Paths of convergence for agriculture, health, and wealth.

This special feature calls for forward thinking around paths of convergence for agriculture, health, and wealth. Such convergence aims for a richer integration of smallholder farmers into national and global agricultural and food systems, health systems, value chains, and markets. The articles identify analytical innovation, where disciplines intersect, and cross-sectoral action where single, linear, and siloed approaches have traditionally dominated. The issues addressed are framed by three main themes: (i) lessons related to agricultural and food market growth since the 1960s; (ii) experiences related to the integration of smallholder agriculture into national and global business agendas; and (iii) insights into convergence-building institutional design and policy, including a review of complexity science methods that can inform such processes. In this introductory article, we first discuss the perspectives generated for more impactful policy and action when these three themes converge. We then push thematic boundaries to elaborate a roadmap for a broader, solution-oriented, and transdisciplinary approach to science, policies, and actions. As the global urban population crosses the 50% mark, both smallholder and nonsmallholder agriculture are keys in forging rural-urban links, where both farm and nonfarm activities contribute to sustainable nutrition security. The roadmaps would harness the power of business to reduce hunger and poverty for millions of families, contribute to a better alignment between human biology and modern lifestyles, and stem the spread of noncommunicable chronic diseases.

Multisectoral lessons from healthy communities.

The healthy communities movement can provide insight into population health efforts in the United States, particularly in the context of recent health care reform. The movement has evolved from multisector partnerships that focused on improving the health, well-being, and quality of life for people and the social determinants of health to partnerships that focus more on chronic disease prevention, health equity, and environmental change. Evaluating the effects of community programs on population health has been challenging for a number of reasons. More metrics need to be developed for population health that will address inequities and focus policies on long-term health effects.

Healthcare reconsidered: forging community wellness among African Americans in the south.

This article details the history of Slossfield Hospital, an African American hospital and community center founded in Birmingham, Alabama, in 1937. During its New Deal-era existence it provided African American physicians institutional support for their medical practices. Additionally, as a community center, it addressed the socioeconomics of good health. This paper uses Slossfield as a case study to explore how some African Americans included the socioeconomic in their definition of public health during the New Deal, as well as to understand how these ideas were subsumed by more mainstream ideas about public health promulgated by black and white physicians and the local and federal governments.

The patient as a policy factor: a historical case study of the consumer/survivor movement in mental health.

This paper analyzes the history of the modern consumer/survivor movement and its impact on the policy-making climate in the mental health field. The growing attentiveness to consumers' perspectives is presented largely as a consequence, not a cause, of radical restructurings of the mental health system. Consumers' perspectives have entered policy discourse in the wake of policy failures and have flourished in a climate of perpetual crisis and tight budgets. Precisely because it has been such a contested arena for so long, the mental health field has produced some innovative responses to demands for patient empowerment.

Defining 'mental illness' in mental health policy.

Mental health policy is shaped fundamentally by the definition of mental illness associated with the policy. Changing policies reflect changing definitions. At various times, the definition may be narrow or broad with respect to the scope of conditions covered by a specific policy. The priority accorded to impairment severity is the most crucial and enduring policy issue related to the definition of mental illness and the scope of that definition. This paper explores the role of definitions in framing mental health policy, using examples from the history of policy making over the past half-century.

O processo do trabalho do agente comunitário de saúde e a construção da integralidade: histórico e a política nacional de atenção básica / The process of the work of the communitarian agent of health and the construction of the completeness: description and the national policy of basic attention

Busca realizar dois movimentos: o primeiro seria um resgate histórico do trabalho e formação dos agentes comunitários e o outro seria, a partir da leitura da nova Política de Atenção Básica, fazer algumas considerações sobre o processo de trabalho do Agente Comunitário de Saúde (ACS) na Equipe de Saúde da Família (ESF), sob a perspectiva da construção da integralidade. Enfatiza que o objetivo principal é contribuir para o debate sobre a formação técnica dos Agentes Comunitários de Saúde no Brasil.

O processo do trabalho do agente comunitário de saúde e a construção da integralidade: histórico e a política nacional de atenção básica / The process of the work of the communitarian agent of health and the construction of the completeness: description and the national policy of basic attention

Busca realizar dois movimentos: o primeiro seria um resgate histórico do trabalho e formação dos agentes comunitários e o outro seria, a partir da leitura da nova Política de Atenção Básica, fazer algumas considerações sobre o processo de trabalho do Agente Comunitário de Saúde (ACS) na Equipe de Saúde da Família (ESF), sob a perspectiva da construção da integralidade. Enfatiza que o objetivo principal é contribuir para o debate sobre a formação técnica dos Agentes Comunitários de Saúde no Brasil (AU)

MAPP and the evolution of planning in public health practice.

