Stakeholders' perspectives on health workforce policy reform.

We administered an electronic survey in October-November 2006 to gauge stakeholder perspectives on Australia's recently adopted health workforce policies. Nearly all of the 41 survey respondents (65% response rate) ranked workforce as very important to overall health policy. Respondents identified decreasing health disparities and rates of disease and mortality as top goals, and identified improved quality and safety and more professionals in rural areas as priority measures for success. Lack of coordination between the governments and insufficient long-range planning were seen as threats to the success of the new workforce initiatives. The survey results suggest the need for clear goals and measurable outcomes. Although they represented different organisations and perspectives, the health workforce policy opinion leaders that participated in this survey reflected remarkable commonality in goals, measures, alternatives, and potential threats.

Trends in abdominal obesity in young people: United States 1988-2002.

OBJECTIVE: To determine the prevalence and trends of abdominal obesity from 1988-1994 to 1999-2002 in American White, Black, and Hispanic youths. METHODS: Data (N = 5020) from the 1988-1994 and 1999-2002 US National Health and Nutrition Examination Surveys were used for this analysis. Abdominal obesity was defined as sex-specific values > or = 95th percentile for waist circumference. Prevalence of abdominal obesity was compared across study periods, race/ ethnicity, socioeconomic status (SES), and age groups 6-11 years. RESULTS: Between 1988-1994 and 1999-2002, increases in waist circumference exceeded those of body mass index in White, Black, and Hispanic young people. The prevalence of abdominal obesity was higher in the 1999-2002 than the 1988-1994 study periods. In 1988-1994, prevalences of abdominal obesity in White, Black, and Hispanic boys were 3.0%, 3.2%, and 6.2% compared with 5.6%, 5.0%, and 9.1% in 1999-2002. The values in girls were 3.9%, 2.9%, and 4.9% in 1988-1994 and 6.0%, 8.1%, and 8.5% in 1999-2002, respectively. Prevalences of abdominal obesity increased with decreasing level of SES in 1988-1994 and 1999-2002 for Whites, Blacks, and Hispanics. At same levels of SES, prevalences of abdominal obesity were higher in Blacks and Hispanic children compared to White children. CONCLUSION: The trend toward increasing obesity among White, Black, and Hispanic American youths is compounded by an unequal increase in abdominal fat accumulation. Further studies are needed to determine the long-term significance of these trends, particularly in Hispanic youths who have greater tendencies for abdominal obesity compared with White and Black youths. The higher increase in the anthropometric markers (waist circumference) of abdominal obesity compared to body mass index suggests that body mass index may be inadequate in estimating changes in generalized adiposity in young people. Health promotion programs in the United States including education, nutrition, and appropriate physical activity targeted at children may help to ameliorate obesity epidemics. Emphasis should be placed on reducing abdominal obesity through physical activity and nutrition, both in school and at home for all children.

Statewide evaluation of local wellness policies in Georgia: an examination of policy compliance, policy strength, and associated factors.

OBJECTIVE: To analyze relationships between demographic characteristics of Georgia school systems and: (1) compliance with the Child Nutrition and WIC Reauthorization Act (CNRA); and (2) strength of wellness policy goals in nutrition, physical activity, and other school-based activities. DESIGN: Each local school district submitted their school-board-approved wellness policy to researchers. Each policy was reviewed and coded for compliance with CNRA and evaluated on the strength of its goals. SETTING: Public school districts. PARTICIPANTS: One hundred seventy-six of 180 Georgia public school systems participated. MAIN OUTCOME MEASURES: Independent variables were demographic characteristics of Georgia school systems. Dependent variables were ratings from the policy evaluation instrument, grouped into composite indices to compare the strength (ie, ratings) of wellness policy goals. ANALYSIS: Pearson correlation, cross-tabulation. RESULTS: Significant positive associations were found between academic performance and: strength of overall wellness policy goals (P < .05), goals in nutrition education (P < .01), and other school-based activities (P < .01). Economic status of the student population was found to be positively associated with strength of nutrition education goals (P < .05). CONCLUSIONS AND IMPLICATIONS: Districts with stronger academic performance had more comprehensive overall wellness policy goals and stronger goals in nutrition education and other school-based activities.

Structuring a framework for public health performance-based budgeting: a Georgia case study.

The ability of public health to meet its functional mandates of assessment, assurance, and policy development footline is driven by the system's capacity to meet basic financing needs. To do so, state and local public health leaders must be able to articulate financing needs in terms that are understandable to policy makers and that link funding to anticipated community impact, benefit, and performance. "Rational" budgeting demands imposed by performance-centered budgeting in the states have proved particularly challenging for public health programs. This Georgia-based case study explores one approach for program budgeting in state and regional public health systems and finds the framework to be normatively sound and appropriately descriptive of the "core functions" of public health. The structure clearly distinguishes between personal health services and population health and allows for the future establishment of measurable program targets, an essential feature of a performance-centered budgeting system.