of-pocket expenses of treating an ailment was several times higher than that in the public sector. A majority of those who were currently "managing" their inpatient care needs through private hospitals, were willing to shift to the public health care system if made available in the locality. (author's)
Attitudes to water fluoridation in South Africa 1998. Part III. An analysis of pro- and anti-fluoridation attitudes in South Africa.
Journal of the South African Dental Association. 2000 Feb; 55(2):70-76.A survey on attitudes to water fluoridation in the South African population (N = 2 220) was undertaken in 1998. The purpose of this study was to evaluate responses to, and underlying reasons for pro- and anti-fluoridation attitudes. In response to a structured questionnaire, 61.9% of respondents were in favour of fluoride being added to drinking water and 9% were against it. Reasons supporting and opposing this measure were as follows. Of those who favoured the measure, 30% of respondents said it was because it would reduce tooth decay and 30% said it 'affects health', presumably positively. Other reasons include, 'it purifies water' (10.3%),'more people will be reached' (9.8%),'it strengthens bones' (6%), 'it prevents plaque' (4.6%) and it 'improves the taste of water' (3.1%). There was a 1.3% 'don't know' response. Those opposed to the measure said, 'water should stay as it is' (26.1%), 'if it stays in the system it will create other problems' (15.6%), it 'affects health', presumably negatively (12.3%) and 'it will increase the cost of water' (8.8%). The 'don't know' response was 10.5%. When asked to give reasons for their 'don't know' response in the 'uncertain' category, 90% said they did not know. Given the contradictory and variable responses in both 'yes' and 'no' categories, the possible reasons for these findings could include: the differences between knowledge and beliefs, alternative health and lifestyle practices, levels of education, resistance to change and personality factors, among others. Understanding the assumption people make about fluoridation would help to structure education programmes to provide accurate and comprehensive information. (author's)
Attitudes to water fluoridation in South Africa 1998. Part II. Influence of educational and occupational levels.
Journal of the South African Dental Association. 2000 Jan; 55(1):23-28.The purpose of this report is to investigate the influence of education, income and occupation on public perceptions of water fluoridation (WF). A questionnaire on current knowledge, sources of information, the purpose of WF and its desirability was administered to a representative sample of 2 220 individuals over the age of 18 years. Knowledge of WF increased with educational level (range from 13.5% in the grade 0-5 group to 59% in the grade 12 plus group). Lack of knowledge decreased from 76% to 37% in these groups respectively. Knowledge levels varied from 19% to 68% across the occupational spectrum and from 13% to 88% across the income spectrum. In educational levels up to grade 12, electronic media were most frequently cited as dominant sources of information among 40-50% of respondents, whereas in the grade 12 plus group print media (37%) dominated. Sources of knowledge on fluoridation were largely obtained from print and electronic media for both categories. Only 28% in the educational level up to grade 5 thought the purpose of WF was to protect teeth against decay. This gradually increased to 55% in the grade 12 plus category. More than a quarter of the population in both the occupational and income categories indicated that the purpose of WF was to purify water and protect teeth from decay. The number of respondents who thought that water should be fluoridated increased with level of education from 58% to 70%, while those who disagreed decreased as qualifications increased. The lower- and middle-income groups were more supportive of WF than the very-high-income groups. Persons in high administrative professional and executive positions were more opposed (27%) to WF than semi-skilled and unskilled workers(5%). (author's)
[Midwives in the Andean communities: a form of female shamanism?] Hebammenwesen im Andenraum: eine form des weiblichen Schamanismus?
Curare. 1997 Nov; (Spec No):303-312.Acquiring an understanding of Andean midwives and their functions under consideration of their cultural background is seen as a challenge. From the viewpoint of village inhabitants, midwives are regarded as recognized members of the community, and are honored and respected because of their healing function. For this reason they are also of interest to public health institutions, who attempt to integrate them as potential representatives of basic public health care services. However, these efforts have not remained unchallenged, and they present the basis for a cultural conflict, which has contributed to misunderstandings concerning the true dimension of their personality, role and function as a representative element and as a symbol of cultural life in the indigenous Andean community. (author's)
Dacca, Bangladesh, Ministry of Information and Broadcasting, April 1977. 41 p.Reports on a survey conducted to identify the formal and informal opinion leaders as perceived by the people of Bangladesh, and to assess their attitude towards family planning. Findings indicate that the contraception practice rate among opinion leaders is significantly higher than the average, and it is recommended that specific orientation and training in the skills of interpersonal and group communication be arranged for them to effect a transfer of motivation to the people in their locality. Also established is the fact that obstacles to family planning due to religious belief is more a function of the leaders' perception of people's attitude than a function of reality. Opinion leaders fail to identify population as the root problem, so that family planning education should be structured around the felt problems of food, unemployment, poverty, and so forth. The need for a greater degree of husband-wife communication about family planning is indicated, as well as a change in the traditional status of women. A family planning program with an incentive-disincentive aspect should be deemphasized. Finally, the survey reveals that the local leadership is not yet ready to take major responsibility in family planning communication.
