Health status in Europe: comparison of 24 urban areas to the corresponding 10 countries (EURO-URHIS 2).

Background: : In Europe, over 70% of the population live in urban areas (UAs). Most international comparative health research is done using national level data, as reliable and comparable urban data are often unavailable or difficult to access. This study aims to investigate whether population health is different in UAs compared with their corresponding countries. : Routinely available health-related data were collected by the EURO-URHIS 2 project, for 10 European countries and for 24 UAs within those countries. National and UA level data for 11 health indicators were compared through the calculation of relative difference, and geographical patterns within Europe were investigated using the Mann Whitney U test. Linear regression modelling was used to adjust for population density, gross domestic product and urbanicity. : In general, the urban population in Eastern Europe is less healthy than the Western European urban population. However, people in Eastern Europe have significantly better broad health outcomes in UAs as compared with the corresponding country as a whole, whereas people in Western Europe have generally worse broader health outcomes in UAs. : For most European countries and UAs that were investigated, the national level health status data does not correspond with the health status at UA level. In order to identify health problems in UAs and to provide information for local health policy, health monitoring and international benchmarking should also be conducted at the local level.

Can foods with added soya-protein or fish-oil reduce risk factors for coronary disease? A factorial randomised controlled trial.

BACKGROUND AND AIMS: To develop functional foods which are capable of reducing key risk factors for coronary heart disease in an at risk population. The specific hypothesis tested here was that providing bread, cracker biscuits and snack bars fortified with DHA (long-chain omega 3) and soya-protein would havd a positive impact on cholesterol and blood pressure. METHODS AND RESULTS: A pragmatic, double-blind, factorial placebo-controlled randomised trial recruiting 213 middle-aged men and women with untreated elevated total cholesterol or blood pressure. The factors examined were the effect of giving supplies of bread, cereal bars and cracker biscuits fortified with 2 g fish oils (DHA, 22: 6n-3), or 25 g soya-protein (containing 50 mg of isoflavonoids) for five weeks. Primary and secondary outcomes included total, low-density and high-density cholesterol (HDL-C), and systolic and diastolic blood pressure. Compliance was assessed using biomarkers and food intake histories. DHA enriched foods increased HDL-C by 6.0% (95% CI 2.5%, 9.6%) but had no effect on total or low-density cholesterol or blood pressure. Overall, soya-protein did not influence any of the outcomes assessed. However, in women only, soya-protein increased systolic blood pressure by 5.9% (95% CI 1.73, 9.9%). CONCLUSIONS: Adding DHA (fish-oils) to staple foods might supplement existing methods to help reduce CVD morbidity and mortality. However, these findings highlight the importance of ensuring that functional foods do not present any harms to particular subgroups within a general population, if they are to be made freely available to consumers. This latter point requires further attention by the research community in relation to soya-protein.

The public health function in central and eastern Europe.

This paper provides a description of the structure and function of public health within seven central and eastern European countries. The information was gathered from senior figures within public health in these countries, who came together at a European Union (EU)-funded seminar on public health which aimed to share recent developments in the public health function in their countries, and to develop a shared vision of the future for public health across an (eventually) much enlarged and united EU. An essential starting point for this was a clear understanding of how public health operates within each of the countries involved. The information gathered and presented here suggests that the countries of central and eastern Europe included in this survey have much in common with current EU member states, in that public health is held to be of national importance. On the whole, they share similar priorities. The organization of the public health function varies quite considerably and variations of degrees of central and local control are manifested. There is also variation in the relationship between the 'health' and 'environmental' aspects of public health. In some countries, these are distinctly separate areas of activity, whereas in others they are integrated. All countries acknowledge that public health practice is a multidisciplinary activity, but this is not necessarily backed up with unified systems for co-ordinated education, training and development, open to all. Continued cross-Europe discussion, exchange of information on the development of the public health function, and collaboration on training, education and development in public health will be of mutual benefit and is essential if high standards in public health practice are to be achieved and maintained across the whole of the European region.

How should public health policy be developed? A case study in European public health.

