The last decade has seen a substantial growth in health policies stressing the need for “prevention orientated” solutions over treatment provision as an approach to addressing health needs. Such an approach infers that there is a clear distinction between the two approaches and that a shift of resources from current care modalities, with their emphasis on addressing health needs through treatment orientated health services, to approaches that adopt interventions aimed at addressing problems before they arise, will provide better outcomes, not least in terms of use of resources. This paper argues that such an approach is too simplistic and fails to take account of the changing nature of health conditions affecting populations.

The major changes in the epidemiology of health conditions have seen a shift in emphasis away from acute to chronic disease problems. This alteration in the pattern of health conditions means that a key feature of health services is their re-orientation from eradication of illness to its management. The dichotomy between prevention and treatment of a particular condition is both inappropriate, indeed damaging in the debate on how to address health needs. Using examples from a number of elements of the health sector, the paper argues that there is a need to move away from interventions using a empirical base centering on prevention or treatment to one that adopts the idea of managing health conditions, the goal of which is the aim of reducing the impacts of the problem on individuals. Such an approach would allow a more constructive dialogue between all sectors involved in improving the health of society, not least ensuring that the economical aspects of policy making have a more sound base.

The concept of health promotion emerged as a new approach to the challenge of health maintenance and improvement. It offered a new quality of thinking about health with strong emphasis on its positive understanding and not only on avoiding diseases. After several decades of translation of health promotion doctrine into practice, it became obvious that health promotion interventions should be seen in the context of complex interrelationships encompassing citizens, communities, health care systems and surrounding environments. This paper was prepared in the context of international project focused on evidence search for health promotion interventions addressed to elderly persons. Thus, the approaches offering systematic thinking about definitions, outcomes and interventions of health promotion are reminded. Furthermore, the concept of disesae prevention is discussed in search for differences and common elements with health promotion. Although, every model or classification is usually only some approximation of strategies applied in real life conditions, their knowledge may be helpful in assessment of available evidence in search of practical recommendations

Acknowledgement

This publication arises from the project Pro-Health 65+ which has received funding from the European Union, in the framework of the Health Programme (2008 - 2013).
The content of this publication represents the views of the author and it is his sole responsibility; it can in no way be taken to reflect the views of the European Commission and/or the Executive Agency for Health and Consumers or any other body of the European Union. The European Commission and/or the Executive Agency do(es) not accept responsibility for any use that may be made of the information it contains.
Publication financed from funds for science in the years 2015 - 2017 allocated for implementation of an international co-financed project.
 

The paper includes considerations on three issues related to the problem of the sources of funds for public health, which are presented in three different parts of the text. In the first part, an overview of the theoretical considerations of the sources of funds for public health activities is provided. In the second part, the authors attempt to identify the sources of funding for public health in Poland, based on the available statistical information. The third part includes the description of proposals and final solutions in the field of public health funding which have been included in the Polish Act on Public Health adopted in autumn 2015. The paper is completed with conclusions on the state responsibilities with regard to indicating the sources of funds for public health and their levels. Despite the diversity in solutions for financing of public health across different countries, they have some common characteristics which have been described in this paper.

Public health is comprised of services, programs, and policies aimed at promoting health, preventing injury and chronic diseases, and responding to health emergencies. Public health professionals include front line providers, consultants, and specialists from various disciplines and professions, such as medicine, nursing, and epidemiology. Public health in Canada is provided through the collaboration between three levels of government, namely municipal, provincial or territorial, and federal. While public health is a shared responsibility of all levels of government, the volume and direction of allocated resources for related activities varies between the provinces and territories. Canada’s public health history predates its founding in 1867. A turning point in public health in the country occurred following the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003. The following year, the federal Public Health Agency of Canada (PHAC) was created. Its role is to improve and maintain population health in Canada. The Chief Public Health Officer is the deputy head of the PHAC and is the government’s lead public health professional. The public health landscape in Canada will continue to evolve to meet the growing needs of its population and to address existing health challenges including adverse health events related to chronic diseases and unhealthy lifestyles. Moreover, it will further adapt to respond to new public health threats, such as the emergence of tropical illnesses, the northward spread of infectious agents due to climate change, and disease transmission related to international travel.

The institutional architecture of public health in the Netherlands is regulated by the Public Health Act (2008), based on the principle of state responsibility for collective prevention.  Increasingly, responsibilities for public health are laid down at the level of municipalities, making their Community Health Services (CHS’s) the central pillar in Dutch public health organization. From the national level municipalities and their CHS’s are supported by a National Institute of Public Health and several health promotion knowledge institutes.  The implementation of interventions at the local level is orchestrated by the CHS’s and requires ample knowledge and organisational skills to collaborate with a large number of stakeholders such as schools and primary health care for positive effects on health risk factors/health determinants. In addition municipalities do influence those health risk factors/health determinants with their local health policies and CHS’s with their public health basic tasks as youth health care, infectious disease control, vaccination and health promotion.

Actual policy is the alignment of public health with cure, care and social welfare for prevention, and health and social actionon well-known spearheads of lifestyle such as smoking, harmful alcohol consumption and overweight.

