International Journal of Environmental Research and Public Health
The Republic of Kazakhstan began undergoing a political, economic, and social transition after 19... more The Republic of Kazakhstan began undergoing a political, economic, and social transition after 1991. Population health was declared an important element and was backed with a substantial commitment by the central government to health policy. We examine key trends in the population health status of the Republic of Kazakhstan and seek to understand them in relation to the ongoing political, economic, and social changes in society and its aspirations in health policy. We used the Global Burden of Disease database and toolkit to extract and analyze country-specific descriptive data for the Republic of Kazakhstan to assess life expectancy, child mortality, leading causes of mortality, disability-adjusted life years, and causes and number of years lived with disability. Life expectancy declined from 1990 to 1996 but has subsequently recovered. Ischemic heart disease, stroke, and chronic obstructive pulmonary disease remain among the leading causes of death; child mortality for children un...
Objectives: Developmental processes influence the determinants of health and, consequently, human... more Objectives: Developmental processes influence the determinants of health and, consequently, human health. Yet, assessing human health impacts in impact assessment, with exception of health impact assessment, is still rather vague. Inclusion of Sustainable Development Goal indicators in environmental impact assessment (EIA) is an opportunity to enhance addressing human health in EIA practices.Methods: We reviewed a list of health-related targets and indicators for SDGs as defined by the Institute of Health Metrics and Evaluation (IHME) in Seattle, WA, United States with the aim of identifying those to be suggested as outcome indicators within EIA.Results: Among 42 health-related indicators, we identified 17 indicators which could be relevant for impact assessment procedures and categorized them into three groups: 1) direct health indicators (e.g., under five mortality). 2) complex indicators (e.g., cancer). 3) environmental determinant indicators (e.g., mean PM2.5).Conclusion: All 17...
Background: Despite improving trends, countries in Europe continue to face public-health challeng... more Background: Despite improving trends, countries in Europe continue to face public-health challenges. This study investigated the priorities of stakeholders for research to meet these challenges. Methods: Public-health research includes population-level and health-system research, but not clinical or biomedical research. The study drew on data from three surveys undertaken through collaboration in SPHERE (Strengthening Public Health Research in Europe). There was participation of ministries in 18 of 28 (64 % response) European countries, from 22 of 39 (56 % response) member national associations of the European Public Health Association, and from 80 civil society health organisations (53 % of members of the European Public Health Alliance) Results: Public-health research fields included disease control, health promotion and health services. Ministries of health, rather than ministries of science or education, mostly took responsibility for public-health research: they reported varied...
Background:When implementing public health interventions in practice, it is recommended to use re... more Background:When implementing public health interventions in practice, it is recommended to use research evidence and to include relevant stakeholders. This should ensure effective interventions but it can be challenging. This study investigates the use of knowledge and inclusion of stakeholders in three different public health interventions at the local government level in Denmark and discusses strategies for future improvements in the use of research evidence. Method:Based on a previous assessment of all public health interventions in Varde Municipality using the European Community Health Promotion Indicator Development Model (EUHPID model), three different types of interventions (one Health Promotion, one Health Protection, and one Disease Prevention) were chosen for a case study analysis. The data consisted of document reviews and interviews. Data were analysed by content analysis using a framework for Evidence Based Practice as a guiding tool. Discussion of strategies for future...
Solid medical waste (SMW) in households is perceived to pose minimal risks to the public compared... more Solid medical waste (SMW) in households is perceived to pose minimal risks to the public compared to SMW generated from healthcare facilities. While waste from healthcare facilities is subject to recommended safety measures to minimize risks to human health and the environment, similar waste in households is often untreated and co-mingled with household waste which ends up in landfills and open dumps in many African countries. In Ghana, the management of this potentially hazardous waste stream at household and community level has not been widely reported. The objective of this study was to investigate household disposal practices and harm resulting from SMW generated in households and the community. A cross-sectional questionnaire survey of 600 households was undertaken in Ga South Municipal Assembly in Accra, Ghana from mid-April to June, 2014. Factors investigated included socio-demographic characteristics, medication related practices, the belief that one is at risk of diseases a...
