Health Promotion International - Advance Access

Disseminating best-evidence health-care to Indigenous health-care settings and programs in Australia: identifying the gaps

Clifford, A., Jackson Pulver, L., Richmond, R., Shakeshaft, A., Ivers, R. — Tue, 03 Nov 2009 07:22:56 PST

Indigenous Australians experience a disproportionately greater burden of harm from smoking, poor nutrition, alcohol misuse and physical inactivity (SNAP risk factors) than the general Australian population. A critical step in further improving efforts to reduce this harm is to review existing efforts aimed at increasing the uptake of evidence-based interventions in Indigenous-specific health-care settings and programs. This study systematically identifies and reviews published Indigenous-specific dissemination studies targeting SNAP interventions. An electronic search of eight databases and a manual search of reference lists of previous literature reviews were undertaken. Eleven dissemination studies were identified for review: six for nutrition and physical activity as a component of diabetes care, three for alcohol and two for smoking. The majority of studies employed continuing medical education (n = 9 studies), suggesting that improving health-care providers’ knowledge and skills is a focus of current efforts to disseminate best-evidence SNAP interventions in Indigenous health-care settings. Only two studies evaluated reminder systems, despite their widespread use in Indigenous-specific health-care services, and only one study employed academic detailing, despite its cost-effectiveness at modifying health-care provider behavior. There is a clear need for more Indigenous-specific dissemination research targeting the uptake of secondary prevention and to establish reliable and valid measures of Indigenous-specific health-care delivery, in order to determine which dissemination strategies are most likely to be effective in Indigenous health-care settings and programs.

Bullying among middle-school students in low and middle income countries

Fleming, L. C., Jacobsen, K. H. — Mon, 02 Nov 2009 06:43:59 PST

This analysis of data from the Global School-based Student Health Survey examined the prevalence of bully victimization in middle-school students in 19 low- and middle-income countries and also explored the relationship between bullying, mental health and health behaviors. In most countries, boys were more likely than girls to report being bullied and the prevalence of bullying was lower with increasing age. Students who reported being bullied in the past month were more likely than non-bullied students to report feelings of sadness and hopelessness, loneliness, insomnia and suicidal ideation. Bullied students also reported higher rates of tobacco use, alcohol use, drug use and sexual intercourse.

Local school policies increase physical activity in Norwegian secondary schools

Haug, E., Torsheim, T., Samdal, O. — Mon, 02 Nov 2009 06:43:58 PST

The implementation of school policies to support the adoption of physical activity is one of the main strategies recommended to increase physical activity levels among this age group. However, documentation of the effect of such policies is so far limited. The purpose of this study was to explore policy-related practices to support physical activity in Norwegian secondary schools and their association with recess physical activity. Emphasis was given to examine the association between policies and physical activity, over and beyond, individual level interests and environmental factors and to examine cross-level interaction effects. This cross-sectional study was based on a nationally representative sample of Norwegian secondary schools and grade 8 students who participated in the Health Behaviour in School-aged Children (HBSC) 2005/06 study. The final sample comprised 68 schools and 1347 students. Data were collected through questionnaires. The results showed that schools with a written policy for physical activity and schools offering organized non-curricular physical activity several times a week had a higher proportion of students reporting daily participation in recess physical activity. Multilevel logistic regression analysis demonstrated a cross-level main effect of the policy index after controlling for sex, socio-economic status, individual-level interests and the physical environment. A significant contribution of adding the policy index to the prediction of recess physical activity above that provided by the individual-level interests and the physical environment was demonstrated. The results are encouraging and give scientific support to policy documents recommending the implementation of school policies to increase physical activity.

