Breadth and depth in research on health disparities: commentary on the work of Nancy Krieger

Geocoding and spatial analysis of data describing populations and health events are important methods in health social science now carried out using GIS technology. This commentary considers Nancy Krieger’s work on health disparities in light of the various ways individuals and organizations use geocoded population and health data: analyzing spatial patterns of health and disease including health disparities, aggregating data spatially, assessing health status of individuals based on characteristics of aggregates, modeling neighborhood contextual factors affecting health, designing observation and intervention studies, and delivering health interventions and services. The extent to which her work addresses each of these purposes is considered. The strengths and limitations of the research including choice of spatial analytic units and techniques as reported in the published work are discussed. Krieger’s work, with her colleagues, has used standard methods of spatial analysis to raise the profile of GIS and spatial analysis in the public health community.     

基于系统有序度熵的河流健康评判方法研究

河流系统是一个耗散结构,因此评价河流健康状况可以从系统的观点出发进行探讨研究。本文应用系统论和信息论的有关概念和理论,提出了基于系统有序度熵的河流健康评价方法,导出了综合考虑河流系统多个子系统(健康目标)的河流健康指标的数学表达。以黄河为例,分析提出了黄河健康因子,研究了各健康因子的阈值范围,评价了黄河现状的健康状况。     

Climate Change and Human Health: Risk Assessments,Early Signals and Response Strategies

Climate change is considered as the biggest global health threat of the 21^st century. The increasing adverse health effects of climate change has been a public concern worldwide. In order to develop the specific health response strategies, a key research project, "Climate change and human health: Risk assessments, early signals and response strategies", was approved by the National Key R & D Program of China in May 2018. This project will integrate researchers from multidisciplinary background, such as public health, medicine, meteorological sciences, disaster management, to address the following scientific questions: ①The impact of climate change on population health and its regional heterogeneity; ②The underlying mechanisms and pathways of how climate change and extreme events impact on health; ③Capture of the early signals of climate system anomalies which may lead to regional health risks; ④The comprehensive health risk assessments and development of coping strategies for tackling climate change. This project will improve our understanding of climate change and health and help policy maker to develop national and local responses to climate change in China.     

黄河内蒙古段生态系统健康状况评价

河流生态系统健康评价研究是目前生态学研究的一个新概念、新问题,生态系统健康是人类与环境间的相互关系协调及实现生态可持续发展的重要基础。基于水文学和生态学原理,对河流生态系统健康的概念进行了界定,建立了河流生态系统健康评价指标体系及其评价方法,将评价结果分为优、中和差3个等级。以黄河内蒙古段为例,对其生态系统健康状况进行了评价。结果表明:黄河内蒙古段2006年生态系统健康评价最终得分为0.558,处于中等健康状态。提出了改善黄河内蒙古段健康状况的对策和建议,评价成果为黄河内蒙古段的生态环境的改善与管理提供重要的理论依据。     

The health state of the Romanian population during the transition period

The paper attempts to make an assessment of the health state of the Romanian population during the transition period; the evolution of the health indicators, analyzed in the European context, shows the precarious health state of the Romanian population, in comparison both to Western countries and to the countries which are crossing a transition phase themselves. The values of the health indicators by region also show inequalities of health, the north-western and south-eastern areas of the country having to face serious problems. The reduction of living standard, the low quality health services, together with other factors associated with lifestyle seem to be responsible for the deterioration of the health state of the Romanian population. The introduction of adequate health and social policies in the following period could bring about an improvement of the situation. This revised version was published online in August 2006 with corrections to the Cover Date.     

The impact of health financing and CO<Subscript>2</Subscript> emission on health outcomes in Sub-Saharan Africa: A cross-country analysis

The current paper examines the relationship between health financing (public and out-of-pocket health financing), CO₂ emission and health outcomes in 35 Sub-Saharan African countries for the period of 1995–2012. The panel unit root and cointegration tests are conducted as pre-tests, followed by the estimation of the parameters using the FM-OLS and DOLS techniques. The findings of the study show the importance of public health financing as one of the major factors that lead to better health outcomes, whereas the out-of-pocket expenditure is found to be harmful to population health since it leads to increase under-5 mortality rate. Although the results show a negative relationship between CO₂ and health outcomes, still these results remain inclusive. In addition, the findings reveal the importance of socioeconomic factors such as income and education as key determinants of health outcomes.     