Integrated pest management (IPM) with an increased used of ecological farming methods and less an... more Integrated pest management (IPM) with an increased used of ecological farming methods and less and safer use of pesticides offers solutions to reduce risks of developing pest resistance, human poisoning, and environmental pollution. Despite being promoted by Food and Agriculture Organization and others, it has not spread readily in low-income countries. This article presents the opinions of Bolivian farmers and agronomists on perceived obstacles and opportunities for a diffusion of IPM. Focus group discussions revealed an increased workload without certainty of higher yields or better prices for products grown with IPM compared with traditional agriculture being hindrances for a spread of IPM. Moreover, IPM requires some new practices not that easy to learn by farmers. In favor of IPM was an increasing awareness of the importance of a healthy and sustainable food production, easiness to try out without expensive investments needed, and a higher quality of the products. A healthy and...
Background : To integrate health impact assessment (HIA) into existing decision-making processes ... more Background : To integrate health impact assessment (HIA) into existing decision-making processes requires not only methods and procedures but also well-trained experts, aware policy makers and appropriate institutions. Capacity building is the assistance which is provided to entities, which have a need to develop a certain skill or competence, or for general upgrading of performance ability. If a new technique is planned to be introduced there is a need for capacity building with no respect to levels (local, regional, national, international) or sectors (health, environment, finance, social care, education, etc.). As such, HIA is a new technique for most of the new Member States and accession countries of the European Union. Methods : To equip individuals with the understanding and skills needed to launch a HIA or be aware of the availability of this methodology and to access information, knowledge and training, we focused on the organization of workshops in participating countries. The workshops served also as pilot events to test a “curriculum” for HIA; a set of basic topics and presentations had been developed to be tested during workshops. In spite of classical in-class workshops we aimed to organize e-learning events as a way to over come the “busyness” problem of decision makers. Results : Throughout March – October 2006 we organized and ran 7 workshops in Denmark, Turkey, Lithuania, Poland, Bulgaria, Slovak Republic and Hungary. Participants came from the public health sector (141), non-public health decision makers (113) and public health students (100). A concise curriculum was developed and tested during these workshops. Participants developed a basic understanding of HIA, skills to develop and use their own screening tools as well as scoping.Within the workshop in Denmark we tested an online, real-time Internet based training method; participants highly welcomed this method as it allowed them to take part in training from their workplace, and it did not disturb their daily work. Conclusions : The workshops set a very good baseline for the introduction of HIA in participating countries. The training documents are being translated into their national languages and will be posted on the national HIA web pages of the participating countries. Participating countries have expressed an interest in continuing on with similar workshops on specific issues related to HIA, providing more in-depth training.
African Journal of Environmental Science and Technology, Mar 30, 2015
Increased awareness about inadequate management of solid medical waste (SMW) has led to increased... more Increased awareness about inadequate management of solid medical waste (SMW) has led to increased independent surveys in African countries and yet published data remain scanty on the subject in Africa as compared to the rest of the world. To evaluate the overall compliance with World Health Organization (WHO)'s ten recommendations on SMW practices in Africa through a literature review, we conducted literature search using search terms as "medical waste OR clinical waste OR biomedical waste OR hospital waste OR healthcare waste OR hazardous waste AND Africa" in PubMed, African Journals Online, Web of Science, Proquest, Embase, Google scholar and Scopus. Additional articles were included from open google search. Articles were selected for inclusion if they described SMW management activities such as waste segregation, collection, transport (on-site and/or off-site), temporary storage, treatment and final disposal; were located in an African country and were written in English; or if written in a different language, had an English abstract with the relevant information. Evaluations were based on fifty eight (58) full text articles which were pooled together. The fifty eight (58) full text articles represented research undertaken in 20 countries. Overall, six countries (30%) broadly met half of the WHO's 10 recommendations. Based on the reviewed articles, the greatest compliance was shown with "daily collection of waste from the service areas" (100%). Areas of least compliance were "appropriate use of color codes" (18%) for labeling waste bins, "off-site conveyance" (16%) and "periodic training" (18%). In spite of growing awareness, SMW management in most African countries was substandard. Appropriate use of color codes, periodic training and off-site conveyance need to be addressed in terms of reporting and practice. Common challenges and unremarkable progress in SMW management in Africa raise a question about whether a unified approach should replace independent country efforts.
