ABSTRACT
In the framework of the tri-annual report to WHO of progress towards "Health for all" the specific question concerning reduction of inequity in health is addressed. Regional variations in health status represent an important aspect of that question which is of particular interest in a federal country where major public health competencies are located at the regional level (cantons in Switzerland). Health status is described by both mortality measures (main causes of death) in the population aged 0-64 years and morbidity indicators (rates of disability pensioners) in the same age group. In addition to the comparison of mortality and morbidity rates between cantons an "index of dissimilarity" (DI) was used. For both criteria, changes over a time period of 10 to 12 years were considered. Results show decreasing trends of mortality from all and main causes of death in both sexes. While this tendency goes along with decreasing dissimilarity as to male overall mortality, the corresponding female DI increases, indicating an increase in inequity between the cantons. A similar pattern is observed as to morbidity: although rates of disability pensioners went up for both sexes, this increase resulted in a lower DI-value for men but a higher one for women. The results are discussed against the background of socioeconomic differences (e.g. unemployment) between the cantons studied.
Subject(s)
Cause of Death , Global Health , Morbidity/trends , Mortality/trends , Adolescent , Adult , Child , Child, Preschool , Cross-Cultural Comparison , Female , Forecasting , Health Services Accessibility/trends , Humans , Infant , Male , Middle Aged , Switzerland , World Health OrganizationABSTRACT
General practitioners are in prime position for promoting primary, secondary and tertiary HIV prevention. Counselling is an integral part of their work and a key step towards behavioural change of their patients. Particular attention must be given to counselling before and after the HIV antibody test. So far, the extraordinary potential of general practitioners to educate patients about HIV infection has been used insufficiently. The primary barriers to providing health education are lack of knowledge and discomfort with initiating discussions of sexuality or drugs use rather than lack of time or 'other health priorities', etc. These findings show the need to implement education programmes for physicians and other members of their medical practice. Additionally, patients should be encouraged to take the initiative in starting discussions about HIV. In Switzerland, an education programme for physicians is currently under way.