In: Medical issues and health care reform in Russia, edited by Vicki L. Hesli and Margaret H. Mills. Lewiston, New York, Edwin Mellen Press, 1999. 65-112. (Studies in Health and Human Services Vol. 35)Universal access to free health care was a hallmark of the Soviet system. Although the system provided health care for large numbers of people, obsession with predetermined quotas and limits by the Ministry of Public Health constrained possibilities for quality, personalized care. In addition, too much emphasis has been placed on specialty and hospital care at the expense of primary and preventive care. Russia’s health care system is currently facing several problems. The challenges for reform include centralization, an uncertain health care insurance system, management, equipment, technology, funding, training of doctors, status of physicians, access to information about health care strategies and medical treatments, immunizations, access to safe contraception, unsafe abortions, an underdeveloped concept of patient rights, and a lack of confidence in the system as a whole. The goal of this paper is to develop a better understanding of how post-Soviet citizens view their own health situation and what they think are the most needed reforms. The issues explored include major problems in the health care system, necessary steps to make improvements, and role of the state and private hospitals or clinics. This paper also tackles the issue of access to free public care versus private care in the post-Soviet setting. Before going into the analysis of public opinion, this paper reviews what is already known about attitudes toward health care and the health care system in Russia and other post-Soviet states.
Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: a US-British comparison.
AMERICAN JOURNAL OF PUBLIC HEALTH. 1998 May; 88(5):749-54.A review of data from recent national probability sample surveys in the US and Britain was conducted to compare patterns of sexual behavior and the effects of such behaviors on public health policy related to sexually transmitted diseases (STDs). Although the two surveys were conducted independently and with different protocols, the general character of the information was similar. Overall, there was greater dispersion in sexual behavior in the US than in Britain. Consistently fewer respondents in Great Britain than in the US reported having two or more sexual partners in the year preceding the survey. Reported condom use was significantly higher among British men than US men. Lifetime STD rates were 2-3 times higher among US men than British men and this discrepancy was even larger among women. In both countries, there was a clear positive association between number of sexual partners and the likelihood of contracting an STD. British respondents were more tolerant than their US counterparts of premarital, extramarital, and homosexual sex. Two factors present in the US--the greater diversity of sexual behavior and the greater degree of absolute public opinion about improper sexual behaviors--may account for the resistance in the US to development of a public health policy such as exists in Britain that promotes safer sexual behavior. The failure in the US to mount an effective public health campaign about sex and STDs may, in part, explain the higher rate of STDs, including HIV/AIDS, in the US compared with Britain.
PUBLIC HEALTH. 1997 Nov; 111(6):399-404.South Africa's government has since coming to office in 1994 expressed its commitment to involving communities in designing and implementing health policies and programs. It remains unclear, however, how to translate that commitment into practical action at the local level. This paper discusses data collected in October 1994 in a national survey of health inequalities in South Africa. In the survey, 3796 men and women aged 16-64 years were asked to report their views on the involvement of communities in aspects of local public health services. The analysis of those data indicates that the South African public favors the involvement of communities in local public health services. There are, however, variations in the support for community involvement in health services with regard to which time to open clinics, the nature of the patient-provider relationship, staff recruitment, and the determination of service charges. Multivariate analysis shows that the level of support for community involvement is significantly low for Whites relative to other races, lower for rural residents than for city dwellers, and high for people with a very good health status. Additional research is needed to better understand the problems and policy options in community involvement in public health programs.
Environmental contamination, public hygiene, and human health concerns in the Third World: the case of Nigerian environmentalism.