The Republic of Kazakhstan is one of the largest and fastest growing post-Soviet economies in Cen... more The Republic of Kazakhstan is one of the largest and fastest growing post-Soviet economies in Central Asia. Despite recent improvements in health care in response to Kazakhstan 2030 and other state-mandated policy reforms, Kazakhstan still lags behind other members of the Commonwealth of Independent States of the European Region on key indicators of health and economic development. Although cardiovascular diseases are the leading cause of mortality among adults, HIV/AIDS, tuberculosis, and blood-borne infectious diseases are of increasing public health concern. Recent data suggest that while Kazakhstan has improved on some measures of population health status, many environmental and public health challenges remain. These include the need to improve public health infrastructure, address the social determinants of health, and implement better health impact assessments to inform health policies and public health practice. In addition, more than three decades after the Declaration of Al...
Background: Pesticide consumption is increasing in Bolivia as well as pest resistance, pesticide ... more Background: Pesticide consumption is increasing in Bolivia as well as pest resistance, pesticide poisonings and pollution of the environment. This survey evaluates the training of small holder farmers on pesticide handling and ecological alternatives to reduce the negative pesticide effects. Method: A baseline survey was performed in 2002 and follow-up surveys in 2004 and 2009. Farmers were selected and trained on Integrated Pest Management (IPM) from 2002 to 2004 in Farmer Field Schools (FFS). After exclusions and drop outs, 23 FFS trained farmers could be compared to 47 neighbor farmers for changes in 'knowledge, attitude and practice' (KAP) on IPM and symptoms of poisoning when handling pesticides. Statistical analysis was performed with SPSS version 21.0 using χ 2-test, Cochran's Q test and Student's T-test. Results: Improvements were seen in both groups but most significant among the FFS farmers. At baseline no difference were seen between the two groups apart from a more frequent use of personal protection among the FFS farmers. After the training was finished significant differences were seen between FFS farmers and neighbor farmers on all KAP variables, a difference reduced to six of the KAP variables in 2009. No difference was seen in self-reported poisonings after pesticide handling. FFS farmers improved their KAP scores markedly during training and there after retained their knowledge, while neighbor farmers improved during the entire period. Ecological farming without the use of pesticides increased most among the FFS farmers. Conclusion: The study showed a sustained improvement among Farmers Field School trained farmers on personal protection and hygiene when handling pesticides, knowledge and use of IPM and ecological alternatives and a reduction in self-reported symptoms after pesticide handling. Similar though less pronounced improvements was seen among neighbor farmers having had less training and information on pesticide handling and alternatives than the FFS trained farmers. Training of farmers on IPM and good agricultural practices has positive effects, but is scarce in Bolivia as in most low-income countries and must be encouraged to support an improved and sustainable food production and to protect the health of farmers and consumers as well as the environment.
Gode erfaringer med brobygning mellem forskning og praksis i folkesundhed. Maja Larsen, Gabriel G... more Gode erfaringer med brobygning mellem forskning og praksis i folkesundhed. Maja Larsen, Gabriel Gulis, Carsten Kronborg Bak, Pernille Tanggaard Andersen, Arja R Aro Ugeskrift for Laeger, unknown, 2011.
The objective of this study was to find out the number of publications (in Danish) and research p... more The objective of this study was to find out the number of publications (in Danish) and research projects (including grey literature) either carried out or ongoing within the field of public health in Denmark, using the same criteria as the SPHERE project, but looking at Danish research databases. The Danish research database served as the main resource for the study supported by national research reports. There is an increasing trend in the number of public health research projects and publications. Compared with public health research projects published in English there are differences in some categories. Overall, public health research in Denmark seems to contribute around 4.8%-6.5% of the total amount of health research. Public health research has a relatively low share of overall health research in Denmark.