Alcohol use and related harms in school students in the USA and Australia

Mon, 02 Nov 2009 06:43:57 PST

Recognizing there have been few methodologically rigorous cross-national studies of youth alcohol and drug behaviour, state student samples were compared in Australia and the USA. Sampling methods were matched to recruit two independent, state-representative, cross-sectional samples of students in Grades 5, 7 and 9 in Washington State, USA, (n = 2866) and Victoria, Australia (n = 2864) in 2002. Of Washington students in Grade 5 (age 11), 10.3% (95% CI 7.2–14.7) of boys and 5.2% (95% CI 3.4–7.9) of girls reported alcohol use in the past year. Prevalence rates were markedly higher in Victoria (34.2%, 95% CI 28.8–40.1 boys; 21.0%, 95% CI 17.1–25.5 girls). Relative to Washington, the students in Victoria demonstrated a two to three times increased likelihood of reporting substance use (either alcohol, tobacco or illicit drug use), and by Grade 9, experiences of loss-of-control of alcohol use, binge drinking (frequent episodes of five or more alcoholic drinks), and injuries related to alcohol were two to four times higher. The high rates of early age alcohol use in Victoria were associated with frequent, heavy and harmful alcohol use and higher overall exposure to alcohol or other drug use. These findings reveal considerable variation in international rates of both adolescent alcohol misuse and co-occurring drug use and suggest the need for cross-national research to identify policies and practices that contribute to the lower rate of adolescent alcohol and drug use observed in the USA in this study.

Evaluation findings on community participation in the California Healthy Cities and Communities program

Kegler, M. C., Painter, J. E., Twiss, J. M., Aronson, R., Norton, B. L. — Mon, 02 Nov 2009 06:43:56 PST

As part of an evaluation of the California Healthy Cities and Communities (CHCC) program, we evaluated resident involvement, broad representation and civic engagement beyond the local CHCC initiative. The evaluation design was a case study of 20 participating communities with cross-case analysis. Data collection methods included: coalition member surveys at two points in time, semi-structured interviews with key informants, focus groups with coalition members and document review. Participating communities were diverse in terms of population density, geography and socio-demographic characteristics. Over a 3-year period, grantees developed a broad-based coalition of residents and community sectors, produced a shared vision, conducted an asset-based community assessment, identified a priority community improvement focus, developed an action plan, implemented the plan and evaluated their efforts. Local residents were engaged through coalition membership, assessment activities and implementation activities. Ten of the 20 coalitions had memberships comprised of mainly local residents in the planning phase, with 5 maintaining a high level of resident involvement in governance during the implementation phase. Ninety percent of the coalitions had six or more community sectors represented (e.g. education, faith). The majority of coalitions described at least one example of increased input into local government decision-making and at least one instance in which a resident became more actively involved in the life of their community. Findings suggest that the Healthy Cities and Communities model can be successful in facilitating community participation.

Cyclists' attitudes toward policies encouraging bicycle travel: findings from the Taupo Bicycle Study in New Zealand

Fri, 30 Oct 2009 06:58:30 PDT

Utility cycling provides substantial health, environmental and economic benefits. Despite a favourable trend in leisure-time cycling, cycling is infrequently used for everyday travel needs in New Zealand. This study investigated cyclists' attitudes toward environmental and policy measures that would encourage them to cycle more, particularly for a trip to work. A cross-sectional analysis was undertaken using baseline data obtained from the Taupo Bicycle Study, a web-based longitudinal study. The study population comprised 2469 cyclists, aged 16 years or over, who had enrolled in the 2006 Wattyl Lake Taupo Cycle Challenge. The majority (88%) reported the provision of bicycle lanes as an important factor that would encourage them to cycle more often, followed by bicycle paths (76%), better bicycle security (64%), reduced motor vehicle speed (55%) and bike friendly public transport (38%). Of those who reported travelling to work at least once a week (N = 2223), varying proportions reported shower facilities at work (61%), fewer difficult intersections (43%), rising fuel costs (41%), fewer car parks (27%), bike designed to commute (26%) and rising cost of car parking (25%) as important factors that would encourage them to cycle to work more often. There were important differences in these perceived influences defined by the participants' socio-demographic characteristics and current cycling habits.

