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Barriers to interventions aimed at promoting the health of health care workers in Brazil

REINHARDT, Erica Lui; FISCHER, Frida Marina
Fonte: PAN AMER HEALTH ORGANIZATION Publicador: PAN AMER HEALTH ORGANIZATION
Tipo: Artigo de Revista Científica
POR
Relevância na Pesquisa
45.97%
Objective. To search the literature for circumstances that impede injury and disease prevention and other activities intended to improve the health of the health care worker. Methods. The SciELO database was searched for articles published in 1967-2008. This was supplemented by a PubMed search for the period 1950-2008. The following key words were used to identify articles in English, Portuguese, and Spanish: work, health personnel, occupational, risks, diseases, ergonomics, work ability, quality of life, organization, accidents, work conditions, intervention, and administration. Articles on injury and disease prevention and occupational health in a health care setting in Latin America were selected, along with articles focused on health promotion in the health sector. Results. The following shortcomings were identified: activities lacked a sound theoretical foundation and were not integrated with the health services management; a failure to evaluate the effectiveness of the activity; health surveillance focused solely on a specific disease or injury; management not committed to the proposed activity; miscommunication; inability of workers to participate, or control the work environment; and, programs or efforts that were limited to changing the workers` behaviors. Conclusions. The literature shows that all the barriers identified by this study affect both the health care workers` health as well as their productivity.

Identifying Priority Health Conditions, Environmental Data, and Infrastructure Needs: A Synopsis of the Pew Environmental Health Tracking Project

Litt, Jill; Tran, Nga; Malecki, Kristen Chossek; Neff, Roni; Resnick, Beth; Burke, Thomas
Fonte: National Institue of Environmental Health Sciences Publicador: National Institue of Environmental Health Sciences
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
45.97%
In this article we describe the methodologic approaches of the Pew Environmental Health Commission at the Johns Hopkins Bloomberg School of Public Health used to identify priority environmental health conditions and develop recommendations to establish a national environmental public health tracking network. We present the results of a survey of public health and environmental practitioners to uncover state and local health tracking needs and priorities. We describe the steps that combined the findings from the state and local health tracking survey and a review of the state of the science on environmental impacts on health to identify priority health end points. Through an examination of national health and health care databases, we then describe trends and public health effects of those diseases that may be linked to the environment. Based on this analysis, respiratory diseases and neurologic diseases are recommended as priorities for tracking. Specific end points recommended for tracking include asthma and chronic respiratory diseases, and chronic neurodegenerative diseases such as multiple sclerosis. Based on trends in reported prevalence, consideration should also be given to developmental disabilities, reproductive disorders...

Self-reported health status and lifestyle behaviours of the residents of the Town of Fort Erie, Ontario, as related to the Canadian Community Health Survey

Morris-Tries, Deanna Elizabeth.
Fonte: Brock University Publicador: Brock University
Tipo: Electronic Thesis or Dissertation
ENG
Relevância na Pesquisa
45.98%
The purpose of this cross sectional survey design was to examine self-reported health status and lifestyle behaviours of the residents of the Town of Fort Erie, Ontario, as related to the Canadian Community Health Survey. Using a mail-out survey, entitled the Fort Erie Survey of Health (FESH), a probability cluster sampling technique was used to measure self-reported health status (present health, health conditions, health challenges, functional health limitations) and lifestyle behaviour (smoking, alcohol use, drug use, physical activity, fruit and vegetable consumption, body weight, and gaming). Each variable was described and analyzed in relation to socio-economic variables, age and gender. The findings from this study were compared to the Canadian Community Health Survey 2000/2001. Overall, 640 surveys were completed. The majority of Fort Erie residents rated their present health as good and were satisfied with their overall health and quality of life. The main chronic conditions reported were arthritis, back pain and heart disease. Other main health problems reported were vision, sleeping and chronic pain. Overall, 14.6% smoke; 58.8% engaged in physical activity either occasionally or never as opposed to regularly engaging in physical activity; 52.1% did not eat the required daily fruits and vegetables; and 40.0% were in the overweight category. Persons who practiced one healthy lifestyle behaviour were more likely to practice other healthy promoting behaviours. Therefore...