International Journal of Environmental Research and Public Health
The Republic of Kazakhstan began undergoing a political, economic, and social transition after 19... more The Republic of Kazakhstan began undergoing a political, economic, and social transition after 1991. Population health was declared an important element and was backed with a substantial commitment by the central government to health policy. We examine key trends in the population health status of the Republic of Kazakhstan and seek to understand them in relation to the ongoing political, economic, and social changes in society and its aspirations in health policy. We used the Global Burden of Disease database and toolkit to extract and analyze country-specific descriptive data for the Republic of Kazakhstan to assess life expectancy, child mortality, leading causes of mortality, disability-adjusted life years, and causes and number of years lived with disability. Life expectancy declined from 1990 to 1996 but has subsequently recovered. Ischemic heart disease, stroke, and chronic obstructive pulmonary disease remain among the leading causes of death; child mortality for children un...
Objectives: Developmental processes influence the determinants of health and, consequently, human... more Objectives: Developmental processes influence the determinants of health and, consequently, human health. Yet, assessing human health impacts in impact assessment, with exception of health impact assessment, is still rather vague. Inclusion of Sustainable Development Goal indicators in environmental impact assessment (EIA) is an opportunity to enhance addressing human health in EIA practices.Methods: We reviewed a list of health-related targets and indicators for SDGs as defined by the Institute of Health Metrics and Evaluation (IHME) in Seattle, WA, United States with the aim of identifying those to be suggested as outcome indicators within EIA.Results: Among 42 health-related indicators, we identified 17 indicators which could be relevant for impact assessment procedures and categorized them into three groups: 1) direct health indicators (e.g., under five mortality). 2) complex indicators (e.g., cancer). 3) environmental determinant indicators (e.g., mean PM2.5).Conclusion: All 17...
Background: Despite improving trends, countries in Europe continue to face public-health challeng... more Background: Despite improving trends, countries in Europe continue to face public-health challenges. This study investigated the priorities of stakeholders for research to meet these challenges. Methods: Public-health research includes population-level and health-system research, but not clinical or biomedical research. The study drew on data from three surveys undertaken through collaboration in SPHERE (Strengthening Public Health Research in Europe). There was participation of ministries in 18 of 28 (64 % response) European countries, from 22 of 39 (56 % response) member national associations of the European Public Health Association, and from 80 civil society health organisations (53 % of members of the European Public Health Alliance) Results: Public-health research fields included disease control, health promotion and health services. Ministries of health, rather than ministries of science or education, mostly took responsibility for public-health research: they reported varied...
Background:When implementing public health interventions in practice, it is recommended to use re... more Background:When implementing public health interventions in practice, it is recommended to use research evidence and to include relevant stakeholders. This should ensure effective interventions but it can be challenging. This study investigates the use of knowledge and inclusion of stakeholders in three different public health interventions at the local government level in Denmark and discusses strategies for future improvements in the use of research evidence. Method:Based on a previous assessment of all public health interventions in Varde Municipality using the European Community Health Promotion Indicator Development Model (EUHPID model), three different types of interventions (one Health Promotion, one Health Protection, and one Disease Prevention) were chosen for a case study analysis. The data consisted of document reviews and interviews. Data were analysed by content analysis using a framework for Evidence Based Practice as a guiding tool. Discussion of strategies for future...
Solid medical waste (SMW) in households is perceived to pose minimal risks to the public compared... more Solid medical waste (SMW) in households is perceived to pose minimal risks to the public compared to SMW generated from healthcare facilities. While waste from healthcare facilities is subject to recommended safety measures to minimize risks to human health and the environment, similar waste in households is often untreated and co-mingled with household waste which ends up in landfills and open dumps in many African countries. In Ghana, the management of this potentially hazardous waste stream at household and community level has not been widely reported. The objective of this study was to investigate household disposal practices and harm resulting from SMW generated in households and the community. A cross-sectional questionnaire survey of 600 households was undertaken in Ga South Municipal Assembly in Accra, Ghana from mid-April to June, 2014. Factors investigated included socio-demographic characteristics, medication related practices, the belief that one is at risk of diseases a...