Mobilizing for Action through Planning and Partnerships, the most recent planning tool in public health practice, is built upon a long history of planning by local public health agencies (LPHAs). Planning by LPHAs has evolved over half a century from the earliest problem/program-focused planning, through more comprehensive approaches like the Planned Approach to Community Health (PATCH) and the Assessment Protocol for Excellence in Public Health (APEXPH) to strategic planning of today. While LPHAs were not notably participants in the federally sponsored health planning of the 1960s and 1970s, this planning left a legacy in public health. Mobilizing for Action through Planning and Partnerships introduces strategic thinking and a systems orientation into public health planning that builds upon this legacy.

Social support and social action organizing in a "grey ghetto": the tenderloin experience. 1982-83.

The Tenderloin Senior Outreach Project (TSOP) is presented as a case study of effective community-based organizing among the isolated elderly in one of America's large "grey ghettos." Based on the theoretical underpinnings of social support theory and Freire's "education for critical consciousness," the Project has attempted to address the interrelated problems of poor health, social isolation and powerlessness endemic among the elderly in Single Room Occupancy hotels. The Project's metamorphosis is traced from a university-sponsored community development effort to a communitycontrolled organization focused on broad social action objectives. The transference of leadership from health education facilitators to indigenous elderly leaders within the hotels is examined, as are some of the strategies employed in increasing Project visibility, preventing burn-out, and facilitating replication in other areas.

Using theory to design an intervention for HIV/AIDS prevention in farm workers in rural Zimbabwe. 1994.95.

A variety of primary prevention strategies are used in HIV prevention programs in Africa. However, these are often developed through intuition and the theoretical basis for many interventions is limited to the knowledge /attitude model. This Article illustrates how research findings from a base-line survey are combined with Paulo Freire's social change theory and the Ecological Model for Health Promotion to develop a participatory intervention for HIV/AIDS prevention in farm workers in Zimbabwe. The article addresses the need to focus attention on the process of change at the interpersonal level, organizational and policy levels of the community. Dialogue is central to the range of strategies proposed for the intervention. The effect will be measured through process and outcome evaluation.

Rural community and health care interdependence: an historical, geographical study.

The relationships between rural health care and community development were examined over time, for the case-study area of Huron and Perth counties in Southwestern Ontario. The underlying premises were that an historical-geographic study could provide both a perspective on the development of rural health services and explore the interdependent relationship between rural community and health care. The research concentrated on examinations of the 2 key elements of rural health care, namely the rural practitioner and the community hospital. Detailed reconstruction revealed that, over time, both physicians and hospitals moved from a marginal to a central position and identity within the community, in parallel with the stages of community development in the 19th and 20th centuries, with hospitals emerging as major foci of rural sustainability. In the last 2 decades, the strength of the area's rural community health system was successfully marshalled to offset the potentially negative aspects of provincial health care restructuring. This reinforced both the perception and the reality of the interdependence of health services and communities in the predominantly rural area.

Confronting the challenges in reconnecting urban planning and public health.

Although public health and urban planning emerged with the common goal of preventing urban outbreaks of infectious disease, there is little overlap between the fields today. The separation of the fields has contributed to uncoordinated efforts to address the health of urban populations and a general failure to recognize the links between, for example, the built environment and health disparities facing low-income populations and people of color. I review the historic connections and lack thereof between urban planning and public health, highlight some challenges facing efforts to recouple the fields, and suggest that insights from ecosocial theory and environmental justice offer a preliminary framework for reconnecting the fields around a social justice agenda.

Profitable gifts: a history of the Merck Mectizan donation program and its implications for international health.

A unique public/private partnership situated around a pharmaceutical, Merck's Mectizan donation program stands out as an example of corporate philanthropy in the history of the pharmaceutical industry and provides insight into future public/private partnerships in public health. This paper considers the issues Merck faced in the decision to donate Mectizan (ivermectin) and in the subsequent development of the Mectizan donation program, delineating the moral and financial debates that arose within the company. Coming after almost 15 years of donation, this assessment of the program's strengths and shortcomings suggests how the pharmaceutical industry can better serve as a viable partner in improving international health.