Testing the hierarchy of effects model: ParticipACTION's serial mass communication campaigns on physical activity in Canada

Craig, C. L., Bauman, A., Reger-Nash, B. — Thu, 29 Oct 2009 06:14:22 PDT

The hierarchy of effects (HOE) model is often used in planning mass-reach communication campaigns to promote health, but has rarely been empirically tested. This paper examines Canada's 30 year ParticipACTION campaign to promote physical activity (PA). A cohort from the nationally representative 1981 Canada Fitness Survey was followed up in 1988 and 2002–2004. Modelling of these data tested whether the mechanisms of campaign effects followed the theoretical framework proposed in the HOE. Campaign awareness was measured in 1981. Outcome expectancy, attitudes, decision balance and future intention were asked in 1988. PA was assessed at all time points. Logistic regression was used to sequentially test mediating and moderating variables adjusting for age, sex and education. No selection bias was observed; however, relatively fewer respondents than non-respondents smoked or were underweight at baseline. Among those inactive at baseline, campaign awareness predicted outcome expectancy which in turn predicted positive attitude to PA. Positive attitudes predicted high decision balance, which predicted future intention. Future intention mediated the relationship between decision balance and sufficient activity. Among those sufficiently active at baseline, awareness was unrelated to outcome expectancy and inversely related to positive attitude. These results lend support to the HOE model, in that the effects of ParticipACTION's serial mass media campaigns were consistent with the sequential rollout of its messages, which in turn was associated with achieving an active lifestyle among those initially insufficiently active. This provides support to an often-used theoretical framework for designing health promotion media campaigns.

Socio-demographic predictors of health behaviors in Mexican college students

Ulla Diez, S. M., Perez-Fortis, A. — Thu, 29 Oct 2009 06:14:21 PDT

Our objectives in this cross-sectional descriptive study were to analyze to what extent freshmen exhibit healthy behaviors, which socio-demographic variables predict healthy or unhealthy lifestyle, and what is the strength of the relationship. Three hundred seven Mexican University students were assessed. t-Test and adjusted multiple regression analysis were computed. Life style was measured by use of the HPLP-II questionnaire and socio-demographics data. The results showed that most students presented a non-healthy lifestyle profile. Overall, the health behavior score was predicted by sex, mother's education and socio-economic level (R² = 0.104; p = 0.00001). When controlling for the other variables, nutrition was partially predicted by mother's education (R² = 0.048; p = 0.001); physical activity and stress management were modulated by sex, marital status and mother's education (R² = 0.111, p < 0.0001; R² = 0.096; p = 0.0001, respectively); interpersonal relations were predicted by mother's education and socio-economic level (R² = 0.104; p < 0.0001). These influences should be taken into account in designing interventions for specific socio-demographic profiles that might be at higher risk for certain behaviors.

Comparative responses to radio and television anti-smoking advertisements to encourage smoking cessation

Durkin, S., Wakefield, M. — Sat, 24 Oct 2009 07:20:58 PDT

While mass media campaigns have been shown to contribute to reductions in smoking prevalence, little research has been undertaken on the effectiveness of radio advertising as a communication medium. This is despite radio being less expensive and having greater reach than television in some low and middle income countries. We aimed to explore the potential of radio as an adjunct or alternative to televised campaigns by comparing reactions to a radio anti-smoking ad with three televised anti-smoking ads, all of which communicated the serious health consequences of smoking in an emotionally evocative way. In pre-exposure interviews, 18–59-year-old daily smokers (n = 306) were asked to listen to a particular radio time slot/watch a particular television program that they usually listened to/watched, in which the ad was broadcast. Post-exposure interviews were conducted within 3 days of exposure and measured recall, recognition, emotional and cognitive responses, and intentions to quit smoking. Findings indicate that the radio ad showed similar or slightly higher levels than a concurrently aired television ad on understanding (radio: 96%; television: 95%), believability (radio: 89%; television: 90%), concern about smoking (both 77%) and motivation to quit (radio: 51%; television: 45%), and significantly higher levels of unprompted recall (radio: 20%; television: 6%). It also compared well against two subsequent anti-smoking television ads. Emotionally evocative radio advertising may be an effective adjunct or alternative to television advertising in jurisdictions where there are substantial limits on funds available for airing these campaigns, or where the reach of radio outstrips television.

