Contributions of social medicine and systems analysis to formulating objectives for a community-based cancer prevention programme

Review Article: Learning and knowledge-production for public health: a review of approaches to evidence-based public health

Public health needs to be evidence-based if it is to be done correctly, which means that learning and knowledge-production for public health must be comprehensive and include knowledge from four different domains: distribution of health, determinants or causal web, consequences, and intervention methods. Specification of development trends in cardiovascular prevention points at four generations of preventive programs; these include a clinical, a bioepidemiological, a socioepidemiological, and an environmental and policy-oriented generation. Generations differ in focus and strategy, in knowledge base - the art of making an impact - and evaluation. Comprehensive public health programs often comprise components from different generations, leading to the need for an expanded model for research and evaluation. There is an urgent need for learning and knowledge-production using both quantitative and qualitative approaches for developing the evidence base for public health action. In addition, epidemiological knowledge is necessary for making appropriate priorities.

Social context for workplace health promotion: feasibility considerations in Costa Rica, Finland, Germany, Spain and Sweden

We constructed a simple, flexible procedure that facilitates the pre-assessment of feasibility of workplace health promotion (WHP) programmes. It evaluates cancer hazards, workers' need for hazard reduction, acceptability of WHP, and social context. It was tested and applied in 16 workplace communities and among 1085 employees in industry, construction, transport, services, teaching and municipal works in Costa Rica, Finland, Germany, Spain and Sweden. Social context is inseparable from WHP. It covers workers' organizations and representatives, management, safety committees, occupational health services, health and safety enforcement agencies, general health services, non-government organizations, insurance systems, academic and other institutions, regulatory stipulations pertaining WHP, and material resources. Priorities, risk definitions, attitudes, hazard profiles, motivations and assessment methods were highly contextual. Management preferred passive interventions, helping cover expert costs, participating in planning and granting time. Trade unions, workers' representatives, safety committees and occupational health services appeared to be important operational partners. Occupational health services may however be loaded with curative and screening functions or be non-existent. We advocate participatory, multifaceted WHP based on the needs and empowerment of the workers themselves, integrating occupational and lifestyle hazards. Workforce in irregular and shift work, in agriculture, in small enterprises, in the informal sector, and immigrant, seasonal and temporary workers represent groups in need of particular strategies such as community health promotion. In a more general framework, social context itself may become a target for intervention.

Emergency medical service systems research: problems of the past, challenges of the future

Out-of-hospital emergency care was designed around the concept of a system of interrelated events that combine to offer a patient the best care possible outside the hospital. However, in contrast to the actual operations of emergency medical service (EMS) systems, research has not typically used systems-based models as the method for evaluation. In this discussion we outline the weaknesses of component-based research models in EMS evaluation and attempt to provide a "systems-analysis" framework that can be used for future research. Incorporation of this multidiscipline approach into EMS research is essential if there is to be any hope of finding answers to many of the important questions that remain in the arena of out-of-hospital health care.

Creating partnership with the food industry in the Stockholm cancer prevention program

To facilitate the supply of healthful foods in institutional kitchens and restaurants, the Stockholm Cancer Prevention Program (SCPP) produced a cookbook in collaboration with the food industry and the SCPP. Fifty different organizations participated in this work. The development of the cookbook was made in several steps and started with a recipe contest to engage chefs and employees in restaurants and institutional kitchens. Criteria for the recipes were that they should present low-fat/high-fiber meals. Complementary recipes were received from the food industry. All recipes were tested in 20 restaurants and institutional kitchens and 11,000 lunch guests assessed the palatability of the dishes. The cookbook was presented in conjunction with a food fair in 1989 and has until now been sold in about 4,000 copies. Production of a cookbook can thus be a focal point for involving food industry, restaurants and institutional kitchens in a community intervention program aiming at a change of dietary habits.