The Institute for Global Health and Development
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Item Multicultural issues in general practice(Australian Drug Information Service, 1999-12) Reidpath, Daniel; Allotey, PascalePeople's experiences of health and illness vary widely and are affected by factors such as age, gender, education, socioeconomic status and culture. Additional factors such as language, culture and pre- and post-migration experience affect people from culturally diverse backgrounds. Individual patients are their own cultural expert; no resource can be comprehensive enough to give the health practitioner better information than asking the patient.Item Information quality in a remote rural maternity unit in Ghana(Oxford University Press, 2000-06-01) Allotey, Pascale; Reidpath, DanielThe collection of accurate maternal outcome data enables causes of morbidity and mortality to be identified, which in turn permits interventions to be targeted appropriately. It also allows estimates to be made about the importance of various indicators in predicting birth outcome. These indicators can then be compared between health services, across time and against programme objectives, thus ensuring a management information system that informs policy and provides for real change. A review was done of data collection at the antenatal clinic and maternity ward in a remote rural hospital in northern Ghana. The data collected came from maternity ward records and participant observation, and they highlight deficiencies in the record management procedures. It is argued that exhorting staff to greater accuracy, although obvious, may not be the only solution, because of the structural impediments that often give an illusion of accuracy. The best data need to be collected within the constraints of the equipment and the people. Furthermore, to make the task more meaningful, regular feedback needs to be provided so that the process of record keeping is relevant to those who do it. Ministries of health need to conduct regular audits, like this microanalysis, so that policies are not based on data that are analyzed under a presumption of accuracy.Item Social, cultural and environmental contexts and the measurement of burden of disease : an exploratory comparison of the developed and developing world(University of Melbourne, 2001) Reidpath, Daniel; Allotey, Pascale; Kouamé, Aka; Cummins, RobertThe Disability Adjusted Life Year (DALY) is a measure of population health that was developed, as part of a World Bank initiated study, to inform health strategy development, priority setting, resource allocation and research, and to measure the global burden of disease. The innovative feature of the DALY was the combination of information on morbidity and mortality within a single index. Since its development in 1992, the rate at which it has been adopted by governments, multilateral agencies and researchers has been staggering. The enthusiasm with which the measure has been taken-up perhaps reflects a desire on the part of health policy makers to embrace an “evidence-based” approach to health policy. Although the DALY has been heavily criticised in some quarters, it has survived. There are a number of reasons why this may be: • It is a good measure of population health; • The enormous political will to see it succeed; and • The lack of empirical data to challenge the validity of the DALY; • In addition, many of the criticisms of the DALY have been about the implicit and explicit social values, which are hard to argue on technical grounds. This report details the findings of an empirical investigation of some of the technical and social assumptions on which the DALY is based.Item Establishing the causes of childhood mortality in Ghana: the ‘spirit child’(Elsevier, 2001-04) Allotey, Pascale; Reidpath, DanielCommunities in remote regions of northeast Ghana record some of the highest rates of under five mortality in West Africa (23.9 per 1000 children/year (Binka, Maude et al. (1995). International Journal of Epidemiology, 24(1), 127–135). The communities, isolated geographically and culturally from the main tribal groups in Ghana continue to adhere very strongly to traditional beliefs and practices. A qualitative study of both traditional and modern maternal and child health care systems in the area, demonstrated that almost 15% of deaths of infants under 3 months of age were due to a belief in chichuru or spirit children, resulting in infanticide. It is therefore a significant public health problem, which has to be addressed in programs for the control of child mortality. A modification of the verbal autopsy method is proposed to assist in the identification of non-biomedical causes of death.Item Data Sharing in Medical Research: An Empirical Investigation(Wiley, 2001-04) Reidpath, Daniel; Allotey, PascaleBackground: Scientific research entails systematic investigation. Publishing the findings of research in peer reviewed journals implies a high level of confidence by the authors in the veracity of their interpretation. Therefore it stands to reason that researchers should be prepared to share their raw data with other researchers, so that others may enjoy the same level of confidence in the findings. Method: In a prospective study, 29 corresponding authors of original research articles in a medical journal (the British Medical Journal) were contacted to ascertain their preparedness to share the data from their research. The email contact was in one of two forms, a general request and a specific request. The type of request a researcher received was randomly allocated. Findings: Researchers receiving specific requests for data were less likely, and slower, to respond than researchers receiving general requests. Only one researcher released data. Most researchers were reluctant to release their data. Some required further information, clarification, or authorship. Interpretation: The general reluctance of researchers to consider requests for their data is of concern. It raises questions about the level of confidence that should be placed on their interpretations of the data. It also highlights an unfortunate situation where researchers are more concerned with losing an advantage than advancing science.Item Addressing cultural diversity in Australian health services(2002-08-01) Allotey, Pascale; Reidpath, Daniel; Manderson, LIssue addressed: Recent changes in the model of health service delivery in Australia have resulted in the attrition of ethnic specific health services and the expectation that patients from culturally and linguistically diverse backgrounds will present to mainstream health services for all health problems. Providers are often ill equipped to provide appropriate care and have expressed concerns with addressing the needs of people from increasingly diverse communities. Meanwhile, community groups and anthropologists have expressed their frustration with the stereotypic and essentialising tone of many of the guides and