A call for an International Collaboration on Participatory Research for Health

Wright, M. T., Roche, B., von Unger, H., Block, M., Gardner, B. — Fri, 23 Oct 2009 06:06:24 PDT

Participatory health research (PHR) has emerged as an important approach for addressing local health issues, including building capacity for health promotion. Increasingly, PHR is drawing the attention of communities, funders, decision-makers and researchers worldwide. It is time to consolidate what we know about PHR in order to secure its place as a source of knowledge and action for public health. This can be achieved through an International Collaboration on Participatory Research for Health to addresses the following issues:

Set a framework in which information can be exchanged, decisions can be reached and information can be disseminated on central issues in PHR.

Provide an international forum to discuss standards and quality.

Produce guidelines for researchers, practitioners and community members.

Synthesize the findings of PHR internationally.

Formulate recommendations regarding generalizable findings.

Similar to the Cochrane Collaboration on clinical trials research, the PHR Collaboration will be dependent on a host of experts from various countries to bring together what we know about PHR and to make that knowledge accessible to an international audience. Unlike the Cochrane Collaboration, the PHR Collaboration will include both quantitative and qualitative research approaches. The goal of the PHR Collaboration will not be able to achieve a standardization of research protocols, but rather to find meaningful ways to judge the quality of PHR and to report on its findings while respecting the variety of locally based approaches to research design, data collection and interpretation.

Cardiovascular disease risk factors and women prisoners in the UK: the impact of imprisonment

Plugge, E. H., Foster, C. E., Yudkin, P. L., Douglas, N. — Fri, 23 Oct 2009 06:06:23 PDT

Cardiovascular disease (CVD) is a leading cause of death throughout the world. In high income countries, the greatest burden of disease is seen in those from lower socio-economic groups. It is therefore likely that CVD is an important issue for prisoners in the UK, the majority of whom were either unemployed or in non-skilled employment prior to imprisonment. However, there is little research examining this issue. The aim of this study was to examine the prevalence of five modifiable cardiovascular risk factors (smoking, physical activity, diet, body mass index and hypertension) in women prisoners on entry to prison and then 1 month after imprisonment. This was a prospective longitudinal study involving 505 women prisoners in England. Participants completed a questionnaire containing questions about health-related behaviours within 72 h of entering prison. The researchers measured their blood pressure, height and weight. They followed up all participants who were still imprisoned 1 month later and invited them to participate again. The results showed that women prisoners were at high risk of CVD in the future; 85% smoked cigarettes, 87% were insufficiently active to benefit their health, 86% did not eat at least five portions of fruit and vegetables each day and 30% were overweight or obese. After 1 month, there were few improvements in risk factors. This may in part reflect the fact that, unlike prisons in other high income countries, there are currently no systematic approaches which address these health issues within UK women's prisons.

Ways of healthy aging: a case study of elderly people in a Northern Thai village

Thu, 22 Oct 2009 00:29:36 PDT

This ethnographic study was conducted to explore ways of healthy aging and the influence of culture on health-related behaviors in a rural community in Northern Thailand. In-depth interviews, focus group discussions, participant observations and field notes were used to understand the lives of seven healthy Thai older adults aged 75 years and over. Data were collected from March 2007 to February 2008, with ongoing ethnographic analysis involving coding, identifying patterns, generalizing and making reflective notes to elucidate the cultural patterns of behavior. All informants perceived health as interrelated with their life styles, which was, in turn, closely related to their cultural roots, suggesting that culture influences the health of all members of smaller, closely knit communities, including the elderly, by integrating physical, social and spiritual health for older adults and their families.

