Public Health - Collected Works

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    Theoretical and conceptual issues around equity in healthcare: application to cervical cancer screening in South Australia
    ( 2006) Ward, Paul Russell ; Kenny, Bernadette ; Tucker, Graeme R ; Luke, Colin
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    How equitable are GP practice prescribing rates for statins?: an ecological study in four primary care trusts in North West England
    (BioMed Central - http://www.biomedcentral.com, 2007-03-27) Ward, Paul Russell ; Noyce, Peter R ; St Leger, Antony S
    Background There is a growing body of literature highlighting inequities in GP practice prescribing rates for a number of drug therapies. The small amount of research on statin prescribing has either focussed on variations rather than equity per se, been based on populations other than GP practices or has used cost-based prescribing rates. Aim To explore the equity of GP practice prescribing rates for statins, using the theoretical framework of equity of treatment (also known as horizontal equity or comparative need). Methods The study involved a cross-sectional secondary analysis in four primary care trusts (PCTs 1–4) in the North West of England, including 132 GP practices. Prescribing rates and health care needs indicators (HCNIs) were developed for all GP practices. Results Scatter-plots revealed large differences between individual GP practices, both within and between PCTs, in terms of the relationship between statin prescribing and healthcare need. In addition, there were large differences between GP practices in terms of the relationship between actual and expected prescribing rates for statins. Multiple regression analyses explained almost 30% of the variation in prescribing rates in the combined dataset, 25% in PCT1, 31% in PCT3, 51% in PC4 and 58% in PCT2. There were positive associations with variables relating to CHD hospital diagnoses and procedures and negative associations with variables relating to ethnicity, material deprivation, the proportion of patients aged over 75 years and single-handed GP practices. Conclusion Overall, this study found inequitable relationships between actual and expected prescribing rates, and possible inequities in statin prescribing rates on the basis of ethnicity, deprivation, single-handed practices and the proportion of patients aged over 75 years.
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    A rapid appraisal case study of South Australia's Social Inclusion Initiative
    (Government of South Australia Department of the Premier and Cabinet, 2007-06) Newman, Lareen Ann ; Biedrzycki, Katherine Rebecca ; Patterson, Jan ; Baum, Fran
    This Rapid Appraisal Case Study of South Australia’s Social Inclusion Initiative was undertaken to contribute to the work of the Social Exclusion Knowledge Network (SEKN) of the Commission on Social Determinants of Health (CSDH). The CSDH was established in 2005 by the World Health Organisation to investigate ways in which international, national, regional and local bodies could take action on the social determinants of health. The knowledge networks are one of the main mechanisms by which the CSDH is gathering evidence. This report provides a rapid assessment of the ways in which South Australia’s Social Inclusion Initiative has originated and operated. The report’s layout follows guidelines developed by the SEKN and draws on documentary and interview evidence. The project was conducted between March and June 2007 by researchers at Flinders University of South Australia, in conjunction with senior staff at South Australia’s Social Inclusion Unit, Department of the Premier and Cabinet. South Australia is a State within a federal system of government and has a population of 1.6 million. The population’s average health and well-being are high by world standards but the State continues to record significant levels of inequality for certain groups and areas, and particularly for its Aboriginal population.
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    Do your patients trust you? A sociological understanding of the implications of patient mistrust in healthcare professionals
    (Australasian Medical Journal, 2008) Meyer, Samantha B ; Ward, Paul Russell
    The trust that patients invest in healthcare professionals and their advice has been shown to facilitate positive clinical outcomes, although there is evidence that patient trust in expertise, including healthcare professionals, has been declining over the years. Questions about whether or not to trust healthcare professionals have been raised recently in international media by Australian pop icon Kylie Minogue, who spoke of her alleged initial misdiagnosis with breast cancer and went on to tell women that they should ‘follow their intuition’ rather than placing unquestioning trust in doctors or medical advice. Given the power of the media in shaping public opinion, there is a potential for such stories to further impact on the already potentially friable doctor-patient relationships, with questions of trust taking centre-stage. Therefore, an understanding of the nature of trust, in addition to the reasons for the decline in patient trust, is exceedingly important for health professionals. This paper presents an overview of social theories of trust that provide a lens through which we can analyse the development of mistrust in healthcare, and identifies ways in which healthcare professionals may aim to facilitate and sustain patient trust.
