Perspective: lessons from the past.

A considered analysis of some factors used in the past 50-70 years in medical education, care on a hospital ward, organisation of health services, medical research and the attitudes of media and politics to health services is described. The possible reasons for changes in these areas over time are considered, and recommendations are made in each area on how current practice could be improved in the light of past experience.

'Avoidable' mortality: a measure of health system performance in the Czech Republic and Slovakia between 1971 and 2008.

BACKGROUND Post-communist health care reforms and the break-up of Czechoslovakia have been studied from various perspectives, but little research has addressed the impact on health system performance. This paper investigates the quality and performance of the Slovak and Czech health systems before and after 1989, including the year of separation in 1993, using the concept of 'avoidable' mortality. METHODS Age-standardized mortality rates for mortality from 'avoidable' and other (non-avoidable) causes have been calculated through indirect standardization to study national and regional trends between 1971 and 2008. RESULTS The paper shows that 'avoidable' mortality in both countries has been continuously decreasing while mortality from other causes has remained unchanged or increased slightly. For some 'avoidable' conditions, mortality rates of the two countries converge while for others divergence can be observed, with either the Czech Republic or Slovakia performing better. CONCLUSION Declines in overall 'avoidable' mortality suggest improvements in the health system's performance and quality of care in both countries, compared with mortality from other causes where factors outside the control of the health care system may be stronger determinants. For conditions where 'avoidable' mortality rates stagnate or increase, more in-depth research should be carried out to identify problems in the delivery of timely and effective prevention and treatment, and to establish steps that would reduce the numbers of unnecessary deaths.

Public health in Austria: an analysis of the status of public health

This book explores the key challenges facing Austria’s public health system. Set firmly in the context of the history, scope, functions and responsibilities of public health in developed countries, it examines how the Austrian system has developed and adapted over the last 50 years to the benefit of the population. It also looks at the challenges presented by life in the 21st century. The book draws on both national research and expert interviews to present a fully rounded picture. This shows that the public health system in Austria is struggling to maintain essential services and develop policies for improvement, and the study proposes strategies and policies to tackle these developments, looking in particular at change within the fields of education, research and training. This book is essential reading for policy-makers, advisers and analysts interested in developing a public health strategy and competence in both developed and developing countries, as well as researchers interested in the Austrian health system.

Screening in Europe

This policy brief addresses the concept of screening in health care, namely actively seeking to identify a disease or pre-disease condition in individuals who are presumed and presume themselves to be healthy. It covers the historical background to screening and definitions; criteria for screening, evaluation, and the benefits and disadvantages; and key issues that are relevant at all stages and to every type of screening in any country. Examples are from the United States, the United Kingdom and other European Union Member States.

Скрининг в Европе

Концепция скрининга в здравоохранении, то есть активного выявления болезни или предболезненного состояния у лиц, считающихся или считающих себя здоровыми, в течение XX в. быстро распространилась и в настоящее время широко принята в большинстве развитых стран. При правильном использовании скрининг может быть действенным инструментом в профилактике заболеваний. Однако необходимо соблюдать устоявшиеся принципы и критерии и препятствовать внедрению практики проведения скрининга, которая не соответствует этим требованиям. Мы начнем этот краткий очерк с исторической справки о скрининге и рассмотрения некоторых определений практики его проведения, основанных на опыте США и Соединенного Королевства, но применимых в более широком контексте. Далее мы исследуем критерии проведения скрининга и его оценки, а также преимущества и недостатки этой практики. Затем мы осветим ряд ключевых вопросов, относящихся ко всем стадиям и каждому типу скрининга в любой стране. И, наконец, прежде чем сделать ряд общих выводов, мы рассмотрим существующую практику проведения скрининга в Европейском союзе (ЕС), используя Соединенное Королевство как модель.

Health technology assessment and public health: a commentary.

This article reviews the developments in HTA in four countries, France, The Netherlands, Sweden, and United Kingdom, in relation to public health. It emphasizes that the majority of assessments made are concerned with individual clinical care rather than with the optimization of health. Possible reasons for the neglect of public health issues are that these are inherently more complex than the assessment of individual procedures or drugs. They are usually multisectoral, politically charged, and often considered mundane and "common sense" and, thus, not requiring evaluation (although when evaluations are done they are often counterintuitive). Unless more emphasis is given to the development and evaluation of public health measures, it is unlikely that there will be any major advances in health status. Possible areas for future assessment should include such issues as smoking, drug and other substance misuse, nutrition, and health inequalities. However, it is unlikely that these major areas of concern will be included in the future unless the methods of choice for priorities of development and assessment are changed to include measures that improve health status rather than only clinical services.