Building capacity in local government for integrated planning to increase physical activity: evaluation of the VicHealth MetroACTIVE program

Thomas, M. M., Hodge, W., Smith, B. J. — Tue, 13 Oct 2009 23:14:45 PDT

Integrated planning is a holistic approach to addressing the needs of local communities built on partnerships between those responsible for development, environmental quality and service provision. This study investigated the extent and key influences on the use of integrated planning to promote physical activity among six metropolitan councils in Melbourne Australia, which took part in the MetroACTIVE Project funded by the Victorian Health Promotion Foundation from 2005 to 2007. The evaluation entailed interviews conducted at the mid-term (N = 67) and completion (N = 50) of the project, and the review of relevant documents. Respondents included elected councillors, chief executive officers, officers from different council divisions and the project staff employed in each council. Three councils showed evidence of integrated planning for physical activity, whereas the remainder focused on the delivery of community participation programs. Leadership from senior management and an organizational culture that supported collaboration across council departments were prerequisites for integrated planning. Employment of a dedicated project officer with skills for engaging management and building partnerships within the organization was important. Barriers to integrated planning were a complex organization structure, high demands on the council due to a growing residential population and a poor climate among staff. Overall, integrated planning was found to be a viable approach for developing a coordinated approach to this issue involving the range of council services and functions. Ongoing strategies are needed to facilitate senior management commitment and organizational capacity for integrated planning, with leadership provided by departments responsible for infrastructure or corporate planning.

An exploration of the theoretical concepts policy windows and policy entrepreneurs at the Swedish public health arena

Guldbrandsson, K., Fossum, B. — Fri, 09 Oct 2009 00:32:39 PDT

In John Kingdon's Policy Streams Approach policy formation is described as the result of the flow of three ‘streams’, the problem stream, the policy stream and the politics stream. When these streams couple, a policy window opens which facilitate policy change. Actors who promote specific solutions are labelled policy entrepreneurs. The aim of this study was to test the applicability of the Policy Streams Approach by verifying whether the theoretical concepts ‘policy windows’ and ‘policy entrepreneurs’ could be discernable in nine specified cases. Content analyses of interviews and documents related to child health promoting measures in three Swedish municipalities were performed and nine case studies were written. The policy processes preceding the municipal measures and described in the case studies were scrutinized in order to find statements related to the concepts policy windows and policy entrepreneurs. All conditions required to open a policy window were reported to be present in eight of the nine case studies, as was the most important resource of a policy entrepreneur, sheer persistence. This study shows that empirical examples of policy windows and policy entrepreneurs could be identified in child health promoting measures in Swedish municipalities. If policy makers could learn to predict the opening of policy windows, the planning of public health measures might be more straightforward. This also applies to policy makers’ ability to detect actors possessing policy entrepreneur resources.

Implementing a standardized community-based cardiovascular risk assessment program in 20 Ontario communities

Fri, 09 Oct 2009 00:32:32 PDT

The aim of the study is to describe the implementation of the Cardiovascular Health Awareness Program (CHAP) in 20 mid-sized communities across Ontario, Canada, and identify key factors in the successful multi-site delivery of a collaborative cardiovascular risk assessment and management program. Lead organizations were identified and contracted following a request for proposals. An Implementation Guide detailed steps in community mobilization and delivery of volunteer-led pharmacy-based cardiovascular risk assessment sessions. Process data were collected through final reports; a debriefing meeting; and interviews with program staff. All 20 communities successfully implemented CHAP. Overall, 99% (338/341) of family physicians agreed to receive assessment results and 89% (129/145) of pharmacies held sessions. Five hundred and seventy-seven volunteers conducted 27 358 risk assessments for 15 889 unique participants. Essential program components were consistently included, however, variations in materials, processes and support occurred. Factors in program success included: local expertise, centralized support, identification and engagement of local physician and pharmacist opinion leaders and a balance of standardization and flexibility. Monitoring delivery of a multi-community cardiovascular risk assessment program yielded key factors in program success to inform development of a sustainable and transferable model.