Integrated pest management (IPM) with an increased used of ecological farming methods and less an... more Integrated pest management (IPM) with an increased used of ecological farming methods and less and safer use of pesticides offers solutions to reduce risks of developing pest resistance, human poisoning, and environmental pollution. Despite being promoted by Food and Agriculture Organization and others, it has not spread readily in low-income countries. This article presents the opinions of Bolivian farmers and agronomists on perceived obstacles and opportunities for a diffusion of IPM. Focus group discussions revealed an increased workload without certainty of higher yields or better prices for products grown with IPM compared with traditional agriculture being hindrances for a spread of IPM. Moreover, IPM requires some new practices not that easy to learn by farmers. In favor of IPM was an increasing awareness of the importance of a healthy and sustainable food production, easiness to try out without expensive investments needed, and a higher quality of the products. A healthy and...
Background : To integrate health impact assessment (HIA) into existing decision-making processes ... more Background : To integrate health impact assessment (HIA) into existing decision-making processes requires not only methods and procedures but also well-trained experts, aware policy makers and appropriate institutions. Capacity building is the assistance which is provided to entities, which have a need to develop a certain skill or competence, or for general upgrading of performance ability. If a new technique is planned to be introduced there is a need for capacity building with no respect to levels (local, regional, national, international) or sectors (health, environment, finance, social care, education, etc.). As such, HIA is a new technique for most of the new Member States and accession countries of the European Union. Methods : To equip individuals with the understanding and skills needed to launch a HIA or be aware of the availability of this methodology and to access information, knowledge and training, we focused on the organization of workshops in participating countries. The workshops served also as pilot events to test a “curriculum” for HIA; a set of basic topics and presentations had been developed to be tested during workshops. In spite of classical in-class workshops we aimed to organize e-learning events as a way to over come the “busyness” problem of decision makers. Results : Throughout March – October 2006 we organized and ran 7 workshops in Denmark, Turkey, Lithuania, Poland, Bulgaria, Slovak Republic and Hungary. Participants came from the public health sector (141), non-public health decision makers (113) and public health students (100). A concise curriculum was developed and tested during these workshops. Participants developed a basic understanding of HIA, skills to develop and use their own screening tools as well as scoping.Within the workshop in Denmark we tested an online, real-time Internet based training method; participants highly welcomed this method as it allowed them to take part in training from their workplace, and it did not disturb their daily work. Conclusions : The workshops set a very good baseline for the introduction of HIA in participating countries. The training documents are being translated into their national languages and will be posted on the national HIA web pages of the participating countries. Participating countries have expressed an interest in continuing on with similar workshops on specific issues related to HIA, providing more in-depth training.
African Journal of Environmental Science and Technology, Mar 30, 2015
Increased awareness about inadequate management of solid medical waste (SMW) has led to increased... more Increased awareness about inadequate management of solid medical waste (SMW) has led to increased independent surveys in African countries and yet published data remain scanty on the subject in Africa as compared to the rest of the world. To evaluate the overall compliance with World Health Organization (WHO)'s ten recommendations on SMW practices in Africa through a literature review, we conducted literature search using search terms as "medical waste OR clinical waste OR biomedical waste OR hospital waste OR healthcare waste OR hazardous waste AND Africa" in PubMed, African Journals Online, Web of Science, Proquest, Embase, Google scholar and Scopus. Additional articles were included from open google search. Articles were selected for inclusion if they described SMW management activities such as waste segregation, collection, transport (on-site and/or off-site), temporary storage, treatment and final disposal; were located in an African country and were written in English; or if written in a different language, had an English abstract with the relevant information. Evaluations were based on fifty eight (58) full text articles which were pooled together. The fifty eight (58) full text articles represented research undertaken in 20 countries. Overall, six countries (30%) broadly met half of the WHO's 10 recommendations. Based on the reviewed articles, the greatest compliance was shown with "daily collection of waste from the service areas" (100%). Areas of least compliance were "appropriate use of color codes" (18%) for labeling waste bins, "off-site conveyance" (16%) and "periodic training" (18%). In spite of growing awareness, SMW management in most African countries was substandard. Appropriate use of color codes, periodic training and off-site conveyance need to be addressed in terms of reporting and practice. Common challenges and unremarkable progress in SMW management in Africa raise a question about whether a unified approach should replace independent country efforts.