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    Defining and conceptualising the 'social' in social epidemiology
    ( 2008) Ward, Paul Russell ; Gill, Tiffany ; Tsourtos, George
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    Smoking and stress
    (Australasian Medical Journal, 2008) Tsourtos, George ; Ward, Paul Russell ; Muller, Robert
    Primary care-based smoking cessation interventions are often less effective among low-SES groups. Higher stress levels may explain the lower quit rate and higher prevalence of smoking in low-SES groups, and why the relative smoking prevalence rate is not declining at an equitable rate (same prevalence rate as higher SES groups). To understand these issues, this paper sought answers to two questions: is stress perceived by ex-smokers and current smokers as a barrier to quitting; and does stress act as a barrier to quitting in relation to other barriers in disadvantaged areas?
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    Learning to prescribe - pharmacists' experiences of supplementary prescribing training in England
    ( 2008) Bissell, Paul ; Guillaume, Louise ; Hutchinson, Allen ; Murphy, Elizabeth ; Ratcliffe, Julie ; Ward, Paul Russell ; Cooper, Richard ; Lymn, Joanne ; Anderson, Claire ; Avery, Tony
    Background The introduction of non-medical prescribing for professions such as pharmacy and nursing in recent years offers additional responsibilities and opportunities but attendant training issues. In the UK and in contrast to some international models, becoming a non-medical prescriber involves the completion of an accredited training course offered by many higher education institutions, where the skills and knowledge necessary for prescribing are learnt. Aims: to explore pharmacists' perceptions and experiences of learning to prescribe on supplementary prescribing (SP) courses, particularly in relation to inter-professional learning, course content and subsequent use of prescribing in practice. Methods A postal questionnaire survey was sent to all 808 SP registered pharmacists in England in April 2007, exploring demographic, training, prescribing, safety culture and general perceptions of SP. Results After one follow-up, 411 (51%) of pharmacists responded. 82% agreed SP training was useful, 58% agreed courses provided appropriate knowledge and 62% agreed that the necessary prescribing skills were gained. Clinical examination, consultation skills training and practical experience with doctors were valued highly; pharmacology training and some aspects of course delivery were criticised. Mixed views on inter-professional learning were reported – insights into other professions being valued but knowledge and skills differences considered problematic. 67% believed SP and recent independent prescribing (IP) should be taught together, with more diagnostic training wanted; few pharmacists trained in IP, but many were training or intending to train. There was no association between pharmacists' attitudes towards prescribing training and when they undertook training between 2004 and 2007 but earlier cohorts were more likely to be using supplementary prescribing in practice. Conclusion Pharmacists appeared to value their SP training and suggested improvements that could inform future courses. The benefits of inter-professional learning, however, may conflict with providing profession-specific training. SP training may be perceived to be an instrumental 'stepping stone' in pharmacists' professional project of gaining full IP status.
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    Population health role of the Divisions of General Practice Network
    (Government of South Australia Department of Health, 2009) Kalucy, Elizabeth Carment ; Hordacre, Ann-Louise ; Howard, Sara Louise ; Moretti, Cecilia Marguerite
    Divisions of General Practice provide services and support to general practices to achieve health outcomes for the community within defined catchment areas. Divisions can achieve systemic improvements in local primary care that cannot be achieved by individual general practitioners working alone. Today the Divisions Network, which is funded largely by the Australian Government, consists of 111 Divisions of General Practice (divisions), six state-based organisations (SBOs), two hybrid SBO-divisions (in the Northern Territory and the Australian Capital Territory) and the Australian General Practice Network. With its national coverage, the network has a workforce of more than 3000 staff members with clinical, health science, public health and management skills, adding substantial infrastructure to primary care.
