Suchergebnisse

Over 83% of major diseases are environmentally mediated. These environmental factors include access to clean air and water, nutritional food, adequate shelter and access to health care. As health care systems across the globe struggle to include not only preventive health, but also health literacy in their approaches, it has become apparent that the most feasible system to combine all of these necessities is the universal health care/coverage (UHC) approach. This system also ensures that everyone has access to health services without financial hardship. It is imperative that environmental health (EH) is included in this approach, however, considering the global burden of disease due to environmental health factors. Epidemiological evidence-based approaches such as Water, Sanitation and Hygiene (WASH), have proven the advantage of utilizing these environmental health practices. In order to integrate EH into UHC, a dual multipronged (preventive and clinical) approach can be implemented; however, many are using a multisectoral approach due to the array of public-private partnerships which aid in its success. In alignment with the Millennium and Sustainable Development Goals, nations must make strides to address health disparities, chronic disease and poverty. Low and middle income countries (LMIC) are disproportionately burdened by economic insecurity, global pollution and preexisting issues within their government infrastructure, creating the worst health outcomes in these nations. Bangladesh has some of the worst chronic disease morbidities in the world due to indoor air pollution, rural and urban health disparities and food insecurity. Although the nation has begun to integrate EH into UHC, better coordination among ministries implementing health care is necessary, along with increased monetary allocation from the government. There is also a dire need for more health care providers who possess appropriate skills to work in the public sector. Lastly, more equitable access to services in both rural and urban areas and an improved financing mechanism must be instilled to successfully implement this EH/UHC approach.

The United States (U.S.) currently ranks number one in the world in both the quantity of privately owned guns and the rate of private gun ownership. These privately owned firearms, which include rifles, shotguns and handguns, are predominantly owned by middle-aged, 35-54, white men, but the gaps have been steadily closing over the years, especially depending on the type of firearm, in all areas including gender, age, race, education level, political affiliation and geographic location. Gun violence is a leading cause of injury death in the U.S. In examining gun violence and potentially reducing its incidence, this article reviews gun ownership, access and utilization in the U.S., outcomes of gun violence, and the impact of community involvement in reducing gun violence. Specific areas of focus include the current state of background checks, with a focus on mental illness, and the role of medical professionals in guiding gun policy development. Gun violence continues to negatively impact the safety of individuals, families and communities. This article will emphasize the importance of social mobilization in enacting meaningful changes in gun policy and the development of relationships among healthcare professionals, social workers, and community members so as to further reduce and/or prevent gun violence.

Outlined in Sustainable Development Goal 3.8, universal health coverage (UHC) ensures all people can access affordable and equitable essential health services without facing economic challenges. Advised by the World Health Organization (WHO), countries can strengthen their health systems and subsequently UHC by establishing a robust health system on a framework of service delivery; health workforce; information; medical products, vaccines and technologies; financing; and leadership and governance. By achieving UHC, countries progress in other health-related goals and provide for healthier children, a stronger workforce and long-term economic development. As announced by Prime Minister Sheikh Hasina in 2011, Bangladesh has remained committed towards UHC through the implementation of programs that increase availability and financial accessibility of essential health services. To produce information regarding their contribution to UHC and specifically the work of its health facilities, Bangladesh produced the 2017 Bangladesh health facilities survey (BHFS). Based on a qualitative analysis, the 2017 BHFS provides substantial information regarding the presence of essential services within different facilities and locations. However, the survey inadequately addresses other components that contribute to availability and accessibility of services, including utilization, patient load, quality of care and financial burden. Subsequently, the 2017 BHFS does not provide a comprehensive evaluation of their health facilities and their contribution to UHC. Arguably, a future survey must address these topics and incorporate a multidisciplinary approach to successfully implement UHC. This approach would incorporate multidisciplinary stakeholders including economists, public health figures and politicians to address challenges such as financial burden, public distrust, and qualified training of providers.

Abstract
Climate change is adversely impacting the burden of diarrheal diseases. Despite significant reduction in global prevalence, diarrheal disease remains a leading cause of morbidity and mortality among young children in low- and middle-income countries. Previous studies have shown that diarrheal disease is associated with meteorological conditions but the role of large-scale climate phenomena such as El Niño-Southern Oscillation (ENSO) and monsoon anomaly is less understood. We obtained 13 years (2002–2014) of diarrheal disease data from Nepal and investigated how the disease rate is associated with phases of ENSO (El Niño, La Niña, vs. ENSO neutral) monsoon rainfall anomaly (below normal, above normal, vs. normal), and changes in timing of monsoon onset, and withdrawal (early, late, vs. normal). Monsoon season was associated with a 21% increase in diarrheal disease rates (Incident Rate Ratios [IRR]: 1.21; 95% CI: 1.16–1.27). El Niño was associated with an 8% reduction in risk while the La Niña was associated with a 32% increase in under-5 diarrheal disease rates. Likewise, higher-than-normal monsoon rainfall was associated with increased rates of diarrheal disease, with considerably higher rates observed in the mountain region (IRR 1.51, 95% CI: 1.19–1.92). Our findings suggest that under-5 diarrheal disease burden in Nepal is significantly influenced by ENSO and changes in seasonal monsoon dynamics. Since both ENSO phases and monsoon can be predicted with considerably longer lead time compared to weather, our findings will pave the way for the development of more effective early warning systems for climate sensitive infectious diseases.