Early-age mortality, socio-economic development and the health system in Mongolia

Neupert, Ricardo F
Fonte: Health Transition Centre, National Centre for Epidemiology and Population Health, Publicador: Health Transition Centre, National Centre for Epidemiology and Population Health,
Tipo: Artigo de Revista Científica Formato: 70742 bytes; application/pdf
EN_AU
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45.97%
Since the 1920s Mongolia has developed an extensive and well-staffed health care system that has made modern health technologies accessible to most of its population. In addition, the country experienced rapid economic and social development whose benefits were equitably distributed among the population. In spite of this progress, infant and child mortality levels are high by contemporary standards and during the past 20 years these rates have remained virtually constant. The modern health care delivery system, externally imposed, failed to take into account the specific characteristics of the Mongolian culture; this fact is identified as one of the major determinants of the unexpected levels of early-age mortality. The excessive orientation toward curative medicine, the lack of health prevention and promotion activities and the lack of community participation have resulted in the people continuing to believe in traditional therapeutic patterns and self-care. They perceive the modern system exclusively in curative terms and not with regard to health preservation and disease prevention. Most Mongolians do not fully understand the health care system, and use its services mainly because they have no alternative, or because of coercion rather than conviction based on the learning and internalization of its basic principles. In practices and ideas of child care...

Mental health status of the South Australian population

Taylor, A.; Wilson, D.; DalGrande, E.; Ben-Tovim, D.; Elzinga, R.; Goldney, R.; McFarlane, A.; Cheok, F.; Kirke, D.
Fonte: Public Health Assoc Australia Inc Publicador: Public Health Assoc Australia Inc
Tipo: Artigo de Revista Científica
Publicado em //2000 EN
Relevância na Pesquisa
45.97%
OBJECTIVE: To determine, by the use of a telephone survey, the mental health status of SA adults (18+ years) using the GHQ-28, SF-12 and self-report as indicators of mental health, and to examine risk factors for mental health morbidity. SAMPLE: A random representative sample of South Australian adults selected from the Electronic White Pages. Overall, 2,501 interviews were conducted (74.0% response rate). RESULTS: Overall, 19.5% of respondents had a mental health problem as determined by the GHQ-28, 11.8% as determined by the mental health component summary score of the SF-12 and 11.9% self-reported a mental health condition. The percentage of people with a mental health problem who had used a psychologist or a psychiatrist in the previous 12 months was 9.6% for people diagnosed by the GHQ-28, 16.2% by SF-12 and 23.7% for self-report. The logistic regression analyses undertaken to describe people with a mental health problem as determined by the GHQ-28 and to describe people who visited a psychologist or psychiatrist produced different age categories, demographic and co-morbidity indicators. Variables found in both analyses included living in the metropolitan area, being economically inactive and being a high user of health services. CONCLUSIONS: One in five South Australian adults has a mental problem. Although the prevalence is higher for younger age groups...

Tantalus and the Tyranny of Territory: Pursuing the dream of parity in rural and metropolitan population health outcomes through effective primary health care programmes

Harvey, P.
Fonte: Australian Journal Primary Health, Australian Institute Primary Care & School Public Health Publicador: Australian Journal Primary Health, Australian Institute Primary Care & School Public Health
Tipo: Artigo de Revista Científica
Publicado em //2004 EN
Relevância na Pesquisa
45.98%
Many health professionals and rural health academics are motivated by the challenge of achieving equitable access to health care in rural communities with the implicit vision that fairer access to services might ultimately lead to more equitable health outcomes for people living in rural and remote settings. The purpose of this paper is to put the issue of rural and urban health outcome parity into perspective and assess recent progress towards achieving the ultimate goal of improving rural health status. I will also explore ways in which rural communities might increase their access to and use of primary health care revenue in the future to improve community health outcomes. While some improvements have been achieved across the rural health system in recent times, the fundamental problem of maintaining infrastructure to service community needs in rural areas remains as daunting as ever. Extensive evidence has now been assembled to show that rural people generally enjoy a much lower standard of health care, health outcomes and life expectancy than their urban cousins. The question underlying all of this evidence, however, is... must this always be so? Is it possible to redress the current inequities between rural and urban populations and could new primary health care initiatives...