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    'Health is the number one thing we go for': healthism, citizenship and food choice
    (The Australian Sociological Association, 2009) Henderson, Julie Anne ; Henderson, Julie Anne ; Ward, Paul Russell ; Coveney, John David ; Taylor, Anne
    This paper explores the centrality of pursuit of health to discourse around food purchasing and eating behaviours. Forty-seven participants from metropolitan and rural South Australia were interviewed about how they decided what to purchase and to eat. The majority (n=39) cite the desire to eat healthily as a consideration in food purchasing. Participants reflect upon a personal and moral responsibility to eat well and to feed their family healthily, a duty that is supported by models of governance which favour personal responsibility for health. While all participants reflect upon this responsibility, it is rejected by a group of males on limited incomes who choose food on the basis of cost, taste, convenience and lack of trust in the health care system. The existence of a moral discourse around food is viewed as an example of healthism in which health is central to all aspects of life and self discipline a means to achieving health.
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    Professional education and the role of general practitioners in public health and population health
    (Government of South Australia Department of Health, 2009) Kidd, Michael Richard
    During their subsequent careers many GPs gain additional skills in areas such as epidemiology, health program management, evaluation, biostatistics and health economics.12 There are many Australian GPs who have gained qualifications such as a Master of Public Health, and there are many GP members among the Fellows of the Australasian Faculty of Public Health Medicine of the Royal Australasian College of Physicians, all contributing to the public health and population health focus of Australian general practice.
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    GP planning in a pandemic
    (Government of South Australia Department of Health, 2009) Litt, John Charles ; Pearce, Rod
    There are a number of good reasons why GPs will need to be prepared for pandemic influenza (PI). These include: workload/business continuity, medico-legal, ethical and personal reasons.
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    How population health data can help primary care services to improve population health: a rural case study
    (Government of South Australia Department of Health, 2009) McNamara, Kevin Peter ; Dunbar, James Anthony ; Reddy, Prasuna ; Philpot, Benjamin Joel ; Vaughan, Clare Maree ; Morgan, Mark Andrew ; Janus, Edward Denis
    Population health can be defined as ‘the health outcomes of a group of individuals, including the distribution of such outcomes within the group’. This field of activity incorporates population-level examinations of health outcomes, determinants of health, and policies and interventions linking the two. A unique outcome from population health data is the identification of ‘sick populations’, where a high average level of disease risk in a population is directly related to the proportion of people at very high risk. In addition, population health data provides a greater understanding of the inter-relationship between multiple determinants of health in affecting health outcomes. Despite such benefits, population health approaches to health care have been criticised for being almost exclusively quantitative and epidemiological in focus, and consequently lacking the context or aptitude to translate population-level information to changes in clinical practice and health service delivery. Using a rural Australian case study, this paper illustrates how population health data can in fact stimulate important changes to general practice and primary health care.
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    Attitudes towards and beliefs about colorectal cancer and screening using the faecal occult blood test within the Italian-Australian community
    (Asian Pacific Organization for Cancer Prevention, 2009) Severino, Giovanina ; Wilson, Carlene J ; Turnbull, Deborah ; Duncan, Amy ; Gregory, Tess Anne
    Studies with minority ethnic communities worldwide reveal important differences in the content of beliefs about cancer and attitudes towards screening. Current initiatives in colorectal cancer (CRC) screening highlight the importance of identifying any illness-specific beliefs that might influence participation rates within the targeted age-range. We conducted semi-structured interviews with 20 Italian-Australians aged between 50 and 78 years, living in Adelaide, South Australia. Qualitative data from the interviews were analysed using framework analysis. Participants articulated specific beliefs about the nature of cancer, risk factors, prevention possibilities, and variety of potential barriers and benefits to faecal occult blood testing (FOBT). Although participants’ beliefs overlapped with conventional medical models of cancer, the results also demonstrated the presence of specific cultural perceptions that might influence FOBT participation. Our results suggest that models used to inform communication about cancer need to be sensitive to culture specific concerns. Within the context of the older Italian-Australian community, there is a suggestion that self and response efficacy may be serious barriers to screening behavior and that bi-lingual, verbal delivery of information may be the most effective mode of communication to increase screening participation.