生态系统与人类健康

简要介绍了千年生态系统评估（MA）项目针对生态系统与人类健康编写的《生态系统与人类福祉：健康综合报告》的核心内容。报告表明：① 生态系统及其服务是人类生存和维持健康的根基,但生态系统与人类健康之间的关系多是间接性的,可能出现时空移位,而且还会受到许多动态因素的影响,因而对其认知难度较大;② 在过去的50年中,主要由人类活动造成的生态系统变化,一方面显著改善了人类的健康状况,另一方面人类也为此付出了日益昂贵的代价,并对未来的人类健康构成了新的威胁;③ 对于未来50年(2000—2050年)的生态系统变化与人类健康状况,虽然MA的4种情景的模拟结果不尽相同,但是,它们一致认为人类对食物和水资源等生态系统服务的需求将大幅增长,人类活动对生态系统的快速转化将会持续,而且难以实现食物安全及消除儿童营养不良等目标;④ 长远来看,生态系统的可持续管理与人类健康状况的改善具有相互促进作用。但是,为了实现改善人类健康和保育生态系统的双赢目标,必需对现行的管理、制度、法规和政策等进行一系列的全面改革。     

Placing sexuality in health policies: feminist geographies and public health nursing

Despite the increasing public profile of same-sex issues, health policies are often shaped by heteronormative assumptions. The health concerns of lesbian, gay, bisexual, transsexual/transgender, two-spirit, intersex, queer and questioning (LGBTTTIQQ) people are complex and require broadening from an often exclusively sexual health and risk focus to a more holistic approach. In this context, this paper illustrates how a critical feminist geography of health, with its focus on the mutual construction of gender relations, space and place, potentially enhances and extends current understandings of public health policy and practice. Moreover, the use of a policy lens foregrounding gender and other power relations suggests that feminist research and coalitions facilitate participatory processes that address “the politics of discourse.” In particular, public health nursing practice can enhance the construction of spaces of resistance that challenge heteronormative discourse through research strategies focused on sexual minority communities’ health experiences and their visions for supportive care. In this respect, two strategies consistent with public health priorities to increase knowledge and participate in alliances are described. Ethnographic research with childbearing lesbians demonstrates that attention to institutional dynamics that foster safe spaces can facilitate access to public health services. Public health nurses’ involvement in community coalitions can enhance dissemination of community knowledges. The implications for gender inclusive and place-sensitive public health nursing practice include the development of sensitive educators, meaningful educational curriculum and related program planning, explicit policies, community partnerships and political leadership in institutional and research venues.     

淮南潘一矿采煤塌陷积水区水环境健康风险评估

以淮南潘一矿塌陷积水区为例,分析测试了塌陷积水区12个采样点水样中的7种重金属元素（Cr、Cd、Zn、Cu、Pb、Ni和Fe）的含量,采用美国环保局（USEPA）推荐的水环境健康风险评价模型,对重金属由食入途径进入人体所引起的健康风险进行评估和分析。研究发现,研究区水体中重金属致癌风险值为（5.06~8.06）×10^-6/a,根据我国环境保护部推荐的健康风险标准,存在健康风险。其中,Cr的致癌风险占总致癌风险的98.52%。非致癌健康风险值在10^-10/a的数量级,健康风险不明显,而非致癌健康风险的贡献大小顺序为,Cu > Pb > Fe > Cr > Cd > Ni > Zn。其中,Cu的贡献率最大,占非致癌总风险值的48.62%。同时还发现,研究区的重金属致癌风险占总健康风险的99.99%,这表明该区域总的水质健康风险几乎全部由致癌风险构成,而致癌风险中又几乎由Cr组成。     

水土流失地区生态系统健康评价——以五华县为例

生态系统健康是一门研究人类活动、自然生态系统、社会经济组织和人类健康的跨学科综合性学科。由于生态系统健康研究是一个新领域,有关它的概念、评价等方面还存在各种争论,在综合分析国内外生态系统健康和水土流失研究进展的基础上,联系对五华县的实地调查,提出水土流失地区生态系统健康的概念,运用“压力状态-响应”模型对其生态系统健康进行分析评价,表明五华县的生态系统处于不健康的状态,进而提出水土流失地区新的修复方法,以优化水土流失地区的生态系统健康。     