Assessment of Systems for Paying Health Care Providers in Mongolia; Implications for Equity, Efficiency and Universal Health Coverage

Joint Learning Network; Mongolia Ministry of Health; World Bank; World Health Organization
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Report; Economic & Sector Work :: Policy Note; Economic & Sector Work
ENGLISH; EN_US
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46%
Achieving access to basic health services for the entire population without risk of financial hardship or impoverishment from out-of-pocket expenditures (‘universal health coverage’ or UHC) is a challenge that continues to confront most low- and middle-income countries. As coverage expands in these countries, issues of financial sustainability, efficiency, and quality of care quickly rise to the surface. Strategic health purchasing is an important lever to efficiently manage funds for UHC through the definition of what is purchased (which services and benefits the covered population is entitled to receive), from whom services are purchase (which providers are contracted to deliver the covered services), and how and how much the providers are paid. The assessment was conducted to help inform the design and implementation of Mongolia’s provider payment systems going forward. Health care provider payment systems, the way providers are paid to deliver the covered package of services, are an important part of strategic purchasing to balance system revenues and costs in a way that creates incentives for providers to improve quality and deliver services more efficiently. This ultimately makes it possible to expand coverage within limited funds (Langenbrunner...

Undergraduate public health education: a workforce perspective

Houghton, S.; Braunack-Mayer, A.; Hiller, J.
Fonte: Public Health Assoc Australia Inc Publicador: Public Health Assoc Australia Inc
Tipo: Artigo de Revista Científica
Publicado em //2002 EN
Relevância na Pesquisa
45.98%
OBJECTIVE: To describe the career paths of students who majored in public health at the undergraduate level and to assess the skills and knowledge these graduates believed were most useful to them in the public health workforce. METHOD: A telephone survey was conducted of all graduates from Adelaide University's Bachelor of Health Sciences degree from 1992-99 who had majored in public health (124 graduates). RESULTS: The response rate to the graduate survey was 71%. Using the definition of public health functions from the National Delphi Study on Public Health Functions to delineate the public health workforce, 59% of respondents were employed in public health. Graduates working in public health valued generic skills such as communication and collaboration more highly than more specific public health skills and knowledge areas. However, they also believed their undergraduate course would have been improved by a more practical orientation. CONCLUSIONS: A high proportion of graduates from this generalist degree who major in public health find employment in the public health workforce. They greatly value the generic skills associated with their undergraduate public health education and believe their entry into the workforce would have been further facilitated by stronger links between their academic program and the working environment of public health professionals. IMPLICATIONS: Studies of workforce training programs in public health must differentiate between the educational needs of undergraduate and postgraduate students. In particular...

"If we can't measure it, we can't do it". The role of health outcomes in community and allied health service accountability

Nancarrow, Susan Alison
Fonte: Universidade Nacional da Austrália Publicador: Universidade Nacional da Austrália
Tipo: Thesis (PhD); Doctor of Philosophy (PhD)
Relevância na Pesquisa
45.98%
Health outcomes fulfill a number of roles in the health sector. Economists, clinicians, researchers and managers use health outcomes in a range of different contexts for distinct purposes. New management approaches that use contracts as the basis for health service accountability have attempted to take health outcomes from their clinical role into a management setting. In particular, the purchasers and managers of some health services expect that service providers should demonstrate that they improve the health outcomes of their patients to justify their on-going funding. However, a number of organisations have experienced barriers to the application of the outcomes approach to health service management and there has been no systematic evaluation of the approach. Nor has there been an investigation into why purchasing organisations have difficulty introducing health outcomes into purchasing contracts. The result is that managers and purchasers continue to assign resources to the pursuit of health outcomes as an accountability tool. This thesis addresses two research questions around the use of health outcomes in community and allied health service accountability. The first is the barriers to the application of health outcomes to health services accountability. The second question examines the conditions that must be met before health outcomes can be used as an accountability tool in purchasing contracts for allied health. The research questions are addressed through the analysis of case studies that explore systematically the approach taken by two organisations...