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    The alcohol industry, neo-liberalism and the political economy of health
    (Australasian Medical Journal, 2009) Ward, Paul Russell
    Writing in the Australasian Medical Journal Bond, Daube, & Chikritzhs present a fascinating analysis of previously confidential, internal industry documents. The documents became available due to the 1998 Master Settlement Agreement, which was originally initiated to allow public access to internal tobacco industry documents, but since some alcohol companies are controlled by tobacco companies (in this case, Phillip Morris), the internal documents of the alcohol companies (in this case, Miller Brewing Company) became available. It is also interesting to note that Kraft foods is also controlled by Phillip Morris, which means that researchers interested in food policy, marketing and regulation can now access potentially useful documentation on the underlying intentions of a particular food company. The paper presented an analysis of a vast array of alcohol industry documents, and the authors discuss a number of key areas with which the alcohol industry stated their concerns. Within this Editorial, I wish to highlight the implications of many of these concerns within two areas of social and political thought: the political economy of health, and the impact of neo-liberalism.
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    Demographic associations with stage of readiness to screen for colorectal cancer
    (Australian Health Promotion Association, 2009) Duncan, Amy ; Wilson, Carlene J ; Cole, Stephen Russell ; Mikocka-Walus, Antonina ; Turnbull, Deborah ; Young, Graeme Paul
    Objective: To describe the distribution of a population in southern urban Adelaide in terms of readiness to screen for colorectal cancer (CRC) by Faecal Occult Blood Test (FOBT) or colonoscopy according to the stages in the Transtheoretical Model (TTM) of behaviour change and to compare the stages according to demographic variables. Methods: A random sample of 664 South Australians aged 50 to 74 were surveyed in June 2006. Chi-squared analyses were performed to determine if statistically significant differences on demographic variables existed between participants at different stages of readiness to screen.
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    A case for reorienting health systems and investing in primary health care in Australia
    (Australasian Medical Journal, 2009) Ward, Paul Russell
    In recent times, many developing countries have been going through a process of re-orienting health policy and services towards early detection and prevention, rather than solely on the treatment and on-going management, of illness and disease. For example, in the UK, the fundamental philosophy underpinning the approach to funding primary healthcare is analogous to the adage ‘prevention is better than cure’, with the NHS Improvement Plan stating that “If England is to secure world-class standards of health, the enormous human, financial and physical resources available to the NHS need to be focussed on the prevention of disease and not just its treatment”. Within Australia, there are similar shifts in thinking and policy, with the development of the National Preventative Health Taskforce, which has been tasked with developing a National Preventative Health Strategy.
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    Trust, social quality and wellbeing: a sociological exegesis
    (Institute for Social Development and Policy Research, Korea, 2009) Ward, Paul Russell ; Meyer, Samantha B
    This paper provides an argument regarding the centrality of ‘trust’ for the development and maintenance of ‘social quality,’ and ultimately for the health and wellbeing of individuals, communities and societies. Within the Social Quality theory, trust is located within one of the four conditional domains: social cohesion. This paper provides a background to Social Quality theory within a political and theoretical context in order to demonstrate that trust underpins a number of the social systems that play a role in the development and maintenance of social quality; therefore, we argue that trust underpins ‘social quality’ and hence the Social Quality theory. We suggest ways in which current social theories of trust may be situated within the Social Quality theory, in terms of the normative and conditional factors. Evidence is provided to support the argument that trust plays a more significant role in social quality than the current model suggests.
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    Social Quality theory in perspective
    (Institute for Social Development and Policy Research, Korea, 2009) Lin, Ka ; Ward, Paul Russell ; van der Maesen, Laurent J G
    For its theoretical development, the social quality (SQ) theory was given birth in 1997, with its original aim directed at addressing the social dimension of state-policy making in Europe, against the neo-liberal Washington consensus, and the handmaiden position of all other public policies. However, after a decade of development, this theory has been developed from various dimensions, as evidenced where SQ theories are applied to particular topics. Accordingly, the merits of this theory can be understood as a normative guideline for policy-making and practice, as a scheme of reference for understanding relevant conditional structures as the basis for this guideline, and as a socio-political goal to enable people to act in a democratic way.