fact-files developed for use in clinical settings. Methods: Applied anthropological approaches were used to negotiate the style and content of a set of resource materials for health providers in community health and hospital settings. Results: Extensive consultation ensured that the resources met providers' needs and were acceptable to communities. Conclusion: The result provides a guide to best practice of clinical care, regardless of cultural or linguistic background. So what: Health services would be assisted by materials on ethnic cultural factors that avoided stereotyping and emphasised asking questions.Item Objectivity in Priority Setting Tools in Reproductive Health: Context and the DALY(Taylor and Francis Group, 2002-11-09) Allotey, Pascale; Reidpath, DanielThe Disability Adjusted Life-Year (DALY) heralded a new age in the development of an evidence base for priority setting and resource allocation. The DALY was intended to represent sound measurement of the incidence and prevalence of conditions in a process by which burden of disease would be determined, health conditions prioritised and interventions evaluated. However, in the reification of objectivity, sight was lost of critical aspects of health and disease, namely that they are not independent of the context in which they occur. This is powerfully illustrated by many reproductive health conditions. Priority setting and resource allocation exercises need to take into account both objective measures and contextually relevant factors. Based on comparative data that highlights the effect of the development gradient on the burden of disease, this paper discusses the implications of context in the assessment of population health and priority setting, with a focus on reproductive health.Item Refugee intake: reflections on inequality(Wiley, 2003-02) Allotey, Pascale; Reidpath, DanielBackground: Refugees represent one of the most marginalised populations with generally poor health outcomes and requirements often very different from, and in excess of, the populations in the countries of asylum. It stands to reason that countries that accept refugees should have the resources to support them. Although governments in industrialised countries are often vociferous about the generosity of their support for refugees, the appearance is that it is the poorest nations that bear the greatest burden. This has important implications for the allocation of resources to support the health and welfare needs of refugees. The distribution of refugees globally and the wealth of the countries of asylum are examined in this paper. Method: Data on the numbers of refugees accepted in each country were obtained from the United Nations High Commissioner for Refugees. These were used to analyse the ‘fairness’ of the distribution of refugees according to the economic capacity of the host countries. Findings: A similar distribution of refugees prevails in the poorest quintile of countries and in the richest. Although there is considerable between-country variation, when account is taken of economic capacity, the poorest countries bear the greatest burden. Interpretation: The distribution of refugees is in stark contrast to the humanitarian rhetoric of the industrialised countries. The implications of the inequitable distribution on health cannot be overemphasised.Item Infant mortality rate as an indicator of population health(BMJ Publishing Group, 2003-05-01) Reidpath, Daniel; Allotey, PascaleBackground: The infant mortality rate (IMR) has been criticised as a measure of population health because it is narrowly based and likely to focus the attention of health policy on a small part of the population to the exclusion of the rest. More comprehensive measures such as disability adjusted life expectancy (DALE) have come into favour as alternatives. These more comprehensive measures of population health, however, are more complex, and for resource poor countries, this added burden could mean diverting funds from much needed programmes. Unfortunately, the conjecture, that DALE is a better measure of population health than IMR, has not been empirically tested. Methods: IMR and DALE data for 1997 were obtained from the World Bank and the World Health Organisation, respectively, for 180 countries. Findings: There is a strong (generally) linear association between DALE and IMR (r=0.91). Countries with low DALE tend to have a high IMR. The countries with the lowest IMRs had DALEs above that predicted by the regression line. Interpretation: There is little evidence that the use of IMR as a measure of population health has a negative impact on older groups in the population. IMR remains an important indicator of health for whole populations, reflecting the intuition that structural factors affecting the health of entire populations have an impact on the mortality rate of infants. For countries with limited resources that require an easily calculated, pithy measure of population health, IMR may remain a suitable choice.Item The DALY, context and the determinants of the severity of disease: an exploratory comparison of paraplegia in Australia and Cameroon(Elsevier, 2003-09) Allotey, Pascale; Reidpath, Daniel; Kouamé, Aka; Cummins, RobertThis paper summarises the findings of an empirical investigation of some of the technical and social assumptions on which the disability adjusted life year (DALY) is based. The objectives of the study were to examine the notion that the burden of disease is broadly similar without regard to country, environment, gender or socio-economic status and to develop detailed descriptions of the experiences of the burden of disease as they related to these contextual factors. The study was a multi-factorial exploratory study employing qualitative and quantitative techniques to obtain data on the effects of country (development), environment (urban versus rural), gender and socio-economic status on people with paraplegia. The data provided an extensive and detailed compilation of context rich descriptions of living with paraplegia. Striking features of the data were the differences between countries with respect to the impact of the health conditions on functioning and highlight a context in which paraplegia of like clinical severity can be fatal in one environment and not in another. While there has been some focus on the control of social determinants of disease, there has been little work on the social determinants of the severity of disease. The underlying assumptions of the DALY, which ignore context in the assessment of the burden of disease, risk exacerbating inequalities by undervaluing the burden of disease in less-developed countries. There is a need to continue to subject the development of indicators to rigorous debate to determine a balance between the assumption of a global “average social milieu” and the treatment of each individual as belonging to their own context in the assessment of population health in order for indicators to be meaningful cross-culturally.