A needs assessment of public health professionals: supporting the implementation of Ontario 2010 revised elementary health and physical education curriculum

Angra, Ishan
Fonte: Brock University Publicador: Brock University
Tipo: Electronic Thesis or Dissertation
ENG
Relevância na Pesquisa
45.97%
Based on the Comprehensive School Health framework, Ontario's Foundations for a Healthy School (2009) outlines an integrated approach to school health promotion. In this approach the school, community and partners (including public health) are fully engaged With a common goal of youth health. With the recent introductions of the Ontario Public Health Standards (2009) and the revised elementary health and physical education curriculum (2010), the timing for a greater integration of public health with schools is ideal. A needs assessment was conducted to identify the perceived support required by public health professionals to implement the mandates of both policy documents in Ontario. Data was collected for the needs assessment through facilitated discussions at a provincial roundtable event, regional focus groups and individual interviews with public health professionals representing Ontario's 36 public health units. Findings suggest that public health professionals perceive that they require increased resources, greater communication, a clear vision of public health and a suitable understanding of the professional cultures in which they are surrounded in order to effectively support schools. This study expands upon these four categories and the corresponding seventeen themes that were uncovered during the research process.

The role of self-presentation in adolescent health risk behaviours

Roth, Kelly.
Fonte: Brock University Publicador: Brock University
Tipo: Electronic Thesis or Dissertation
ENG
Relevância na Pesquisa
45.97%
Self-presentation has been identified as playing a key role in the perfonnance of various potentially hazardous health behaviours such as substance abuse, eating disorders and reckless behaviours (Leary, Tchividjian, & Kraxberger, 1994; Martin & Leary, 2001; Martin, Leary, & O'Brien, 2001). The present study investigated the role of selfpresentation on adolescent health-risk behaviours. Specifically, this study examined the prevalence of adolescent identified health-risk behaviours rooted in self-presentational motives in youths aged 13-18 years. The current study also identified the specific images associated with these behaviours desired by youth, and the targets of these behaviours. Also, the relationship between these behaviours, and several trait measures (social physique anxiety, public-self consciousness, fear of negative evaluations, selfpresentational efficacy) of self-presentation were examined. Finally, the gender differences in health risk behaviours and self-presentational concerns were examined. Participants in the present study were 96 adolescent students, 34 male and 62 female, recruited from various private schools across Southern Ontario. Students ranged in age from 13 to 18 years for both males (M age = 15.81 years...

Exploring Chinese-Canadians' perspectives on health : a quantitative study

Chen, Dengshu.
Fonte: Brock University Publicador: Brock University
Tipo: Electronic Thesis or Dissertation
ENG
Relevância na Pesquisa
45.97%
Chinese have unique perspectives on health and illness, which is mostly umecognized by western medicine. Immigration may contribute to problems with health consultations, inconvenience, and dissatisfaction. As the largest visible minority in Canada, Chinese- Canadians' perspectives on health should be studied in order to help Chinese immigrants adapt to a new health-care and health-promotion system, and keep them healthy. A quantitative questionnaire was designed based on the findings from a pilot study and previous literature. A hundred participants were recruited from Toronto, Vancouver, Halifax, and St. Catharines. Descriptive analysis and correlation analysis were used to investigate the structure of the variables. Findings indicated that most oftheir attitudes and corresponding practices to the different health aspects were positive. The relation between dietary practices and attitude was only found in small cities. Their attitudes were impacted by their length of stay in Canada. Their attitudes to regularly timed meals and psychological consultation were related to their acculturation level, as was the regularity of their practice of dental flossing. Their self-evaluated general health levels were also found to be affected by their medical history...