Back to the Future? Reflections on past reforms and future prospects for health services in New Zealand

In 1991 the New Zealand health system began to experience what has been termed the `turbulent decade'. Without health sector consultation or public mandate, an era of imposed market oriented reforms began. These changed the overall culture of health care delivery and the expectations of New Zealanders regarding the role of the state in the provision of welfare. In retrospect the ideologically driven imposition of the market-oriented reforms was not an exercise of bold leadership but one of political arrogance and rejection of established community values. Within the community, the neoliberal experiment heightened income and health inequalities, created a loss of social cohesion and generally provoked feelings of powerlessness. In the health sector, the reforms polarised clinical and commercial cultures and changed the geography of health care delivery. This occurred not only because place was de-emphasised, but also because decentralisation of purchasing created four health systems with widely divergent contracting arrangements and standards of care. The lessons of the health reforms have been painful, and must not be lost. A fundamental lesson is that market approaches to the delivery of health care have major limitations and that the ultimate goal of a health system should be the equitable, effective and efficient provision of care, not the profitable sale of commodities. Since 1997 there has been a retreat from the market, although it is not clear whether recent policy developments represent a new or distinctive `third way' or a pragmatic `pick and mix', combining the best from the market and the managerialism first introduced by Labour in the 1980s. Quite clearly, the experiment with the market was not sustainable. Whether this will also be true of the more recent and pragmatic `pick and mix' approach of the `third way' to health care reform is uncertain. This revised version was published online in July 2006 with corrections to the Cover Date.     

‘The germs are not harmful’: health risk perceptions among consumers of peri-urban grown vegetables in Kumasi,Ghana

Consumption of peri-urban grown vegetables has raised public health concerns due to potential risks of contamination from pathogens, pesticides and heavy metals. Understanding how the public perceives of risk is key in managing the population at risk of consuming contaminated vegetables. However, health risk perceptions research of consumers has largely been given little attention. Using both quantitative and qualitative research techniques, and drawing on risk perception theory, this study examined consumers’ health risk perceptions in relation to urban vegetable consumption in the Oforikrom sub-metropolitan area of the Kumasi Metropolis in Ghana. Results suggest that heath risk perceptions of consumers of urban-grown vegetables is generally low, an indication that consumers’ perceptions have not changed a decade after similar results were reported in Ghana. Consumers’ interpretation of the quality of vegetables and associated health risks deviates from scientific health risk assessments which, does not translate into desired risk mitigation behaviour. Continuous public education on potential health risks of consuming these vegetables and appropriate health risk mitigation measures could be vital in reducing the population at risk.     

评价生态系统健康的指标

随着世界主要生态系统的急剧恶化, 迫切需要开发出可操作的生态系统健康指标, 科学掌握生态系统健康状况的变化, 以便及时改善生态系统状况, 实现自然与人类的可持续发展. 综述了生态系统健康定义的历史沿革, 回顾了评价生态系统健康的各类指标, 并以Costanza的定义为例, 指出要评价健康必须从多个尺度对系统的活力、组织和恢复力进行综合测量, 进一步介绍了如何根据该定义构建指标体系. 最后, 以Ulanowicz的信息指标为例, 说明如何从系统层面评价生态系统健康, 提出了用信息指标评价生态系统健康的潜力.     

河流生态健康评价研究综述

随着河流污染日益严重,人们开始关注河流的生存,河流健康由此而生.在全面总结国内外研究的基础上,对河流健康的概念进行了阐释,分析了评价河流健康的指标体系,及其标准和权重,列举了几种常用的评价模型,并指出了现阶段河流健康评价工作的不足及其未来的发展方向.     

神府矿区生态系统健康水平评价

煤矿区生态系统健康对矿区可持续发展有着重要影响。在对神府矿区调查分析的基础上,利用模糊综合评价模型研究了2000-2006年神府矿区生态系统健康水平的变化轨迹。结果表明：神府矿区的生态系统健康整体状况基本呈现逐年改善趋势,健康状况从疾病上升到一般疾病。对5个要素变化过程分析得出,矿区生态系统对人类健康的影响、活力和恢复力3个因素均具有较大的提升空间,并呈现出较快的发展速度。     

生态系统健康：理论/概念与评价方法

生态系统健康研究是目前生态与环境领域兴起的研究热点之一。在阅读和分析大量国内外文献的基础上,系统总结了健康和生态系统健康的概念,指出引入生态系统健康概念的目的是要得到一个重要生态指标清单,以此开展生态系统健康评价。然后,总结出生态系统健康评价的3种主要方法：指示物种法、指标体系法和指示区域法,并以代表实例阐述了此3种方...     