ENVIRONMENT AND BEHAVIOR. 1996 Sep; 28(5):614-46.Recent evidence suggests that people in Third World countries have similar environmental concerns as their counterparts in developed countries. This paper examines responses to a public opinion poll in Nigeria, discusses the development of national environmental policy, and provides a theoretical explanation for the evolution of Nigerian environmentalism. Although the Nigerian government has a bureaucracy for dealing with environmental issues, only 1% of the total budget is allocated to environmental management. Nigeria is experiencing soil erosion, deforestation, problems related to urban solid waste generation, industrial pollution, illegal importation of toxic chemicals, and uncontrolled dumping of hazardous materials. Rural ecological problems differ from urban ones. Environmental contamination and poor sanitation result in soil- and water-borne diseases. Several environmental groups operate at the state, regional, and national levels. Membership appears to be among elites. The anthropocentric belief in human supremacy over nature led to the world view known as the Dominant Social Paradigm (DSP); in western societies, the Human Exceptualism Paradigm (HEP), and in nonwestern societies, the Traditional Environmental Paradigm (TEP). In 1992 the Gallop International Institute conducted a Health of the Planet Survey in 24 industrialized and nonwestern nations. Findings in Nigeria indicate that 76% of the adult population sampled considered the economy the most important problem. Only 1% identified the environment as the most important. On specific environmental questions, 45% rated environmental problems in Nigeria as very serious, and 87% said they were personally very concerned. Global environmental problems were of lesser importance than local problems. Although the survey did not identify the sources of environmental concerns, the evidence suggests the persistence of traditional environmental conservation values.
In: AIDS. Prevention through education: a world view, edited by Jaime Sepulveda, Harvey Fineberg, Jonathan Mann. New York, New York, Oxford University Press, 1992. 255-72.US public health officials have depended on the broadcast media to deliver potent anti-AIDS messages to vast audiences. While most Americans now know a great deal about AIDS, this knowledge has not always resulted in the adoption of preventive behavior. Since promoting condom use will result in the greatest reduction in AIDS transmission, messages which are targeted to homosexual, bisexual, and heterosexual audiences and are designed to address the psychological barriers to condom use are needed. It is difficult to convince the broadcast media to communicate targeted messages, even to heterosexuals, for fear of the political and economic repercussions of viewer alienation. The media has been used successfully to promote health, and anti-AIDS campaigns have achieved a high level of understanding of the disease on the part of the public. These include the American Red Cross' "Rumors Are Spreading Faster Than AIDS" and the Centers for Disease Control's "America Responds to AIDS" and print advertisements for condom use. The news media has played a role in informing, and sometimes confusing, the public by presenting unchallenged and unsubstantiated inaccurate reports, especially in the early days of the disease. Surveys now indicate that AIDS knowledge is good in areas that have been the focus of media reports, and awareness of the role of condoms to prevent transmission is high, higher in fact than the use of condoms. It is time to move beyond delivering current information and to begin motivating condom use. Condoms are maligned in the US and are associated with reduced pleasure or "illicit" sex, requesting their use also raises issues of interpersonal trust. These specific concerns need to be addressed, but the current standards of the national broadcast media block delivery of messages to motivate condom use. Entertainment programming is a possible source, since it is only subject to general guidelines, depending on audience and context, but these opportunities are not frequent enough to make a significant difference. To successfully promote condoms, their image has to be changed to that of a product used by couples rather than individuals which might actually enhance sexual pleasure, and peer consensus in favor of condom use must be implied. Marketing efforts using suggestive names and slogans and offering different shapes, colors, and textures are attempting such an image change. In light of current media restrictions, it is important to develop community-based educational programs which focus on condom promotion and can be assisted by local mass media. Local sentiment will ultimately dictate whether paid condom adds or public service spots will be used to address the psychological barriers to condom use.
New York, New York/Montreux, Switzerland, Gordon and Breach, 1989. xi, 117 p.This is a collection of articles by different authors writing about the AIDS pandemic from an anthropological perspective. Chapters are included on metaphors of sex and deviance in the representation of disease; the social classification of AIDS in U.S. epidemiology; sexual behavior and the spread of AIDS in Mexico; surveys on the prevalence of HIV infection in central and eastern Africa; strategies for dealing with AIDS based on those used for hepatitis B; the role of a community-based health education program in the prevention of AIDS; preventing AIDS contagion among intravenous drug users; human rights and public health; the legal status of AIDS in the workplace in the United States; and the politics of AIDS at the microlevel, using the example of a gay rights ballot measure proposed in Houston, Texas, in 1985.