Incorporating Environmental Health into Pediatric Medical and Nursing Education

McCurdy, Leyla Erk; Roberts, James; Rogers, Bonnie; Love, Rebecca; Etzel, Ruth; Paulson, Jerome; Witherspoon, Nsedu Obot; Dearry, Allen
Fonte: National Institute of Environmental Health Science Publicador: National Institute of Environmental Health Science
Tipo: Artigo de Revista Científica
EN
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45.97%
Pediatric medical and nursing education currently lacks the environmental health content necessary to appropriately prepare pediatric health care professionals to prevent, recognize, manage, and treat environmental-exposure–related disease. Leading health institutions have recognized the need for improvements in health professionals’ environmental health education. Parents are seeking answers about the impact of environmental toxicants on their children. Given the biologic, psychological, and social differences between children and adults, there is a need for environmental health education specific to children. The National Environmental Education and Training Foundation, in partnership with the Children’s Environmental Health Network, created two working groups, one with expertise in medical education and one with expertise in nursing education. The working groups reviewed the transition from undergraduate student to professional to assess where in those processes pediatric environmental health could be emphasized. The medical education working group recommended increasing education about children’s environmental health in the medical school curricula, in residency training, and in continuing medical education. The group also recommended the expansion of fellowship training in children’s environmental health. Similarly...

Changes Not for the Fainthearted: Reorienting Health Care Systems Toward Health Equity Through Action on the Social Determinants of Health

Baum, Fran E.; Bégin, Monique; Houweling, Tanja A. J.; Taylor, Sebastian
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
Publicado em /11/2009 EN
Relevância na Pesquisa
45.97%
Entrenched poor health and health inequity are important public health problems. Conventionally, solutions to such problems originate from the health care sector, a conception reinforced by the dominant biomedical imagination of health. By contrast, attention to the social determinants of health has recently been given new force in the fight against health inequity. The health care sector is a vital determinant of health in itself and a key resource in improving health in an equitable manner. Actors in the health care sector must recognize and reverse the sector's propensity to generate health inequity. The sector must also strengthen its role in working with other sectors of government to act collectively on the deep-rooted causes of poor and inequitable health.

Why Do Health Labour Market Forces Matter?

McPake, Barbara; Maeda, Akiko; Correia Araújo, Edson; Lemiere, Christophe; El Maghraby, Atef; Cometto, Giorgio
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Journal Article; Publications & Research :: Journal Article; Publications & Research
EN_US
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45.97%
Human resources for health have been recognized as essential to the development of responsive and effective health systems. Low- and middle-income countries seeking to achieve universal health coverage face human resource constraints – whether in the form of health worker shortages, maldistribution of workers or poor worker performance – that seriously undermine their ability to achieve well-functioning health systems. Although much has been written about the human resource crisis in the health sector, labor economic frameworks have seldom been applied to analyze the situation and little is known or understood about the operation of labor markets in low- and middle-income countries. Traditional approaches to addressing human resource constraints have focused on workforce planning: estimating health workforce requirements based on a country’s epidemiological and demographic profile and scaling up education and training capacities to narrow the gap between the “needed” number of health workers and the existing number. However, this approach neglects other important factors that influence human resource capacity, including labor market dynamics and the behavioral responses and preferences of the health workers themselves. This paper describes how labor market analysis can contribute to a better understanding of the factors behind human resource constraints in the health sector and to a more effective design of policies and interventions to address them. The premise is that a better understanding of the impact of health policies on health labor markets...

Poverty, equity, human rights and health

Braveman,Paula; Gruskin,Sofia
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2003 EN
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45.99%
Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions' work. Equity and human rights perspectives can contribute concretely to health institutions' efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing...

Oral health information systems - towards measuring progress in oral health promotion and disease prevention

Petersen,Poul Erik; Bourgeois,Denis; Bratthall,Douglas; Ogawa,Hiroshi
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2005 EN
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45.99%
This article describes the essential components of oral health information systems for the analysis of trends in oral disease and the evaluation of oral health programmes at the country, regional and global levels. Standard methodology for the collection of epidemiological data on oral health has been designed by WHO and used by countries worldwide for the surveillance of oral disease and health. Global, regional and national oral health databanks have highlighted the changing patterns of oral disease which primarily reflect changing risk profiles and the implementation of oral health programmes oriented towards disease prevention and health promotion. The WHO Oral Health Country/Area Profile Programme (CAPP) provides data on oral health from countries, as well as programme experiences and ideas targeted to oral health professionals, policy-makers, health planners, researchers and the general public. WHO has developed global and regional oral health databanks for surveillance, and international projects have designed oral health indicators for use in oral health information systems for assessing the quality of oral health care and surveillance systems. Modern oral health information systems are being developed within the framework of the WHO STEPwise approach to surveillance of noncommunicable...

Strategies and approaches in oral disease prevention and health promotion

Watt,Richard G.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2005 EN
Relevância na Pesquisa
45.98%
Oral health is an important element of general health and well-being. Although largely preventable, many people across the world still suffer unnecessarily from the pain and discomfort associated with oral diseases. In addition, the costs of dental treatment are high, both to the individual and to society. Effective evidence-based preventive approaches are needed to address this major public health problem. The aim of this paper is to outline public health strategies to promote oral health and reduce inequalities. An extensive collection of public health policy documents produced by WHO are reviewed to guide the development of oral health strategies. In addition a range of Cochrane and other systematic reviews assessing the evidence base for oral health interventions are summarized. Public health strategies should tackle the underlying social determinants of oral health through the adoption of a common risk approach. Isolated interventions which merely focus on changing oral health behaviours will not achieve sustainable improvements in oral health. Radical public health action on the conditions which determine unhealthy behaviours across the population is needed rather than relying solely on the high-risk approach. Based upon the Ottawa Charter...

A framework for assessing the performance of health systems

Murray,Christopher J.L.; Frenk,Julio
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2000 EN
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45.99%
Health systems vary widely in performance, and countries with similar levels of income, education and health expenditure differ in their ability to attain key health goals. This paper proposes a framework to advance the understanding of health system performance. A first step is to define the boundaries of the health system, based on the concept of health action. Health action is defined as any set of activities whose primary intent is to improve or maintain health. Within these boundaries, the concept of performance is centred around three fundamental goals: improving health, enhancing responsiveness to the expectations of the population, and assuring fairness of financial contribution. Improving health means both increasing the average health status and reducing health inequalities. Responsiveness includes two major components: (a) respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt attention, access to social support networks during care, quality of basic amenities and choice of provider). Fairness of financial contribution means that every household pays a fair share of the total health bill for a country (which may mean that very poor households pay nothing at all). This implies that everyone is protected from financial risks due to health care. The measurement of performance relates goal attainment to the resources available. Variation in performance is a function of the way in which the health system organizes four key functions: stewardship (a broader concept than regulation); financing (including revenue collection...

China's public health-care system: facing the challenges

Liu,Yuanli
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2004 EN
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45.98%
The severe acute respiratory syndrome (SARS) crisis in China revealed not only the failures of the Chinese health-care system but also some fundamental structural deficiencies. A decentralized and fragmented health system, such as the one found in China, is not well-suited to making a rapid and coordinated response to public health emergencies. The commercial orientation of the health sector on the supply-side and lack of health insurance coverage on the demand-side further exacerbate the problems of the under-provision of public services, such as health surveillance and preventive care. For the past 25 years, the Chinese Government has kept economic development at the top of the policy agenda at the expense of public health, especially in terms of access to health care for the 800 million people living in rural areas. A significant increase in government investment in the public health infrastructure, though long overdue, is not sufficient to solve the problems of the health-care system. China needs to reorganize its public health system by strengthening both the vertical and horizontal connections between its various public health organizations. China's recent policy of establishing a matching-fund financed rural health insurance system presents an exciting opportunity to improve people's access to health care.