Impact of front-of-pack 'traffic-light' nutrition labelling on consumer food purchases in the UK

Sacks, G., Rayner, M., Swinburn, B. — Thu, 08 Oct 2009 06:58:24 PDT

Front-of-pack ‘traffic-light’ nutrition labelling has been widely proposed as a tool to improve public health nutrition. This study examined changes to consumer food purchases after the introduction of traffic-light labels with the aim of assessing the impact of the labels on the ‘healthiness’ of foods purchased. The study examined sales data from a major UK retailer in 2007. We analysed products in two categories (‘ready meals’ and sandwiches), investigating the percentage change in sales 4 weeks before and after traffic-light labels were introduced, and taking into account seasonality, product promotions and product life-cycle. We investigated whether changes in sales were related to the healthiness of products. All products that were not new and not on promotion immediately before or after the introduction of traffic-light labels were selected for the analysis (n = 6 for ready meals and n = 12 for sandwiches). For the selected ready-meals, sales increased (by 2.4% of category sales) in the 4 weeks after the introduction of traffic-light labels, whereas sales of the selected sandwiches did not change significantly. Critically, there was no association between changes in product sales and the healthiness of the products. This short-term study based on a small number of ready meals and sandwiches found that the introduction of a system of four traffic-light labels had no discernable effect on the relative healthiness of consumer purchases. Further research on the influence of nutrition signposting will be needed before this labelling format can be considered a promising public health intervention.

Barriers to regular exercise among adults at high risk or diagnosed with type 2 diabetes: a systematic review

Korkiakangas, E. E., Alahuhta, M. A., Laitinen, J. H. — Wed, 30 Sep 2009 00:49:54 PDT

The aim of this systematic review was to identify the reported barriers to regular exercise among adults either at high risk or already diagnosed with type 2 diabetes (T2D), because of the importance of exercise in the prevention of T2D. We searched the MEDLINE, Cinahl and PsycINFO databases. All potentially relevant articles were reviewed by two researchers, and 67 titles were found, of which 13 papers met inclusion criteria. Internal and external barriers to exercise were identified among adults either at high risk of T2D or already diagnosed. Internal barriers were factors which were influenced by the individual's own decision-making, and external barriers included factors which were outside of the individual's own control. It is important for counselling to identify the internal and external barriers to regular exercise. In this way, the content of counselling can be developed, and solutions to the barriers can be discussed and identified. Further research on the barriers to regular exercise is needed.

Creating community action plans for obesity prevention using the ANGELO (Analysis Grid for Elements Linked to Obesity) Framework

Wed, 16 Sep 2009 01:31:47 PDT

Community-based interventions are an important component of obesity prevention efforts. The literature provides little guidance on priority-setting for obesity prevention in communities, especially for socially and culturally diverse populations. This paper reports on the process of developing prioritized, community-participatory action plans for obesity prevention projects in children and adolescents using the ANGELO (Analysis Grid for Elements Linked to Obesity) Framework. We combined stakeholder engagement processes, the ANGELO Framework (scans for environmental barriers, targeted behaviours, gaps in skills and knowledge) and workshops with key stakeholders to create action plans for six diverse obesity prevention projects in Australia (n = 3), New Zealand, Fiji and Tonga from 2002 to 2005. Some sites included sociocultural contextual analyses in the environmental scans. Target groups were under-5-year-olds (Australia), 4–12-year-olds (Australia) and 13–18-year-olds (all four countries). Over 120 potential behavioural, knowledge, skill and environmental elements were identified for prioritization leading into each 2-day workshop. Many elements were common across the diverse cultural communities; however, several unique sociocultural elements emerged in some cultural groups which informed their action plans. Youth were actively engaged in adolescent projects, allowing their needs to be incorporated into the action plans initiating the process of ownership. A common structure for the action plan promoted efficiencies in the process while allowing for community creativity and innovation. The ANGELO is a flexible and efficient way of achieving an agreed plan for obesity prevention with diverse communities. It is responsive to community needs, combines local and international knowledge and creates stakeholder ownership of the action plan.

