ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1989.tb00170.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractEpidemic diseases move in grand cycles, accompanying changes in culture, social organization, and environment. Coronary heart disease (CHD), a mass disease of twentieth century industrialized society, has a predominantly environmental aetiology. Although the major biomedical risk factors appear to have been identified over the past 40 years of epidemiological research, we are not certain why CHD is now on the wane in most Western nations. In Australia, CHD death rates have, since 1968, declined much more in professional and white‐collar men than in blue‐collar men.Any substantial reduction in CHD rates will require a generalized population shift towards a lower CHD risk profile. Numerically, the greatest gains should come from reducing the CHD risk of the bulk of the population, who are currently at medium risk of CHD. Notions of risk need, in the first instance, to be based on up‐to‐date knowledge of biomedical risk factors and mechanisms in order to develop optimal intervention strategies.A population‐based strategy can be achieved via community education and structural modification of the social environment. The latter approach will require public health research into broader questions of the social‐environmental influences on population cardiovascular health: for example, research into the social, political, and economic determinants of national food and nutrition policies; and into the various environmental (including workplace) changes that will facilitate risk‐lowering behaviour. Hopefully, intervention strategies in such areas, set within a community development context, will be developed within the incipient National Program for Better Health. Public health research should be extended and adapted to enable evaluation of these various social interventions, and to contribute to public health po

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1989.tb00171.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1989.tb00172.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractThis article describes the development of a community work approach to the problem of isolation within a semi‐rural and urban community. Reasons for adopting a community work emphasis within this community health service are explained. Two projects which illustrate ways in which the approach was put into practice are described and implications and issues for health workers are discussed using community participation, empowerment, and co‐ordination of services as a basis for discuss

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1989.tb00173.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractFashion parades, balls, raffles, and weekly deductions from thousands of workers' pay packets were integral to success of the Cancer Appeal‐a‐thon in the Illawarra region. In 1986–87 the Illawarra community was induced to contribute $1.5 million in order to purchase a linear accelerator for the Wollongong Hospital. The community agreed that a radiotherapy machine was the number one health service priority for the region. Or did it?Application of Alford's structural interests framework to this case‐study reveals how failure to examine power relations between medical monopolizers, health care rationalizers and community participants results in an inability to recognise that alternative community needs — for cancer prevention, domiciliary care, or alternative therapies — might be unarticulated or unobservable, and in an inability to ask whether the community may be mistaken about, or unaware of, its own health needs.Specifically, the paper argues that, ‘community needs’ are easily manipulated or distorted by powerful interest groups and that the political context within which community needs are recognized, articulated and mobilized is the most important issue for community participation in the health policy

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1989.tb00174.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1989.tb00175.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1989.tb00176.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1989.tb00177.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1989.tb00178.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractThis paper illustrates problems in the evaluation of community development programs for health promotion. It is based on the authors' retrospective process evaluation of the Wanganui Community Alcohol Action Program (WCAAP), a recent example of a health promotion program directed at reducing alcohol‐related problems in a small New Zealand town. Described by its designers as a community‐based program, it included coordination of community organizations, education, publicity and increased enforcement of drinking laws. Discussion of the problems in the evaluation of such programs puts them within the context of the substantial body of previous social science research in both evaluation and community development. This, it is argued, is a body of knowledge with which health promotion researchers need to be conversant. Community development programs usually stem from a process of negotiation between interest groups with differing objectives. This results in a changing definition of both the problem to be solved and the nature of the solution, making evaluation difficult. Community development is also likely to be seen as a new solution providing a panacea for old problems. This can lead to such programs being too ambitious. From the point of view of experimental design these programs are likely to have a number of technical problems. This paper argues that these problems are so significant that it is often unwise to attempt large scale evaluations of community development programs. Rather, attention should be concentrated on critically assessing the policy‐making process and disseminating previous knowledge about such pro

ISSN:0314-9021    

DOI:10.1111/j.1753-6405.1989.tb00179.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY