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Adult Day Health Care Bác sĩ Nguyễn văn Đức Vài năm nay, một tệ trạng làm buồn lòng không ít những người bác sĩ đàng hoàng hiểu biết sự việc, tệ trạng “Adult Day Health Care Center”. Buồn lòng vì thấy những lạm dụng chướng tai gai mắt của một số Adult Day Health Care Centers, và cũng buồn lòng vì nhiều vị bệnh nhân của mình đem giấy tờ của các chỗ này đến nhờ điền để được vào chơi trong các chỗ này, khi giải thích là không thể làm vậy vì vị bệnh nhân không đủ các điều kiện đòi hỏi, vị bệnh nhân không vui nghĩ bác sĩ khó, thậm chí có người còn lớn tiếng hoạnh họe bác sĩ sao không chịu ký, dọa sẽ đi bác sĩ khác. Mọi chuyện chính phủ cho lập ra đều có mục đích, có những điều kiện đòi hỏi hẳn hoi. Và tất nhiên, dịch vụ nào cũng tốn kém, tiêu vào ngân quĩ tiểu bang, chúng ta phải dùng cho đúng. Danh dự của người bác sĩ trong chữ ký, chiều lòng người bệnh đặt bút xuống để ký chứng nhận gian là điều đáng xấu hổ, không những vậy, còn có thể lôi thôi với pháp luật. Luật pháp rất trọng chữ ký của người bác sĩ, cho người bác sĩ nhiều quyền hạn trong lãnh vực sức khỏe, nhưng cũng sẵn sàng tước bỏ những quyền hạn này nếu có chứng cớ người bác sĩ gian giảo. Adult Day Health Care (chăm sóc sức khỏe ban ngày dành cho người lớn) là một dịch vụ hữu ích, các Adult Day Health Care Centers được chính phủ tiểu bang California cho phép lập ra, với mục đích giúp những người thụ hưởng MediCal (không nhất thiết phải cao niên) vì bệnh tật, thể xác hoặc tinh thần, không thể tự ăn uống, chăm sóc cho mình ở nhà lúc ban ngày ban mặt. Thiếu dịch vụ Adult Day Health Care, tình trạng sức khỏe của các vị này sẽ suy sụp, khiến các vị có thể sẽ phải rời nhà vào phòng cấp cứu, vào bệnh viện, hoặc nursing home. Mỗi ngày, chính phủ trả tiền cho những dịch vụ cung cấp giúp những người đủ điều kiện được chăm sóc trong các Adult Day Health Care Centers. Số tiền này không nhỏ, và cũng không phải đây là tiền tự nhiên từ trên trời rơi xuống, mà là tiền của những người công dân Mỹ đóng thuế chúng ta. Như vậy, một vị cao niên khỏe mạnh, tự gọi phòng mạch lấy hẹn rồi đi bộ, đi xe đạp, đi xe buýt, đi xe nhà, cầm giấy tờ của Adult Day Health Care Center đến nhờ bác sĩ chứng để vào chỗ này, chẳng bác sĩ đàng hoàng và hiểu biết nào dám ký. Một số các Adult Day Health Care Centers họ cũng biết thừa điều này (vì họ có các tiêu chuẩn đòi hỏi của chính phủ trong tay), nhưng cứ đưa giấy tờ cho các vị cao niên, bảo các vị đến bác sĩ, biết đâu gặp một bác sĩ không biết rõ các điều kiện đòi hỏi nên ký, hoặc thường hơn, một bác sĩ quen chiều lòng bệnh nhân (cho thuốc lung tung, cho thử máu, cho chụp phim không cần thiết, cho sữa, cho giường, cho xe lăn, cho đủ thứ) sẽ ký bừa. Theo California Association for Adult Day Services (Hiệp Hội Cung Ứng Dịch Vụ Cho Người Lớn của California), dưới đây là 5 tiêu chuẩn (criteria) cần hội đủ để được săn sóc trong các Adult Day Health Care Centers. Tiêu chuẩn 1 Người bệnh cần được chăm sóc trong Adult Day Health Care Center vì đang hay đã từng bị một hay nhiều tình trạng bệnh tật thể xác hoặc tinh thần nên nay phải được: - Theo dõi (monitoring): liệt kê tình trạng bệnh - Chữa trị (treatment): liệt kê tình trạng bệnh - Chăm sóc, giúp đỡ (intervention): liệt kê tình trạng bệnh Trong mục này, phải liệt kê các tình trạng bệnh hiện tại hay trong quá khứ khiến người bệnh nay đang cần được theo dõi, chữa trị, chăm sóc, giúp đỡ. Tiêu chuẩn 2 Người bệnh bị một tình trạng sức khỏe khiến khó có thể tự mình làm được 2 hay nhiều hơn các việc dưới đây: - Tắm rửa - Mặc áo quần - Đi lại - Ăn uống - Tiêu tiểu - Rời khỏi giường - Đến các cơ sở y tế (đi bác sĩ, đến phòng thí nghiệm để thử máu, …) - Làm công việc nhà - Làm các công việc vệ Global Health Global Health Bởi: OpenStaxCollege Social epidemiology is the study of the causes and distribution of diseases Social epidemiology can reveal how social problems are connected to the health of different populations These epidemiological studies show that the health problems of highincome nations differ greatly from those of low-income nations Some diseases, like cancer, are universal But others, like obesity, heart disease, respiratory disease, and diabetes are much more common in high-income countries, and are a direct result of a sedentary lifestyle combined with poor diet High-income nations also have a higher incidence of depression (Bromet et al 2011) In contrast, low-income nations suffer significantly from malaria and tuberculosis How does health differ around the world? Some theorists differentiate among three types of countries: core nations, semi-peripheral nations, and peripheral nations Core nations are those that