Efforts to reduce infestations should continue to focus on water tank sanitation and improving housing conditions, but also engage community religious leaders to help promote safe practices. Vulnerable populations should be especially targeted by prevention activities. A surveillance programme can produce evidence to guide interventions.
ObjectiveTo consider how Cuba’s acknowledged achievement of excellent health outcomes may relate to how health determinants are addressed intersectorally.MethodsOur team of Canadian and Cuban researchers and health policy practitioners undertook a study to consider the organization and practices involved in addressing health determinants in 2 municipalities (1 urban and 1 rural). The study included a questionnaire of municipal Health Council members and others involved in health and non-health sectors, key informant interviews of policy makers, focus groups in each municipality and examination of three common case scenarios.ResultsRegular engagement of different sectors and other agencies in addressing health determinants was quite systematic and comparable in both municipalities. Specific policies and organizational structures in support of intersectoral actions were frequently cited and illustrated in case scenarios that demonstrate how maintenance of regular linkages facilitates regular pursuit of intersectoral approaches.ConclusionsThe study demonstrates the feasibility of examining processes of intersectoral action for health processes and suggests that further examination in evaluating factors such as training, particular practices, etc., can be a fruitful direction to pursue comparatively and with analytical designs.
In the first years after Cuba's 1959 revolution, the island's new government provided international medical assistance to countries affected by natural disasters or armed conflicts. Step by step, a more structural complementary program for international collaboration was put in place. The relief operations after Hurricane Mitch, which struck Central America in 1998, were pivotal. From November 1998 onward, the "Integrated Health Program" was the cornerstone of Cuba's international cooperation. The intense cooperation with Hugo Chávez's Venezuela became another cornerstone. Complementary to the health programs abroad, Cuba also set up international programs at home, benefiting tens of thousands of foreign patients and disaster victims. In a parallel program, medical training is offered to international students in the Latin American Medical School in Cuba and, increasingly, also in their home countries. The importance and impact of these initiatives, however, cannot and should not be analyzed solely in public health terms.
The difficult economic times that Cuba has had to face have taken a considerable toll on its urban ecosystems, with data suggesting that indicators of health, the environment, and social services have been deteriorating. This has been particularly evident in Centro Habana, a municipality with the highest population density in the country. More than half the population was without daily access to potable water, waste disposal was insufficient, overcrowding was serious, disease vectors were prevalent, and rates of various infectious as well as noncommunicable diseases and injuries were highest in the country. To improve the situation, the municipality requested help from the National Institute for Hygiene Epidemiology and Microbiology (INHEM) to determine the best use of scarce resources to improve health. INHEM performed an ecological descriptive study and conducted focus groups in five communities to assess perceptions of health, social, and environmental factors, followed by a household survey. INHEM then engaged collaborators at the University of Manitoba to assist in developing a framework, analyzing the data, and planning and undertaking the evaluation requested. Maximum likelihood factor analysis was used to reduce the dimensionality of the data. The perception data were then merged with the ecological level health and environmental data to ascertain the relationship between these two data sources and determine which indicators might be useful for an intervention analysis. The perception results indicated that the greatest community concern was quality of housing, but that the risk perception results were independent of ecological data on morbidity, mortality, and basic sanitation indicators. Based on this conclusion, it was decided to use a combined qualitative and quantitative approach to evaluate actual and potential interventions, using the driving force‐pressure‐state‐exposure‐effects‐action (DPSEEA) framework. It was also decided to adopt an ecosystem approach that fully involves the community in developing a set of ecosystem human health indicators. Data from repeat focus groups and household surveys are planned, with these data to again be integrated with ecological data including environmental, socioeconomic, and health outcome information, using a pre‐ versus postintervention with concurrent control design. Our findings in this first phase indicated that an ecosystem framework is invaluable in ascertaining determinants of health and prioritizing and evaluating interventions to improve the health of communities.
A set of interventions was undertaken between 1995 and 1999 to improve the quality of life and human health in Cayo Hueso, an inner city community in Central Havana. The municipality and community organizations contacted the agency responsible for public and environmental health in Cuba (INHEM) to evaluate whether these improvements were as effective and efficient as possible, so as to assist in planning further interventions in this and other communities. With the aid of international researchers, an effort was made to strengthen the community's capacity to apply an ecosystem health approach, adapting the analytical framework (DPSEEA: driving force–pressure–state–exposure–effects–action) developed for this purpose by the World Health Organization. A series of workshops and focus groups with community representatives and researchers was conducted in late 1999 and early 2000 to develop appropriate indicators for the analysis. Interventions were grouped into those relating to improved housing, the physical community infrastructure (e.g., water, sewage, street lights), and the socio‐cultural environment (e.g., programs for youths and seniors). The DPSEEA framework was embraced by the community and used to define indicators at the individual, household, and neighborhood levels; the community‐researcher team then collectively elaborated the methodology to obtain the needed information. Data collection is now underway with the process having triggered a series of new partnerships, including other communities (comparison groups) now eager to learn from the Cayo Hueso interventions. With the capacity to apply this approach strengthened, the community is preparing to use the results of the analyses to set new priorities and pursue longer‐term ecosystem health interventions.
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