RESUMO
BACKGROUND: Government policy measures have a key role to play in the prevention and control of non-communicable diseases (NCDs). The Caribbean, a middle-income region, has the highest per capita burden of NCDs in the Americas. Our aim was to examine policy development and implementation between the years 2000 and 2013 on NCD prevention and control in Barbados, and to investigate factors promoting, and hindering, success. METHODS: A qualitative case study design was used involving a structured policy document review and semi-structured interviews with key informants, identified through stakeholder analysis and 'cascading.' Documents were abstracted into a standard form. Interviews were recorded, transcribed verbatim and underwent framework analysis, guided by the multiple streams framework (MSF). There were 25 key informants, from the Ministry of Health (MoH), other government Ministries, civil society organisations, and the private sector. RESULTS: A significant policy window opened between 2005 and 2007 in which new posts to address NCDs were created in the MoH, and a government supported multi-sectoral national NCD commission was established. Factors contributing to this government commitment and funding included a high level of awareness, throughout society, of the NCD burden, including media coverage of local research findings; the availability of policy recommendations by international bodies that could be adopted locally, notably the framework convention on tobacco control (FCTC); and the activities of local highly respected policy entrepreneurs with access to senior politicians, who were able to bring together political concern for the problem with potential policy solutions. However, factors were also identified that hindered multi-sectoral policy development in several areas, including around nutrition, physical activity, and alcohol. These included a lack of consensus (valence) on the nature of the problem, often framed as being predominantly one of individuals needing to take responsibility for their health rather than requiring government-led environmental changes; lack of appropriate detailed policy guidance for local adaptation; conflicts with other political priorities, such as production and export of alcohol, and political reluctance to use legislative and fiscal measures. CONCLUSION: The study's findings indicate mechanisms to promote and support NCD policy development in the Caribbean and similar settings.
Assuntos
Doença Crônica/prevenção & controle , Planejamento em Saúde/legislação & jurisprudência , Medicina Preventiva/legislação & jurisprudência , Prevenção Primária/legislação & jurisprudência , Barbados , Feminino , Humanos , Masculino , Programas Nacionais de Saúde , Formulação de Políticas , Serviços Preventivos de Saúde/organização & administração , Pesquisa QualitativaRESUMO
The January 2010 earthquake in Haiti was a catastrophe not only for the loss of life it caused, but also because it destroyed the very thin layer of state administrative capacity that was in place in the country. This article argues that the fragility of the Haitian state institutions was exacerbated by international strategies that promoted NGOs as substitutes for the state. These strategies have generated a vicious circle that, while solving immediate logistical problems, ended up weakening Haiti's institutions. However, the article does not call for an overarching condemnation of NGOs. Instead, it explores two cases of community-based NGOs, Partners In Health and Fonkoze, that have contributed to creating durable social capital, generated employment and provided functioning services to the communities where they operated. The article shows that organisations that are financially independent and internationally connected, embrace a needs-based approach to their activities and share a long-term commitment to the communities within which they operate can contribute to bringing about substantial improvement for people living in situations of extreme poverty. It concludes that in the aftermath of a crisis of the dimension of the January earthquake it is crucial to channel support towards organisations that show this type of commitment.
Assuntos
Terremotos , Organizações , Áreas de Pobreza , Assistência Pública , Saúde Pública , Socorro em Desastres , Fatores Socioeconômicos , Distúrbios Civis/economia , Distúrbios Civis/etnologia , Distúrbios Civis/história , Distúrbios Civis/legislação & jurisprudência , Distúrbios Civis/psicologia , Planejamento em Desastres/economia , Planejamento em Desastres/história , Planejamento em Desastres/legislação & jurisprudência , Terremotos/história , Haiti/etnologia , História do Século XXI , Direitos Humanos/economia , Direitos Humanos/educação , Direitos Humanos/história , Direitos Humanos/legislação & jurisprudência , Direitos Humanos/psicologia , Organizações/economia , Organizações/história , Organizações/legislação & jurisprudência , Medicina Preventiva/economia , Medicina Preventiva/educação , Medicina Preventiva/história , Medicina Preventiva/legislação & jurisprudência , Assistência Pública/economia , Assistência Pública/história , Assistência Pública/legislação & jurisprudência , Logradouros Públicos/economia , Logradouros Públicos/história , Logradouros Públicos/legislação & jurisprudência , Saúde Pública/economia , Saúde Pública/educação , Saúde Pública/história , Saúde Pública/legislação & jurisprudência , Socorro em Desastres/economia , Socorro em Desastres/história , Socorro em Desastres/legislação & jurisprudência , Problemas Sociais/economia , Problemas Sociais/etnologia , Problemas Sociais/história , Problemas Sociais/legislação & jurisprudência , Problemas Sociais/psicologia , População Urbana/históriaRESUMO
The present paper focuses on the reconstruction of the historical circumstances of knowledge production as well as and the debates about endemic goiter disease during the period 1916-1955 in Argentina. Taking into account the social, political and material dimensions, this text explores the re-signification of scientific and medical knowledge oriented to the prevention and health treatment, through the positioning of several social actors engaged all along the period, and the diverse historical and institutional contexts.
Assuntos
Pesquisa Biomédica , Dieta , Bócio Endêmico , Medicina Preventiva , Saúde Pública , Argentina/etnologia , Pesquisa Biomédica/economia , Pesquisa Biomédica/educação , Pesquisa Biomédica/história , Pesquisa Biomédica/legislação & jurisprudência , Dieta/economia , Dieta/etnologia , Dieta/história , Dieta/psicologia , Alimentos/economia , Alimentos/história , Bócio Endêmico/economia , Bócio Endêmico/etnologia , Bócio Endêmico/história , Bócio Endêmico/psicologia , História do Século XX , Serviços Preventivos de Saúde/economia , Serviços Preventivos de Saúde/história , Serviços Preventivos de Saúde/legislação & jurisprudência , Medicina Preventiva/economia , Medicina Preventiva/educação , Medicina Preventiva/história , Medicina Preventiva/legislação & jurisprudência , Saúde Pública/economia , Saúde Pública/educação , Saúde Pública/história , Saúde Pública/legislação & jurisprudênciaRESUMO
Good nutrition depends on access to a healthful food supply. Although a great deal of attention has been paid to food intake as a determinant of nutrition and overall health, little attention has been paid to the food supply system, health risks embedded in it, and its effect on people's choices. Most national governments intervene in their agricultural sectors in order to provide benefits to producers and consumers; however, these interventions are not designed with public health in mind. Governments should consider population nutrition and chronic disease risk when devising and implementing agricultural and food policies. They should seek opportunities to adjust agricultural and trade policies to be consistent with national health and nutritional priorities and guidelines. Although the paper gives several examples, country-specific policy changes can be determined only through analysis of individual country policies and nutrition conditions.