Social capital does matter for adolescent health: evidence from the English HBSC study

Morgan, A., Haglund, B. J. A. — Thu, 27 Aug 2009 23:12:50 PDT

Social capital has grown out of the recognition that health-related behaviours are shaped and constrained by a range of social and community contexts and that the ways in which an individual relates to social networks and communities has important effects on their health and well-being. Given the strong and complex inequalities that exist in adolescent health at both the national and international levels, social capital, acting a protective factor (or asset), may help reduce poor outcomes. The aim of this study was to measure and assess the relative importance of a range of social indicators representing the different domains of social capital on the health, wellbeing and health-related behaviours of young people. The study population was a random sample of 6425 school children aged 11–15 years old in 80 schools in England. Data were collected by a standardized questionnaire under supervised conditions in the classroom developed as part of the WHO Health Behaviour in School Aged Children (HBSC) study. This study has shown that social capital matters for young people's health, statistically significant relationships were found between the range of social capital indicators and the health and health-related outcomes selected for study. For example, young people with a low sense of family belonging and low involvement in the neighbourhood were almost twice as likely to report poor health (OR = 1.87 and 1.96, respectively). Low involvement in the neighbourhood was also highly associated with low consumption of fruit (OR = 2.48) and vegetables (OR = 2.62). Overall, however the strength of associations found varied across health behaviours and indicators of social capital and this requires further examination.

Health impact assessment of quality wine production in Hungary

Adam, B., Molnar, A., Bardos, H., Adany, R. — Thu, 30 Jul 2009 00:59:31 PDT

Alcohol-related health outcomes show strikingly high incidence in Hungary. The effects of alcohol consumption are influenced not only by the quantity, but also the quality of drinks; therefore, wine production can have an important effect on public health outcomes. Nevertheless, the Hungarian wine sector faces several vital problems and challenges influenced by the country's accession to the European Union and by the need for restructuring. A comprehensive health impact assessment (HIA) based on the evaluation of the Hungarian legislation related to the wine sector has been carried out, aiming to assess the impact of the production of quality wine versus that of table wine, using a range of public health and epidemiological research methods and data as well as HIA guidelines. The study finds that the toxic effects of alcohol can be reduced with an increased supply of quality wine and with decreased overall consumption due to higher cost, although this might drive some people to seek illegal sources. Quality wine production allows for improved use of land, creates employment opportunities and increases the incomes of producers and local communities; however, capital-scarce producers unable to manage restructuring may lose their source of subsistence. The supply of quality wine can promote social relations, contribute to a healthy lifestyle and reduce criminality related to alcohol's influence and adulteration. In general, the production and supply of quality wine can have an overall positive impact on health. Nevertheless, because of the several possible negative effects expected without purposeful restructuring, recommendations for the maximization of favourable outcomes and suggestions for monitoring the success of the analysis have been provided.

Social vaccines to resist and change unhealthy social and economic structures: a useful metaphor for health promotion

Baum, F., Narayan, R., Sanders, D., Patel, V., Quizhpe, A. — Thu, 23 Jul 2009 06:36:04 PDT

The term ‘social vaccine’ is designed to encourage the biomedically orientated health sector to recognize the legitimacy of action on the distal social and economic determinants of health. It is proposed as a term to assist the health promotion movement in arguing for a social view of health which is so often counter to medical and popular conceptions of health. The idea of a social vaccine builds on a long tradition in social medicine as well as on a biomedical tradition of preventing illness through vaccines that protect against disease. Social vaccines would be promoted as a means to encourage popular mobilization and advocacy to change the social and economic structural conditions that render people and communities vulnerable to disease. They would facilitate social and political processes that develop popular and political will to protect and promote health through action (especially governments prepared to intervene and regulate to protect community health) on the social and economic determinants. Examples provided for the effects of social vaccines are: restoring land ownership to Indigenous peoples, regulating the advertising of harmful products and progressive taxation for universal social protection. Social vaccines require more research to improve understanding of social and political processes that are likely to improve health equity worldwide. The vaccine metaphor should be helpful in arguing for increased action on the social determinants of health.