BACKGROUND: Article 129 of the Treaty of Rome (as amended at Maastricht) gave new powers to the European Union (EU) institutions to develop and implement public health programmes at EU level. The authors were invited by the cabinet of Commissioner Flynn to assist the Commission by developing new policy proposals in certain specific areas. METHODS: The approach was agreed with officials of the Public Health Unit (now the Public Health and Safety Directorate) in DG V. Working groups of experts were appointed to review policy options in five discrete areas. The experts were resident in 13 of the 15 current EU member states, and were employed in academic departments, in health ministries, in local government, and in non-governmental organizations. Draft reports were presented to an evaluation panel of additional experts, whose comments contributed to the final report to the Commission. RESULTS: The final report consisted of five main chapters, corresponding to the work of the five working groups. The recommendations were grouped into those for which implementation would be short term, medium term or longer term, and these were summarized as a Plan of Action. CONCLUSION: Five criteria for good public health policy development were satisfied, but the approach used was excessively expensive and time-consuming. Some further lessons for future policy development work have also been recorded. This work provided a fascinating insight into the workings of the EU institutions.

Establishment of primary health care in Vietnam.

Basic demographic and epidemiological data relevant to health problems in Vietnam are described in this paper. Existing health service arrangements are referred to, with particular emphasis on the strategy for development of primary health care. The establishment of the paediatric centre in Ho Chi Minh City is reported, and examples of its valuable work in primary health care development are described.

PIP: In spite of Vietnam's 40-year history of war, infant mortality rate of 50-60/1000 live births in urban areas, life expectancy of 55 years for women and 61 years for men, growth rate of 21.5/1000 population and population totaling 61-66 million in 1986, the health status of the Vietnamese, is better than the mean for all African countries and no worse than developing countries with a GNP per head greater than Vietnam's US 210. The incidence of infectious disease remains high for both adults and children, with malaria leading for adults and diarrheal disease for children as well as malnutrition due to dietary insufficiency. Air pollution, poor sanitation, and chemical pollution of water supplies pose a serious threat to health in Saigon, as do dioxin-related diseases in the surrounding countryside. A decentralized government hospital service with health centers in all communities provides 1 doctor for every 18,000 population. This system is criticized for lack of attention to socioeconomic conditions or diet. The health care strategy developed in 1986 targets the following goals for 1990: adequate nutrition, drinking water, essential drugs, and sanitation as well as more extensive immunization, family planning services, and home treatment of illness. Along with the 3000 community health centers, community health workers provide basic treatment and health education from their homes. Although the health system is paternalistic, vital provisions of salts and sugars for combating diarrhea, and A and D supplements and food are given to the poor. Dr. Duong Quynh Hoa's pediatric research institute, children's hospital, and new medical school are principally concerned with the development of socioeconomic conditions where the doctor is only 1 among many collaborating to improve the quality of life. One pediatric center project, for example, has been successful in promoting the active participation of people in an environmental hygiene program, a clean drinking water program, immunization efforts, and a diarrhea control program funded through UNICEF, WHO, and French and British charities. Investment is being sought from developed countries for economic development and food aid.

Cardiovascular risk factors and health behavior: some preliminary findings from the Cardiovascular Diseases and Alimentary Comparison Study.

This paper presents some preliminary findings from one particular Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study data collection center. The population and the environment of the Western Isles, Scotland, from where the subjects were drawn, are described. The methodology was as according to the CARDIAC Study protocol. The results show that in this population there is a high mean serum total cholesterol level, a high prevalence of smokers, and a high mean body mass index. However, knowledge, attitudes, and reported behavior change regarding diet were encouraging. Much further data processing work remains to be done.

Hospital postgraduate medical education facilities.

A survey of facilities made available to support the training requirements of junior hospital doctors within the North Western Region of England revealed a general under-provision of certain facilities, significantly greater provision of some facilities in teaching hospitals as compared with other hospitals, significant evidence in some cases of special effort in non-teaching hospitals to improve facilities, and significant differences between specialties regarding efforts made to provide training facilities.