矿区生态系统健康的可拓评价

建立了多层次多指标的矿区生态系统健康综合评价体系,并给出矿区生态系统健康等级标准以及相应评价指标的量值。应用物元概念和可拓集合关联函数,并采用层次分析法确定各评价指标的权重,构建矿区生态系统健康的可拓评价模型。将该模型应用于大同矿区的生态系统健康评价。通过关联度计算,得出该矿区生态系统健康的综合关联度为-0.023,健康等级为Ⅲ级,属于合格水平。该可拓学评价方法能够准确、科学地区分矿区生态系统健康的等级,为矿区生态系统保护措施的制定提供依据,具有实用性。     

喀斯特洞穴康养适宜性评价——以贵州红果树景区天缘洞为例

被誉为“空气维生素”的空气负离子具有调节神经中枢、促进新陈代谢等生物效应,有益于人体身心健康;同时负离子还具有抑菌、杀菌的作用,在喀斯特洞穴中负离子含量高,也造就了洞内洁净的空气。喀斯特洞穴康养就是依托于洞穴环境与小气候而开展的疗养、康体、休闲等一系列有益身心健康的活动。本文采用指数分析法,从人体感受与环境卫生学角度选取人体气候舒适度指数、空气清洁度指数和空气负离子富含度指数构建喀斯特洞穴康养功能指数（CRFI）并以贵州红果树景区天缘洞为实例,来评价喀斯特洞穴的康养适宜性。通过层次分析法确定三个指标权重分别为0.142、0.286、0.572。根据2017年8月至2018年7月的洞穴环境连续监测数据发现,天缘洞洞内氡浓度年均为610.26 Bq.m-3,洞内CO2浓度年均521.900 ×10-6,符合国际辐射安全要求,满足洞穴康养开展的前提条件;洞内年均温为14 ℃,相对湿度大,人体气候舒适度相对较低;洞内正负离子含量在时间与空间上都存在较大幅度的变化,负离子浓度空间分布规律存在以TY-4地下湖为中心向洞口方向逐渐递减趋势,天缘洞4-9月全洞段空气负离子含量较高,空气清洁度指数均高于1.00,属于最清洁空气,极有利于人体健康。天缘洞全年的洞穴康养功能指数显示天缘洞最佳洞穴康养时间为5月与9月,最佳康养地点位于TY-4地下湖附近,仅有12月与1月不适宜开展洞穴康养活动。      

Township ecosystem health assessment based on fuzzy synthesis evaluation method: a case study of Tongzhou District, Beijing, China

With the quick development of urbanization, the urban environmental problem has broken out in rural towns. In this study, a reasonable review of the research progress in the field of urban ecosystem health was addressed. Based on the analysis of the structure-function characteristics of the compound ecosystem, the connotation of the township ecosystem health was determined. Then ecosystem health of eleven towns of Tongzhou District was evaluated. This was accomplished by first constructing an index system including three layers which were criterion, factor and index. The criterion layer contained five elements including vigor, organization structure, resilience, ecosystem service function and population health. The indicators amounted in the aggregate to twenty-two. Then the health assessment of the study area was carried out using the fuzzy synthesis evaluation method. The evaluation results were analyzed by GIS techniques. Comprehensive analysis for integral health has shown that eight towns are in sub-healthy conditions, and the other three towns of Songzhuang, Xiji and Yongledian are healthy.     

Locating diversity: race,nativity and place in health disparities research

Nancy Krieger has been one of the leading voices in documenting how social ‘axes of difference’, including race, ethnicity and class make people vulnerable to poor health and limit their access to effective health care. We discuss the importance of ‘locating’ diversity in health inequalities research. This includes critically dissecting racial and ethnic axes into more nuanced social categories that incorporate differences based on immigration and other factors. It also involves considering how diverse population groups vary in their perception and use of space for health-related activities and exposures. Examples relating to immigrant populations’ health and access to health care are discussed.