In: International Health in the 1990s: Directions in Research and Development, NCIH Southern Regional Conference, Chapel Hill, North Carolina, October 29-31, 1987, selected proceedings, coordinated by Maureen Heffernan. Washington, D.C., National Council for International Health, 1988 Spring. 123-6.The issue of AIDS and all Sexually Transmitted Diseases (STDs) is now caught in the middle of a struggle to shape public opinion, and future funding of education services and research depends, to a large degree, on the outcome of that struggle. The issue is very sensitive, being involved with sex and fear. It has been highly politicized in the US because of several factors. 1) The public's education on the issue came mainly through the press, often making it unbalanced and sensational. 2) The public gets mixed signals: they are told that there is nothing to fear from a person with AIDS at work place or at school, but also read that many doctors and dentists avoid AIDS patients. 3) Federal government policy decisions on the issue often seem to be political, not coming from its medical experts. 4) The typical victim is among the disenfranchised of our society, and blaming the victim is a common reaction. Society has been unwilling to accept the reality of sexually transmitted diseases, as is clearly reflected in the way the government has allocated government funds. The challenge to America is to create an atmosphere that allows rational policy. 1) More and better information dissemination is critical; other countries are way ahead of the US in this matter. 2) The issue of heterosexual transmission should be put in proper perspective. 3) Professional training in all aspects of STDs and AIDS research, care and prevention needs to be vastly expanded. 4) The AIDS issue should be placed in the broader context of STDs and other public health problems to avoid all types of unhealthy competition among special interests.
MILBANK MEMORIAL FUND QUARTERLY. HEALTH AND SOCIETY. 1986; 64(Suppl 1):168-82.This article outlines some of the potential societal consequences of the acquired immunodeficiency syndrome (AIDS) epidemic. The epidemic hit the US after a long process of affirming certain rights to privacy and decriminalization of certain victimless private acts. Now US society is faced with the possibility of having to alter private behavior to halt the advance of a very serious disease. From a liberal point of view, measures designed to restrict personal freedom must be justified by a strong showing that no other path exists to protect the public health. The public health departments in the 2 US cities most affected have shown remarkable restraint in the face of demands for very strong measures to control the infection's spread, including strict quarantines, mostly on the part of conservative elements and press. Actually, the practical aspects of separating great numbers of people (adequate testing, transportation, feeding and housing, forcible containment), preclude this solution, even assuming these people were not overwhelmingly opposed. An alternative suggestion: mass screening, would also present immense logistical and civil-liberties obstacles, even in modified versions, i.e. government-mandated workplace testing, and mass-screening with the sole purpose of education and counseling would be inconceivable: the logic leads inevitably to mass quarantine. Quarantine or similar control exerted over AIDS-antibody positive individuals who continue to behave in ways exposing others to infection risk (e.g. male and female prostitutes) has historical precedents, but would probably have little impact on the epidemic, especially since it would not affect those who, in private, continue to engage in dangerous behavior. Mass education, though legally, morally, and politically palatable, has often not shown results in campaigns to eliminate other types of dangerous behavior. However, innovative efforts especially by gay community groups to educate for safe sex seem to have been dramatically successful.
MILBANK MEMORIAL FUND QUARTERLY. HEALTH AND SOCIETY. 1986; 64(Suppl 1):97-117.This artical discusses the concept of quarantine and social and attitudinal manifestations of it through history, with a view towards preparing for the likely societal reaction to acquired immunodeficiency syndrome. Will public fears surrounding the AIDS epidemic spur public efforts for a quarantine? AIDS is prevalent among groups traditionally held in low esteem (homosexual men, and intravenous drug users), engaging in practices that are or have been illegal, and shares characteristics with diseases historically inspiring quarantines: leprosy, where the church took a role in the quarantine ritual; bubonic plague, where the breath, contact, and even gaze of victims were suspect; yellow fever, which in the US inspired much debate over the relative benefits of quarantine or environmental cleanliness, with quarantine often winning out at the expense of cleanliness; cholera, which killed 1000s in New York City in 1832 despite immense powers given to the Board of Health to control shipping and transportation; and tuberculosis, which, like AIDS, has a long latent period and period and period of contagiousness when the patient can continue to be in contact with the community. Irrational beliefs associating the use of certain drugs with ethnic groups (e.g. opium with Chinese; marijuana with Mexicans); as well as a perceived threat to racial purity of contact with these groups have often inspired restrictive immigration laws and discriminatory practices. AIDS has shown potential for spreading outside of traditional risk groups. History also shows that quarantines are often attempted over the objections of the contemporary medical establishment. Reminders of the past ineffectiveness of quarantines and an improved knowledge of AID's characteristics should help protect against irrational fears prompting a quarantine.