we think of as highly developed or industrialized, semi-peripheral nations are those that are often called developing or newly industrialized, and peripheral nations are those that are relatively undeveloped While the most pervasive issue in the U.S health care system is affordable access to health care, other core countries have different issues, and semi-peripheral and peripheral nations are faced with a host of additional concerns Reviewing the status of global health offers insight into the various ways that politics and wealth shape access to health care, and it shows which populations are most affected by health disparities Health in High-Income Nations Obesity, which is on the rise in high-income nations, has been linked to many diseases, including cardiovascular problems, musculoskeletal problems, diabetes, and respiratory issues According to the Organization for Economic Cooperation and Development (2011), obesity rates are rising in all countries, with the greatest gains being made in the highest-income countries The United States has the highest obesity rate Wallace Huffman and his fellow researchers (2006) contend that several factors are contributing to the rise in obesity in developed countries: Improvements in technology and reduced family size have led to a reduction of work to be done in household production 1/5 Global Health Unhealthy market goods, including processed foods, sweetened drinks, and sweet and salty snacks are replacing home-produced goods Leisure activities are growing more sedentary, for example, computer games, web surfing, and television viewing More workers are shifting from active work (agriculture and manufacturing) to service industries Increased access to passive transportation has led to more driving and less walking Obesity and weight issues have significant societal costs, including lower life expectancies and higher shared healthcare costs High-income countries also have higher rates of depression than less affluent nations A recent study (Bromet et al 2011) shows that the average lifetime prevalence of major depressive episodes in the 10 highest-income countries in the study was 14.6 percent; this compared to 11.1 percent in the eight low- and middle-income countries The researchers speculate that the higher rate of depression may be linked to the greater income inequality that exists in the highest-income nations Health in Low-Income Nations In low-income countries, malnutrition and lack of access to clean water contribute to a high child mortality rate (Photo courtesy of Steve Evans/flickr) In peripheral nations with low per capita income, it is not the cost of health care that is the most pressing concern Rather, low-income countries must manage such problems as infectious disease, high infant mortality rates, scarce medical personnel, and inadequate water and sewer systems Such issues, which high-income countries rarely even think about, are central to the lives of most people in low-income nations Due to such health concerns, low-income nations have higher rates of infant mortality and lower average life spans One of the biggest contributors to medical issues in low-income countries is the lack of access to clean water and basic sanitation resources According to a 2011 UNICEF report, almost half of the developing world’s population lacks improved sanitation 2/5 Global Health facilities The World Health Organization (WHO) tracks health-related data for 193 countries In their 2011 World Health Statistics report, they document the following statistics: Globally, the rate of mortality for children under five was 60 per 1,000 live births In low-income countries, however, that rate is almost double at 117 per 1,000 live births In high-income countries, that rate is significantly lower than seven per 1,000 live births The most frequent causes of death for children under five were pneumonia and diarrheal diseases, accounting for 18 percent and 15 percent, respectively These deaths could be easily avoidable with cleaner water and ...Second BGSU International Management Conference Global Risk Management Hyatt Regency, Cleveland, OH 17-18 April 2002 Managing Global Financial Risk Using Currency Futures and Currency Options Sung C. Bae Ashel G. Bryan/Mid American Bank Professor Department of Finance Bowling Green State University Bae 2 Corporate Risk Financial Derivatives Commodity Risk · Risk associated with movement in commodity prices · Operational risk Commodity Price Derivatives · Ex-traded commodity futures · Ex-traded commodity options · Commodity swaps Interest Rate Risk · Risk associated with movement in interest rates · Financing and