Harvard Public Health Review
New publications from the HSPH faculty
Guide to Producing National Health Accounts: With Special Applications
for Low-Income and Middle-Income Countries
Peter Berman, Principal Contributor
World Health Organization, 2003, 309 pp.
To enhance the performance of their countries' health care systems, policy makers need reliable information on how funds for health are collected and spent by what is often a complex and shifting combination of government and private-sector entities. National health accounts help provide that information. These tables of data are powerful tools for evaluating and restructuring a nation's health care financing, and for developing and assessing fiscal strategies to improve the public's health.
In the Guide to Producing National Health Accounts, Peter Berman, professor of population and international health economics at HSPH, draws upon the experience and expertise of seasoned practitioners in the field. This comprehensive manual covers the theory, concept, practice, as well as use of health accounts. Providing a framework compatible with emerging international standard practice, the guide walks readers step by step through the process of acquiring and evaluating data, and shows how raw numbers can be turned into information useful for health policy analysis and development. It is published under the auspices of the World Bank, the World Health Organization, and the United States Agency for International Development.
Escape Fire: Designs for the Future of Health Care
Donald M. Berwick
Jossey-Bass, 2003, 315 pp.
This book brings together 11 speeches by Dr. Donald Berwick, president and chief executive officer of the Institute for Health Care Improvement and a professor in the Department of Health Policy and Management at HSPH. Delivered at the Institute for Healthcare Improvement's annual National Forum on Quality Improvement in Health Care from 1992 to 2002, Berwick's speeches call for an all-new health care system, one designed to ensure that all patients receive care based on the best scientific knowledge available. Berwick identifies lessons for promoting this change from varied sources--a girls' soccer team, a sinking ship, and the safety standards at NASA.
Escape Fire takes its title from the 1949 Mann Gulch tragedy in which 13 firefighters were trapped in a Montana hillside wildfire. Their leader, Wag Dodge, devised a creative escape plan: He burned a patch of grass and lay down in the middle of the scorched earth. Refusing to join Dodge, most of his team perished.
Applying lessons from the catastrophe to the United States health care system, Berwick says ingrained practices must make way for innovation. Noting that the current system has evolved to serve the needs and interests of health care providers, insurers, and other players working inside it, he outlines new designs and practical tools that would put patients at the center instead.
Be Healthy! It's a Girl Thing: Food, Fitness, and Feeling
Lilian Cheung and Mavis Jukes
Crown Books for Young Readers, 2003, 128 pp.
Dr. Lilian Cheung, lecturer in the Department of Nutrition at HSPH, joined with children's author Mavis Jukes to write this book, intended as an inspiring, upbeat health guide for adolescent girls. The book presents what the authors believe girls need to know in order to achieve an active lifestyle and avoid the pitfalls surrounding dieting and body-image issues. The authors' "Cactus Plan"--which is largely derived from the research-based healthier food pyramid model developed by HSPH faculty from the departments of Nutrition and Epidemiology with collaborators from affiliated institutions--aims to increase energy and concentration, improve athletic ability, reduce stress, and foster an improved appearance. Readers are encouraged to take charge of their well being in accordance with the plan, which presents basic nutritional information and elements of a balanced diet along with guidelines for physical activity, safe exercise, hydration, and rest. A chapter on advertising helps counter unrealistic images of girls and women portrayed in the media.
Handbook of Cancer Risk Assessment and Prevention
Graham A. Colditz and Cynthia J. Stein
Jones & Bartlett Publishers, 2004, 343 pp.
Noting that over 50 percent of cancers in the United States could be prevented, this guide aims to help health care providers reach patients with up-to-date, engaging messages about practical ways of lowering their cancer risk. Covered in depth are 14 of the most common cancers: bladder, breast, cervical, colorectal, esophageal, kidney, lung, oral, ovarian, pancreatic, prostate, skin, stomach, and uterine. Authors Graham Colditz, who is a professor in the Department of Epidemiology at HSPH and director of the Harvard Center for Cancer Prevention, and Cynthia Stein, a project manager at the Center, provide for each disease a scientific summary of risk factors, ideas for promoting risk-reducing lifestyle changes, and risk assessment tools that patients can use to estimate their risk. These tools are adapted from the Center's popular website, Your Cancer Risk, which was recently expanded to Your Disease Risk.
