Reducing health disparities and improving health equity in the United States and Saint Lucia

OBJECTIVE: To create a sustainable model for community health education, tracking and monitoring of selected health conditions (diabetes and mental health), research training, and health policy action in St. Lucia, which may be applicable to underserved African Americans in the U.S. DESIGN AND METHODS: Phase one of this pilot study included a mixed methods analytic approach. Adult clients at risk for or diagnosed with diabetes (n=157) and health care providers/clinic administrators (n=39) were recruited from 5 diverse healthcare facilities in St. Lucia to assess their views on health status, health care services and existing challenges/opportunities to improve health equity. Content analyses of the qualitative data were conducted. RESULTS: Preliminary analyses of qualitative data indicated an awareness of the relatively high prevalence of diabetes and other chronic illnesses. Patients generally acknowledged that one’s socioeconomic status (SES) has an overall impact on health outcomes, though anyone, regardless of SES, may be diagnosed with a chronic disease. Finally, participants indicated desire for better accessibility to healthcare services and improvements to existing healthcare infrastructures to provide better services. CONCLUSION: Findings from this pilot project could serve as a model to help advance health equity among diverse populations through evidence based, culturally tailored community education and prevention efforts. These activities may play a vital role in improving the health status and healthcare among St. Lucians with chronic health conditions and inform similar strategies that may be effective in the United States.

Changes in HIV needs identified by theNational AIDS Hotline of Trinidad and Tobago

OBJECTIVES: To examine utilization of the National AIDS Hotline of Trinidad and Tobago (AIDSLINE), evaluate its validity as a reliable data source for monitoring national HIV-related needs, and identify changes in caller requests between two different time periods. METHODS: A total of 7 046 anonymous hotline calls in 1998–2002 (T1) and 2 338 calls in 2007 (T2) were analyzed for associations between caller characteristics and call content. A subsample of the data was also analyzed qualitatively. T1 findings were compared with HIV-related data collected by national policy-makers during that period, to evaluate the hotline's validity as a data source, and findings from T2, to reveal changes in call content over time. RESULTS: In T1, the hotline was well utilized for information and counseling by both the general population and those living with HIV/AIDS. Call content from T2 indicated an increase versus T1 in 1) general awareness of HIV and other sexually transmitted diseases; 2) HIV testing; and 3) knowledge of HIV symptoms and transmission. HIV-related mental health needs, and the relationship between HIV and both child sexual abuse (CSA) and intimate partner violence (IPV), were identified as emerging issues. CONCLUSIONS: AIDSLINE is a well-utilized tool for providing information and counseling on national HIV-related issues, and a valid, cost-effective, easily accessed information source for planners and policy-makers involved in HIV management. Over the two study periods, there was an increase in HIV awareness and testing and in requests related to mental health, CSA, and IPV, but no change in sexual behaviors.

Epidemiological surveillance of rabies in the Americas, 1999

In 1999, the countries of the Americas reported 73 cases of human rabies. This represents a 16.1 percent reduction in relation to the preceding year, and a 71 percent reduction compared with 1990, thus continuing the downward trend of the disease during the decade. In Latin America, all subregions experienced reductions in the number of cases in humans, with the exception of the Andean Area, which had an increase of 38.1 percent. Reductions in the other subregions were 62.5 percent in Cantral America, 55.6 percent in the Southern Cone, 50 percent in the Latin Caribbean, 40 percent in Mexico, and 10.7 percent in Brazil. The non-Latin Caribbean and North American subregions did not report any occurence of human cases.

Managing the environment for health and safety: priorities for research and intervention: results of interviews

Reports on interviews conducted for the pilot year of the research project `Managing the Environment for Health and Safety', the objective of which was to facilitate an understanding of the types of environmental degradation facing the Caribbean, and their effects on health, and the linkages between economic development and health-related environmental degradation. Attempts to give an up-to-date picture of environmental degradation and its actual and potential effects in Jamaica and St. Lucia, to identify issues which were priorities for research and intervention. (AU)

Grenada: country environmental profile

Provides background information on the general environmental setting of the country and also briefly reviews the historical and cultural data. This is followed by a demographic overview and a discussion of the economy. Other sections reviews the country's natural resource base, including a discussion of primary environmental issues; industry and energy, environmental pollution; land use planning; institutional framework for environmental management. The final chapter summarizes the key environmental issues and problems facing Grenada and makes recommendations to enhance the achievement of a sustainable balance between resource development on the one hand and resource conservation and resource management on the other