Investment risk Interest Rate Derivatives · Forward rate agreements · Ex-traded interest rate futures · Ex-traded interest rate options · Interest rate swaps · Over-the-counter (OTC) options Foreign Exchange Risk · Risk associated with movement in foreign exchange (currency) rates · Operational, financing, & investment risk Foreign Exchange Derivatives · Forward currency contracts · Ex-traded currency futures · Ex-traded currency options · OTC options · Currency swaps Corporate Risk Management Bae 3 What Derivatives U.S. Corporations Use? BI 1989 Greenwich 1992 II 1992 Treasury 1993 JKF 1995 Foreign Ex. Derivatives Forward contracts 99% 91% 64% 70% 93% Ex-traded futures/options 20 11 9 20/17 Currency swaps 64 51 6 53 OTC options 48 45 40 53 49 Interest Rate Derivatives Forward rate agreements (FRAs) 35 11 Ex-traded futures/options 25 12 29 17 Interest rate swaps 68 35 79 83 OTC Options (caps, etc.) 43 19 14 16 Commodity Price Deriv. Ex-traded futures/options 7 Commodity swaps 6 15 10 Equity Derivatives Ex-traded futures/options 10 3 Equity swaps 5 6 Bae 4 Hedging w/ Currency Futures Loss/ProfitProfit/LossNet position Long => BUYShort => SELLLater Short => SELLLongNow Loss/ProfitProfit/LossNet Position Short => SELLLong => BUYLater Long => BUYShortNow Futures Market Position Cash Market Position Bae 5 Case Study: Using Forward Prices to Reduce Capital Costs (1/5) Hewlett Packard (HP) Company: Type: Multinational corporation Major Products: computer, computer system, printer, electronic & analytical instruments Employees: 96,200 Annual Sales: $28,000,000 from 65 countries Sales distribution: US (50.1%), Europe (28.7%), Asia, Canada, and Latin America (21.2%) Bae 6 Case Study: Using Forward Prices to Reduce Capital Costs (2/5) Leybold Technologies Co. Sell a thin film deposition system Buys from a German company and has to pay in DM. HP Microwave Technology Division Quoted Prices in Purchasing Contract: •German DM: DM1,314,720 in four installments; fixed price •U.S. $: $792,000 (rate = DM1.660/$); varies based on rate on payment date. Bae 7 Case Study: Using Forward Prices to Reduce Capital Costs (3/5) 1990 1992 Annual Sales $15,000,000 $23,000,000 Capital Budget (equipment only) $10,000,000 ($2,500,000) $22,000,000 ($7,500,000) Foreign Sources of Equipment Purchases by MT Division Country Amount Percentage (%) Japan $4,500,000 60.0 Germany 1,200,000 16.0 Austria 1,000,000 13.3 England 800,000 10.7 Total $7,500,000 100.0% Sales and Capital Budget of Microwave Technology Division, HP Bae 8 Case Study: Using Forward Prices to Reduce Capital Costs (4/5) Hedging Through Forward Contracts: Payment rate DM1.66/$ Payment in $ 158,400 158,400 356,400 118,800 Total: $792,000 Actual rate 1.5701 1.4982 1.6122 1.7199 $ Equivalent 167,470 175,507 366,967 114,663 Total: $825,407 Profit (loss) $9,070 $17,107 $10,567 ($4,137) Net Profit = $32,607; 4.1% of total purchase amount Payment Schedule: 7/90 9/90 12/90 3/91 5/91 0 2 A Public Health Approach to Children’s Mental Health A Conceptual Framework Authors Jon Miles, PhD Searchlight Consulting LLC Rachele C. Espiritu, PhD Neal M. Horen, PhD Joyce Sebian, MS Ed Elizabeth Waetzig, JD National Technical Assistance Center for Children’s Mental Health Georgetown University Center for Child and Human Development A Public Health Approach to Children’s Mental Health A Conceptual Framework Authors Jon Miles, PhD Searchlight Consulting LLC Rachele C. Espiritu, PhD Neal M. Horen, PhD Joyce Sebian, MS Ed Elizabeth Waetzig, JD National Technical Assistance Center for Children’s Mental Health Georgetown University Center for Child and Human Development Support for this activity was provided by the Child, Adolescent and Family Branch, Division of Service and Systems Improvement and the Mental Health Promotion Branch, Division of Prevention, Traumatic Stress and Special Programs, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration (SAMHSA) Document Available from: National Technical Assistance Center for Children’s Mental Health Georgetown University Center for Child and Human Development Box 571485 Washington, DC 20057 Phone: 202-687-5000 Website: gucchd.georgetown.edu Suggested Citation: Miles, J., Espiritu, R.C., Horen, N., Sebian, J., & Waetzig, E. (2010). A Public Health Approach to Children's Mental Health: A Conceptual Framework. Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health. Georgetown University provides equal opportunity in its programs,activities, and employment practices for all persons and prohibits discrimination and harassment on the basis of age,color,disability,family responsibilities,gender identity or expression,genetic information, marital status,matriculation, national origin, personal appearance,political affiliation, race,religion, sex, sexual orientation,veteran status or another factor prohibited by law.Inquiries regarding Georgetown University’s non- discrimination policy may be addressed to the Director of Affirmative Action Programs,Institutional Diversity,Equity & Affirmative Action, 37th and O Streets, N.W.,Suite M36, Darnall Hall, Georgetown University,Washington,DC 20005. Acknowledgements vii Foreword ix Executive Summary xii CHAPTER 1: Introduction 1 A Vision for Children and Communities 1 A New Framework 3 Background 5 Children’s Mental Health Problems 5 The Evolution of Children’s Mental Health Care 7 Positive Mental Health as Distinct from Mental Health Problems 9 Shaping Environments and Skills to Optimize Children’s Mental Health 10 Children’s Mental Health Partnerships 11 Public Health Approach 12 “Surely the Time is Right” 13 Challenges to Overcome 15 CHAPTER 2: Laying the Foundation: Key Terms and Concepts 17 Key Terms and Concepts 18 Outcomes and Indicators Language 18 Intervention Language 25 Other Public Health Language 29 Summary 35 CHAPTER 3: Key Concepts of a Public Health Approach 37 Background 38 History of Public Health 38 Different Terms That Refer to Public Health 39 Defining Public Health and a Public Health Approach 39 Key Concepts 41 Population Focus 41 Promoting and Preventing 43 Determinants of Health 46 Process/Action Steps 48 Summary 50 iii A Public Health Approach to Children’s Mental Health:A Conceptual Framework Table of Contents CHAPTER 4: Applying a Public Health Approach to Children’s Mental Vision A world where people live healthier, safer and longer lives Mission Protect and improve health globally through science, policy, partnership and evidence-based public health action CDC Global Health Strategy 2012 - 2015 Center for Global Health Office of the Director Centers for Disease Control and Prevention Global Health Strategy 1 Table of Contents Foreword 3 Executive Summary 5 CDC Global Health Vision 8 Building on Existing Public Health Infrastructure 8 Strengthening Country Public Health Capacity 9 Shaping the Global Health Agenda in Collaboration with Partners 9 CDC Global Health Mission 10 CDC Core Technical Strengths 10 Providing Technical Expertise 11 Implementing Evidence-Based Public Health Programs 11 Developing Surveillance and Strategic Information Systems 11 Translating Research into Public Health Policy and Practice 11 Building Public Health Workforce Capacity 12 Strengthening Laboratory Systems 12 Improving Emergency Preparedness and Response Capabilities 12 Conducting Monitoring and Evaluation Activities 12 Partnerships 12 CDC Global Health Strategy 14 Goal 1: Health Impact: Improve the Health and Well-being of People around the World 16 Objective 1.1: Prevent New HIV Infections and Serve the Needs of HIV Positive Individuals Globally 16 Objective1.2: Reduce Tuberculosis Morbidity and Mortality 18 Objective 1.3: Reduce Malaria Morbidity and Mortality 19 Objective 1.4: Reduce Maternal and Perinatal Mortality 20 Objective 1.5: Reduce Child Morbidity and Mortality 21 Objective 1.6: Eliminate and Control Targeted Neglected Tropical Diseases 23 Objective 1.7: Control, Eliminate, or Eradicate Vaccine-Preventable Diseases 23 Objective 1.8: Reduce Burden of Non-Communicable Diseases 25 Centers for Disease Control and Prevention Global Health Strategy 2 Goal 2: Health Security: Improve Capabilities to Prepare and Respond to Infectious Diseases, Other Emerging Health Threats, and Public Health Emergencies 28 Objective 2.1: Strengthen Capacity to Prepare for and Detect Infectious Diseases and Other Emerging Health Threats 28 Objective 2.2: Respond to International Public Health Emergencies and Improve Country Response Capabilities 30 Goal 3: Health Capacity: Build Country Public Health Capacity 32 Objective 3.1: Strengthen Public Health Institutions and Infrastructure 32 Objective 3.2: Improve Surveillance and Use of Strategic Information 33 Objective 3.3: Build Workforce Capacity 34 Objective 3.4: Strengthen Laboratory Systems and Networks 35 Objective 3.5: Improve Research Capacity 36 Goal 4: Organizational Capacity: Maximize Potential of CDC’s Global Programs to Achieve Impact 38 Objective 4.1: Strengthen Organizational and Technical Capacity to Better Support CDC’s Global Health Activities 38 Objective 4.2 Enhance Communication to Expand the Impact of CDC’s Global Health Expertise 39 Conclusion 40 Appendix: Global Health Strategies, Frameworks, and Plans 41 Endnotes 45 Centers for Disease Control and Prevention Global Health Strategy 3 Foreword Since the