Additional chapters focus on five key lifestyle behaviors that lower the risk of not only cancer, but other chronic diseases as well. The book also suggests strategies for counseling patients on making these behavioral changes.
Rethinking AIDS Prevention: Learning from Successes in Developing
Edward C. Green
Greenwood Press, 2003, 392 pp.
For years, American and international policymakers have emphasized the use of condoms to prevent transmission of HIV/AIDS. In this book, Dr. Edward Green, a medical anthropologist and senior research scientist at the Harvard Center for Population and Development Studies at HSPH, calls on health officials to rethink that approach, particularly in programs that target Africa.
A recent appointee to the Presidential Advisory Council on HIV and AIDS, Green supports the "ABC" model of AIDS prevention, meaning Abstinence, Be faithful, or use Condoms, if A and B are not practiced. The author looks objectively at countries that have succeeded in reducing HIV infection rates, such as Uganda, where simple, sustainable interventions like ABC have helped produce an unprecedented two-thirds decline in HIV prevalence, from 15 to 5 percent between 1992 to 2002. He shows that low-cost behavioral change programs, which stress monogamy and delayed sexual activity for young people, have made the greatest headway in preventing the disease's spread.
Green's goal is to change policy. Noting that the current paradigm of AIDS prevention is based on risk reduction, primarily in the form of condom use, he argues for a greater emphasis on interventions that avoid the risk in the first place.
Managing Health: An International Perspective
Nancy Kane and Nancy Turnbull
Jossey-Bass, 2003, 460 pp.
Managing Health provides students and professionals with an international perspective on tools and mechanisms that have been used to manage the care, cost, and health of populations. This book features 11 teaching cases based on original research by the authors, who are professors of health policy and management at HSPH. The cases aim to provide a deeper understanding of the challenges of health care reform and a framework for developing solutions to real world situations.
Designed for use as a global health management textbook, Managing Health explores health programs and plans in North America, Western Europe, Eastern Europe, Asia, and South America. Through these examples, the authors show that no country has a perfect approach to containing costs, improving quality and access, and advancing the people's health. However, the lessons learned are valuable for a comparative analysis of international health systems, and provide a stimulus for opportunities to develop more effective solutions for problems in the United States. The book also offers insight into the roles played by many health system stakeholders, including government leaders, employers, insurers, providers, suppliers, and consumers.
Private Guns, Public Health
University of Michigan Press, 2004, 304 pp.
On an average day in the United States, guns are used to kill almost 90 people and wound nearly 300 more. Such outcomes are generally accepted as a natural consequence of the country's high rates of violence. Yet if any other consumer product had this sort of disastrous effect, the public outcry would be deafening.
Private Guns, Public Health argues that gun violence should be treated as a consumer-safety issue, and demonstrates how a public health approach--one that emphasizes prevention over punishment, and has successfully reduced rates of injury and death from infectious disease, car accidents, and tobacco consumption--could substantially reduce gun-related injury and death. Author David Hemenway, director of the Harvard Injury Control Research Center at HSPH, summarizes the research to date on the causes and effects of gun violence, including data showing that a gun in the home increases occupants' chances of dying as a victim of homicide, suicide, or unintentional shooting. Hemenway also explores complex connections between guns and self-defense, suicide, homicide, and violence in the schools.
Finally, Hemenway outlines a course of regulation and policy change. A start, he writes, would be to establish a federal agency to regulate the manufacturing and distribution of firearms. Such an agency could require childproof safeties and tamper-resistant serial numbers on firearms, and promote new technologies, such as "smart" guns that can only be fired by authorized users. The licensing of gun owners and registration of handguns could also be required on a national level, Hemenway advises, and loopholes that allow guns to be sold without background checks should be closed.
Colleen Capodilupo is the development communications assistant for the Review
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