Infant health and survival in the US compare unfavorably with other Western industrial democracies. Circumstances that contribute to favorable pregnancy outcomes in other countries include nearly complete participation of pregnant women in early prenatal care and linkage of care to extensive support benefits. The study reported here extends these earlier observations to preventive health services for children from infancy through adolescence and to the social benefit programs that support their families. This report looks at the condition of children in 10 European countries: Belgium, Denmark, France, the Federal Republic of Germany, Ireland, the Netherlands, Norway, Spain, Switzerland, and the United Kingdom. All of these countries have better infant survival rates than the US, and they all share elements of pluralism in their systems of health care.
Three hundred and seventy-four general practitioners (GPs) in Denmark filled in a questionnaire on attitudes to include information on gender and diet in the strategy for prevention of coronary heart disease, cancer, osteoporosis, and overweight/underweight. Risk factors for disease in general were ranked as follows: smoking, alcohol, stress, diet, physical exercise, heredity and hygiene. The patients' lack of motivation, insufficient time for each patient, and inadequate knowledge about nutrition were stated as barriers to dietary counselling. The GPs stated that the gender of the patient was important only to the counselling on osteoporosis. Lack of time and insufficient knowledge were perceived as barriers for including gender specific issues in prevention. It is concluded that GPs consider dietary counselling important but lack time and knowledge. The results point at a need for better pre- and postgraduate training in nutrition, and for a better reimbursement system for time spent on prevention.
To allocate HIV prevention resources effectively, it is important to have information about the effectiveness of alternative prevention programs as a function of expenditure. We refer to this relationship as the "production function" for a prevention program. Few studies of HIV prevention programs have reported this relationship. This paper demonstrates the value of such information. We present a simple model for allocating HIV prevention resources, and apply the model to an illustrative HIV prevention resource allocation problem. We show that, without sufficient information about prevention program production functions, suboptimal decisions may be made. We show that epidemiologic data, such as estimates of HIV prevalence or incidence, may not provide enough information to support optimal allocation of HIV prevention resources. Our results suggest that good allocations can be obtained based on fairly basic information about prevention program production functions: an estimate of fixed cost plus a single estimate of cost and resulting risk reduction. We find that knowledge of production functions is most important when fixed cost is high and/or when the budget is a significantly constraining factor. We suggest that, at the minimum, future data collection on prevention program effectiveness should include fixed and variable cost estimates for the intervention when implemented at a "typical" level, along with a detailed description of the intervention and detailed description of costs by category.
As of now, there are prerequisites for enhancing the efficiency of tuberculosis-controlling measures and for reducing their cost by utilizing material and personnel resources in priority areas. These include: to detect patients with tuberculosis by using current computer technologies, to apply digital X-ray plants, to recruit general practitioners for preventive measures against tuberculosis, to reduce the cost of treatment in patients with tuberculosis by decreasing hospital stay. Introduction of currently available procedures substantially lowers the cost of antituberculous aid and enhances its efficiency.