creation of the Centers for Disease Control and Prevention (CDC) in 1946, the agency’s global health activities have expanded in scale, scope, and depth to address evolving health challenges and emerging threats around the world. From an early focus on malaria prevention and control in the United States, CDC’s efforts have expanded globally over time to encompass diverse diseases and conditions, protect the United States from external health threats, improve public health capacity internationally, and acquire science-based a report of the csis global health policy center December 2011 Author Janet Fleischman The Global Health Initiative in Malawi new approaches and challenges to reaching women and girls a report of the csis global health policy center The Global Health Initiative in Malawi new approaches and challenges to reaching women and girls December 2011 Author Janet Fleischman About CSIS At a time of new global opportunities and challenges, the Center for Strategic and International Studies (CSIS) provides strategic insights and bipartisan policy solutions to decisionmakers in government, international institutions, the private sector, and civil society. A bipartisan, nonprofit organization headquartered in Washington, D.C., CSIS conducts research and analysis and develops policy initiatives that look into the future and anticipate change. Founded by David M. Abshire and Admiral Arleigh Burke at the height of the Cold War, CSIS was dedicated to finding ways for America to sustain its prominence and prosperity as a force for good in the world. Since 1962, CSIS has grown to become one of the world’s preeminent international policy institutions, with more than 220 full-time staff and a large network of affiliated scholars focused on defense and security, regional stability, and transnational challenges ranging from energy and climate to global development and economic integration. Former U.S. senator Sam Nunn became chairman of the CSIS Board of Trustees in 1999, and John J. Hamre has led CSIS as its president and chief executive officer since 2000. CSIS does not take specific policy positions; accordingly, all views expressed herein should be understood to be solely those of the author(s). © 2011 by the Center for Strategic and International Studies. All rights reserved. Cover photo credit: Woman carries water from the village pump, Khulungira, Malawi, May 18, 2009; http://www.flickr.com/photos/ilri/4573801279/. Center for Strategic and International Studies 1800 K Street, NW, Washington, DC 20006 Tel: (202) 887-0200 Fax: (202) 775-3199 Web: www.csis.org | 1 embedd Janet Fleischman 1 Introduction The Obama administration designated Malawi as a GHI Plus country in June 2010, one of the first eight countries selected to implement the Global Health Initiative’s (GHI) more comprehensive approach to global health and serve as learning labs for other GHI country programs. 2 The GHI team in Malawi has identified the health of women and girls, including HIV and family planning (FP)/reproductive health (RH) services, as critical, promising areas for GHI success. Though still in early stages of implementation, new approaches are emerging in Malawi that leverage resources from the President’s Emergency Plan for AIDS Relief (PEPFAR) to develop greater program synergies for women and girls. Yet Malawi’s weak health system, combined with ever more serious concerns about governance and human rights issues that are undermining donor support, present challenges that may threaten GHI’s ability to achieve sustainable results. Although over half of U.S. funding to Malawi is focused on HIV/AIDS, Malawi was not one of the original PEPFAR focus countries. 3 The U.S. government has relatively balanced health and development funding in Malawi, which gives the GHI comparatively greater potential for impact than in neighboring countries where U.S. flexibility is limited because funding is effectively tied to 1 Janet Fleischman is a senior associate with the CSIS Global Health Policy ... population lacks improved sanitation 2/5 Global Health facilities The World Health Organization (WHO) tracks health- related data for 193 countries In their 2011 World Health Statistics report, they document... Research Study this map on global life expectancies: http://gamapserver.who.int/mapLibrary/ Files/Maps /Global_ LifeExpectancy_2009_bothsexes.png What trends you notice? 4/5 Global Health References Bromet... (http://www.unicef.org/wash) World Health Organization 2011 “World Health Statistics 2011.” Retrieved December 12, 2011 (http://www.who.int/gho/publications/world _health_ statistics/ EN_WHS2011_Part1 .pdf) 5/5