The Republic of Kazakhstan is one of the largest and fastest growing post-Soviet economies in Cen... more The Republic of Kazakhstan is one of the largest and fastest growing post-Soviet economies in Central Asia. Despite recent improvements in health care in response to Kazakhstan 2030 and other state-mandated policy reforms, Kazakhstan still lags behind other members of the Commonwealth of Independent States of the European Region on key indicators of health and economic development. Although cardiovascular diseases are the leading cause of mortality among adults, HIV/AIDS, tuberculosis, and blood-borne infectious diseases are of increasing public health concern. Recent data suggest that while Kazakhstan has improved on some measures of population health status, many environmental and public health challenges remain. These include the need to improve public health infrastructure, address the social determinants of health, and implement better health impact assessments to inform health policies and public health practice. In addition, more than three decades after the Declaration of Al...
Background: Pesticide consumption is increasing in Bolivia as well as pest resistance, pesticide ... more Background: Pesticide consumption is increasing in Bolivia as well as pest resistance, pesticide poisonings and pollution of the environment. This survey evaluates the training of small holder farmers on pesticide handling and ecological alternatives to reduce the negative pesticide effects. Method: A baseline survey was performed in 2002 and follow-up surveys in 2004 and 2009. Farmers were selected and trained on Integrated Pest Management (IPM) from 2002 to 2004 in Farmer Field Schools (FFS). After exclusions and drop outs, 23 FFS trained farmers could be compared to 47 neighbor farmers for changes in 'knowledge, attitude and practice' (KAP) on IPM and symptoms of poisoning when handling pesticides. Statistical analysis was performed with SPSS version 21.0 using χ 2-test, Cochran's Q test and Student's T-test. Results: Improvements were seen in both groups but most significant among the FFS farmers. At baseline no difference were seen between the two groups apart from a more frequent use of personal protection among the FFS farmers. After the training was finished significant differences were seen between FFS farmers and neighbor farmers on all KAP variables, a difference reduced to six of the KAP variables in 2009. No difference was seen in self-reported poisonings after pesticide handling. FFS farmers improved their KAP scores markedly during training and there after retained their knowledge, while neighbor farmers improved during the entire period. Ecological farming without the use of pesticides increased most among the FFS farmers. Conclusion: The study showed a sustained improvement among Farmers Field School trained farmers on personal protection and hygiene when handling pesticides, knowledge and use of IPM and ecological alternatives and a reduction in self-reported symptoms after pesticide handling. Similar though less pronounced improvements was seen among neighbor farmers having had less training and information on pesticide handling and alternatives than the FFS trained farmers. Training of farmers on IPM and good agricultural practices has positive effects, but is scarce in Bolivia as in most low-income countries and must be encouraged to support an improved and sustainable food production and to protect the health of farmers and consumers as well as the environment.
Gode erfaringer med brobygning mellem forskning og praksis i folkesundhed. Maja Larsen, Gabriel G... more Gode erfaringer med brobygning mellem forskning og praksis i folkesundhed. Maja Larsen, Gabriel Gulis, Carsten Kronborg Bak, Pernille Tanggaard Andersen, Arja R Aro Ugeskrift for Laeger, unknown, 2011.
The objective of this study was to find out the number of publications (in Danish) and research p... more The objective of this study was to find out the number of publications (in Danish) and research projects (including grey literature) either carried out or ongoing within the field of public health in Denmark, using the same criteria as the SPHERE project, but looking at Danish research databases. The Danish research database served as the main resource for the study supported by national research reports. There is an increasing trend in the number of public health research projects and publications. Compared with public health research projects published in English there are differences in some categories. Overall, public health research in Denmark seems to contribute around 4.8%-6.5% of the total amount of health research. Public health research has a relatively low share of overall health research in Denmark.
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Papers by Gabriel Gulis