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Measuring Contextual Characteristics for Community Health

December 1, 2003 | Journal Article

In the past few years, researchers have become increasingly interested in studying the interplay between the characteristics of communities and a wide range of health issues. The bulk of this research, however, has tended to emphasize the effects of concentrated poverty and other manifestations of disadvantage. This phenomenon is partly due to the limitations of commonly used or routinely collected data, but it also reflects a lack of alternative model structures to inform examinations of the link between community context and individual health. To address this issue, the authors collaborated with a workshop of consultants and developed both a framework to explain how community characteristics could affect community health, and a library of data to measure these characteristics. The workshop generated 12 conceptual dimensions that were linked to health status in a given context. These domains include, but are not limited to, the dimensions of economics, employment, education and politics. Beneath these more general areas are several levels of increasingly specific variables that address the context-health relationship. For example, under the behavioral dimension, tobacco use, physical activity, diet, alcohol and drug use and violence are all given specific treatment. The authors propose three principles to guide our understanding of the impact of contextual characteristics on health. The first is to conceive of "health" not as a single outcome but as a multidimensional concept with a broad range of outcomes. The second is to consider the natural history of different health outcomes, and to think about which stage in the natural history of a condition is of concern. The third is to consider the lifecourse processes, and to look beyond contemporaneous contexts for more complete explanations of health outcomes.

Perceptions of Medical School Deans and State Medical Society Executives about Physician Supply

December 1, 2003 | Journal Article

Based on 2003 analyses of trends in health care, current rates of production are insufficient to meet the growing demand for physicians. Despite already existing shortages, there is controversy about their significance and potential solutions. This study used telephone surveys and internet questionnaires to collect perceptions of medical school deans and state medical society executives about the status of physician supply in their areas, the impact of supply on the medical schools' accomplishment of their mission, and potential for schools to change class size in response to supply shortages. In all, the authors drew data from 77 medical school deans, and 44 medical society executives in the United States and Puerto Rico. The vast majority of deans reported physician shortages (85 percent), while 10 percent perceived surpluses, often coexisting with shortages. Eighty-three percent of deans that reported shortages stated that it had a negative impact on their schools. Some deans reported recent or planned increases in class size (27 percent) or expansion in capacity (34 percent). However, 7 percent mentioned recent decreases in class size. Taken together, changes in class size could result in approximately 8 percent additional graduating physicians each year. This limited capacity for expansion poses a serious challenge that needs resolution if future physician supply is to sufficiently meet future health care demand.

The FOOTPRINTS Model of Pediatric Palliative Care

December 1, 2003 | Journal Article

Poor training in pediatric palliative care contributes to care that is often fragmented and may neglect the physical, psychosocial and spiritual needs of the child and family.