The public health system in the province of Ontario in Canada is a publicly funded system that is responsible for addressing the health status of the population. Public health involves the combined effort of all levels of government (federal, provincial, municipal) in the country to strengthen the health system and promote the health of Canadians. The federal Canada Health Act guides the delivery of health services, with the administration of the health system a provincial responsibility. There are multiple organizations involved in public health including the Ontario Ministry of Health and Long-Term Care, Local Health Integration Networks, local Boards of Health, Public Health Ontario, and the Ontario Public Health Association. Public health program costs at Ontario’s 36 public health units are shared between municipal and provincial governments. Public health initiatives undertaken by public health units and governmental agencies are aimed at addressing and improving the population’s determinants of health.

The assessment of weather conditions on days with registered calls for emergency medical service (EMS) was made with the use of weather charts at the level of 850hPa, 00 UTC provided by the German Weather Service (www.wetterzentrale.de/topkarten/tkfaxbraar.htm).  Synoptic situations on days with registered calls for EMS were categorized into 13 weather types according to the German Weather Service. This paper analyses the number of calls for EMS recorded on individual days in Stargard Szczeciński province in the period of 2008-2011 to people suffering from coronary heart disease, including myocardial infarction, mental disturbances (mainly schizophrenia), epilepsy, stroke, arterial hypertension, asthma and emergency-related ambulance trips as well as death. The number of calls registered in Stargard Szczeciński province in the period of 2008-2011 amounted to more than 41 thousand, and the daily number ranged from 13 to 50 – the highest in March and January, lowest in September and October. From the analysed 13 weather types the following types were most predominant on days with calls for EMS: the centre of low pressure area (type 6), cold air advection in the retral part of low pressure area (type 7), and lingering centre of high pressure area (type 1, 2). 70-80% of the analysed days in a year were characterised by low pressure system and weather types connected with it: 4 (warm aid advection in the front part of low pressure area), 5 (warm sector of low pressure area), 6 (the centre of low pressure area), 7 (cold air advection in the retral part of low pressure area); and high pressure system and weather types: 1 (high pressure centre – no thermal inversions), 2 (high pressure centre – thermal inversions), 11 (cold high pressure area), 12 (warm sector of high pressure). From the remaining 5 types of weather (3, 8, 9, 10, 13) occurring on days with calls for EMS, the following weather types were predominant: type 3 (air slips at the edge of high pressure area) – 10.1%, followed by type 8 (waving front zone) – 9.4%. Depending on the type of illness, the sensitivity of patients to changing meteorological conditions, expressed by the number of calls for EMS, varied during a year. People suffering from asthma and COPD required EMS help in summer on days with low pressure systems – 64.7%, and in winter during lingering high pressure areas – 33.3%. Epileptic seizures were more common in summer during the transition of low pressure systems – 63%, and in autumn during high pressure systems – 20% of days under study. The frequency of calls for EMS to people suffering from arterial hypertension was the highest in autumn and winter – approximately 57% each, during transition of low pressure areas, and in winter during lingering high pressure – 25.4%.

Dietitian on the medical services market in Poland and other selected countries

The aim of the article is to analyse and evaluate the importance of the profession of dietetics in the Polish health care system. Reason for taking research is the global obesity epidemic and the dysfunctionality of the existing system regulation of the profession dietitian in Poland compared with other countries. The existing system of legal and organizational solutions are a major barrier to access by persons with diet-related diseases to necessary medical services or completely prevent you from using them. They cause a lot of other negative health, social and economic effect. Analysis were activities of individual entities that create market for dietary services taking into account the most important public health problems and directions of contemporary health policy. The summary contains the postulate of organizational and functional restructuring of the health care system, involving the inclusion of nutritionists to the system in a wider range. The postulate is part of a recommended modern model of comprehensive health care. Its goal is not only to extend the scope of health services, the reorganization and rationalization of human resources available to the sector, but also to improve the quality, effectiveness and efficiency of the system and increase satisfaction recipients and providers.

Fruit and vegetable consumption and proper nutrition in patients with cardiovascular diseases

Aim.Assessment of the fruit and vegetable consumption and nutrient intake among patients with CVD.

Materials and methods.Nutrient intake was assessed among 127 (32 women and 95 men; age: 62 ± 11 years) patients with CVD using 3-day dietary records method. Subjects with fruit and vegetables intake at least 400 g/d were classified as group I (fruit and vegetables intake according with recommendation), and others were classified as group II. Then, nutrient intake for both groups was compared with dietary recommendations.

Results.The higher percentage of patients, who fulfilled dietary guidelines was observed in group I in the case of the intake of minerals and vitamins and fiber.  

Conclusions.Present studies have shown incorrect dietary intake among most patients with CVD, but the higher percentage of patients, who fulfilled dietary recommendations for  minerals, vitamins and fiber was observed in group I.

Komu zależy na zdrowiu publicznym?

z prof. Andrzejem Wojtczakiem i dr. Maciejem Pirógiem rozmawia Elżbieta Cichocka