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Abstracts Book
Reviews Commentaries Contributors
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Volume
25 2004 Number 3-4: Abstracts
Changing the Debate about Health Research for Development Abrahams, N., Adhikari, R., Bhagwat, I. P., Christofides, N., Djibuti, M., et al. We represent ten groups of citizens and researchers from low- and middle-income countries who were recipients of International Health Research Awards (IHRA) presented at the Bangkok Conference on International Health Research for Development, 2000. The IHRA, funded by the Rockefeller Foundation and administered by the World Health Organization, recognized the need for us to find effective ways of solving our countries' health problems and acknowledged the special environmental constraints we face in conducting research and exploiting the results. We used this funding to explore alternative ways for harnessing largely untapped resources in our countries to generate and apply knowledge to improve people's health and address inequalities. In the Bangkok Declaration, we joined many others to express our commitment to research as a vital force for health of all of our people. Six of our ten projects explored, for particular themes or health topics, ways of extending the benefits of research to special groups or populations. Four more proposed specific approaches to consolidate national research policy and systems for allocating public research funds and managing research. From our collective reflection about what we have learned, we note ways in which our experiences represent change, particularly expansion of the traditional boundaries of research: –broadening the research agenda by adding new topics, more voices and more perspectives than has been the norm in our settings –expanding capacity to design and conduct research by preparing new groups of researchers to pose questions, design and carry out studies, and by engaging more partners and disciplines in addressing national priorities –extending dissemination of research results, especially by using websites and mass media to reach decision makers and broader segments of the public –encouraging uptake of research for policy and practice. We want research to improve the health of our societies' most disadvantaged groups and to engage them in the process. Our work benefited immeasurably from networks and other forms of collaboration that our grants helped to support—and supported to an extent that was unusual compared to other forms of research funding. We linked our national and regional collaborations to global efforts, but endeavored to do so without being driven or preempted by the latter. We are optimistic about the value of our experiences, but remain acutely aware of the unfinished agenda—an agenda that we incorporate into A CHALLENGE and A CALL for future action. We challenge ourselves, and others, to evaluate the effectiveness of our approaches to research for improving health systems and population health. We call on policy makers to adopt an evidence-based approach and to ensure that health systems are equipped to use rigorous research methods to embrace and analyze information from all participants. We close by asking donors and other international agencies for more flexible support so that we can benefit from global collaboration while maintaining our own priorities and building national and regional infrastructures to implement and evaluate new ways of doing research. Access
to Essential Drugs in 11 Brazilian Cities: A community-based evaluation
and action method
Results show that smoking prevalence in the workplace in Taiwan is high, particularly among males, ranging from 38 to 68%. More than 75% of smokers in Taiwan smoke in the workplace. The percentage of workplaces implementing restrictive smoking policies in Taiwan is low, particularly in small-sized workplaces. The Tobacco Hazard Control Act in Taiwan has not been strongly enforced in public places, let alone in private companies. Several constructive suggestions are presented in the study. For example, establishing workplace smoking policies, informing employers that secondhand smoke is a human carcinogen, providing financial support for employers to initiate cessation programs, and modifying the current Tobacco Hazard Control Act, etc.
Legal
Approaches to the Obesity Epidemic: An introduction We describe the epidemic of obesity in the United States: escalating rates of obesity in both adults and children, and why these qualify as an epidemic; disparities in overweight and obesity by race/ethnicity and sex, and the staggering health and economic consequences of obesity. Physical activity contributes to the epidemic as explained by new patterns of physical activity in adults and children. Changing patterns of food consumption, such as rising carbohydrate intake – particularly in the form of soda and other foods containing high fructose corn syrup – also contribute to obesity. We present as a central concept, the food environment – the contexts within which food choices are made – and its contribution to food consumption: the abundance and ubiquity of certain types of foods over others; limited food choices available in certain settings, such as schools; the market economy of the United States that exposes individuals to many marketing/advertising strategies. Advertising tailored to children plays an important role.
Childhood obesity is a major public health problem in the United
States, yet US children are targeted as never before with marketing
for foods high in sugar, fat, salt, and calories. Food marketing
to children is highly sophisticated, increasingly well-funded, and
takes place within the context of a barrage of other kinds of child-targeted
marketing. The proliferation and sophistication of electronic media,
the escalation of marketing in schools, changing families, and a
political climate that favors deregulation have allowed marketers
unprecedented access to children, including babies and toddlers.
The notion – promulgated by the food industry – that
parents can “just say no” to requests for highly marketed snacks
and junk food is simplistic at best and cynical at worst. Instead
of being viewed as a familial problem, the current marketing maelstrom
should be viewed as a societal issue and addressed as such. Restriction
of advertising to children is common in industrial democracies other
than the United States – and is just one of many corrective
actions that could be taken by our governments.
Legislative bodies in the United States have often passed laws to
regulate food in its production, content, and sale. Additionally,
legislatures have created economic policies that directly affect
the food supply and determine both the type and quantity of food
available. Legislatively-enacted federal programs, such as the National
School Lunch Program, also provide opportunities to promote good
nutrition. These traditional areas of legislation represent the
most efficient means to affect the food environment legislatively.
While exploring legislative solutions to obesity, it is also imperative
to monitor attempts by the legislature to constrain other public
health strategies by limiting private enforcement and limiting the
regulatory freedom of traditional public health authorities.
The marked increase in the prevalence of obesity appears to be attributable
to environmental conditions that implicitly discourage physical
activity while explicitly encouraging the consumption of greater
quantities of energy-dense, low-nutrient foods. In the United States
food environment, consumers are bombarded with advertising for unhealthy
food, and receive inadequate nutritional information, especially
at restaurants. In the US school environment children have access
to sugary sodas and unhealthy à la carte foods in their cafeterias,
at the same time getting inadequate physical activity and nutrition
education. In the built environment, sprawl has reduced active living.
We describe these environments and explore the potential effects
of regulatory measures on these environments. In the United States,
regulatory opportunities exist at the national, state and local
levels to mandate action and to allocate funds for promising health-promoting
strategies. Regulatory approaches, much like litigation, can transform
the entire environment in which corporations operate. Even with
incomplete enforcement of rules, they send a public message about
what is acceptable behavior for corporations and individuals. Additionally,
because the United States is party to many multilateral and bilateral
trade agreements and is an active participant in the GATT/WTO framework,
US regulatory actions promise to have a beneficial impact both domestically
and globally.
Private enforcement, or litigation, has played a historic role in
protecting public health in the United States. Litigation is often
employed as a means to protect public health when government regulation
is absent or ineffectual. Litigation has been successfully employed
to control both asbestos and tobacco and is poised for success in
combating the obesity epidemic. Litigation is effective because
it makes public industry practices and increases industry self-policing.
Litigation related to obesity would likely employ theories of “unfair
and deceptive trade practice” or general “personal injury” or tort
claims. While opponents to the use of litigation often cite personal
responsibility and the individual as the true locus of liability,
these arguments fail to take into account the context of an individual's
choice. While litigation can be effective, media attention and current
political discourse on “tort reform” has engendered a set of legislative
actions that would foreclose litigation as a public health strategy.
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