Health and tourism in the Caribbean

Discusses the major concerns of how environmental matters affect tourist industry and how the industry might impact negatively on the environment, thereby creating a health hazard for all. Identifies priority issues as degradation of the coastal and marine environment, solid and liquid waste mangement and water quality and supply as crucial to tourism. Examines the behaviour related health problems associated with tourism; excess alcoholic consumption, sexually transmitted diseases and drug abuse and the ability of the health services to respond to these problems. Comments on the need for greater development of health tourism in the region and points to the need for Caribbean governments to collaborate in gathering more data on health and tourism (AU)

Post-disaster epidemiological surveillance following Hurricane Hugo in Montserrat - abstract

Hurricane Hugo struck the island of Montserrat during the night of 17th September, 1989. Sustained winds of 130 mph were experienced for 8 hours with damage to 93 per cent of buildings; 50 per cent seriously and 20 per cent destroyed. The main hospital lost its roof and most health centres were severely affected. Two thousand five hundred persons were rendered homeless, of whom 1,000 were housed in shelters. Three days after, environmental health surveillance revealed unsatisfactory conditions in shelters with inadequate water supplies and faecal disposal. Water was trucked to shelters and a pit latrine programme commenced so that by the first week of October, all shelters had acceptable faecal disposal facilities. Island-wide, symptom-based daily reports of disease surveillance was introduced 9 days after the hurricane for respiratory infections and gastroenteritis. This allowed daily monitoring of disease occurrence by locality, targeting of health education and environmental health measures, and made it easier to dispel rumors which occurred after the hurricane. There was an increase in gastroenteritis 10 - 14 days after, but this subsided as potable water supplies were established. One month after, 30 cases of fever of unknown origin were detected. At first suspected to be dengue fever, it turned out to be influenza A (hl, N1) (AU)

Health and tourism in the Caribbean

Health and tourism impact on each other in the Caribbean, so it is both appropriate and necessary that those concerned with tourism in the region should consider health issues. The health and environment of the Caribbean can have good or bad effects upon the health of visitors, and tourism has health consequencies for local residents. Tourism for health purposes also needs to be considered. This article points out the major issues related to these interactions, indicates where more data are needed, and suggests lines of future action. (AU)

Pesticides and environmental monitoring in the Eastern Caribbean: current setting and needs, Grenada

Summarizes issues raised during a number of pest control interviews in Grenada. These interviews discuss the use of pesticides on agricultural crops and the effect of pesticide residues on the environment. Concludes that pesticide monitoring is becoming increasingly important especially as recently the United States has implemented strict rules on the importation of agricultural products which have been chemically treated during post harvesting. Similar actions are foreseen in Europe with the formation of the single market in 1992. Points out that Grenadian farmers have a limited knowledge of appropriate pesticide use and that training is needed in this area. Attachments include texts of pesticide legislation and regulations since 1973

Plan of action for the AIDS programme in Grenada

Provides details of a 3-year medium-term plan aimed at reducing the risk of sexual transmission of HIV; ensuring that measures already implemented to prevent transmission through infected blood or non-sterile injection continue to be adequate; educating all health care workers on ways in which to prevent HIV transmission in health care settings. The programme also entails epidemiological surveillance, distribution of condoms, upgrading of blood transfusion services and education of the population, among others things. The methodology and procedures for carrying out these tasks are given. Details of the budget for these programmes are also outlined

Environmental impact assessment - an important tool for decision makers

The use of Environmental Impact Assessment, EIA, as a tool for decision makers is described. EIA can be used for identifying, predicting and assessing impacts arising from proposed activities such as major development projects like industrial complexes, highways and water-related projects. Implementation of EIAs is usually for projects for which a number of alternatives may be assessed. The methods used at each stage of the EIA process are identified. The matrix method is used to illustrate an EIA of the development of an industrial complex, port and urban development. The alternatives of continuing with the traditional uses, that is, agriculture (sugar cane), fisheries and recreation are also assessed. Additionally, the impact of a third alternative of changing the monocrop agriculture to diversified agriculture is considered. It is recommended that EIAs are formally integrated into the planning process in Trinidad and Tobago. (AU)

Final report on the environmental monitoring: a survey course on sampling analytical techniques and data evaluation

This report covers information on the planning, organization, presentataion, progress and accomplishments of a two-week course on environmental monitoring. The course was designed to provide training in laboratory skills, background information, rationale for performing environmental monitoring and data evaluation. Much emphasis was placed on laboratory demonstrations and practiced analytical techniques used for environmental monitoring in the field (AU)