Public Health Policy

The high costs of cheap tanning: pricing and promotional practices of indoor tanning facilities in six cities in the United States Abstract Few studies have investigated pricing and promotional practices used by the indoor tanning industry, despite their potential to promote indoor UV tanning—a well-established risk factor for melanoma skin cancer. Posing as potential customers, we telephoned 94 indoor tanning businesses in six United States (U.S.) cities and requested pricing information. The price of a single tanning session ranged from $0 to $23, and was lower at facilities that offered indoor tanning as a secondary service (mean $4.82 and free in 35%) than at tanning salons (mean $16.45). Session prices in salons could be as low as $1.50 with daily use of an unlimited monthly plan. Free indoor tanning, monthly packages, and memberships encourage increased use. Policies that limit free indoor tanning or that restrict pricing and advertising for indoor tanning exist in several places in the U.S. and Europe. Future research should evaluate whether those policies are effective in reducing indoor tanning.

The double burden of malnutrition: an assessment of ‘stunted child and overweight/obese mother (SCOWT) pairs’ in Kerala households Abstract A double burden of malnutrition (DBM) is the coexistence of under-nutrition and over-nutrition in a single household that has been reported from many developing countries. We performed a secondary analysis on India Human Development Survey (IHDS-II) data assessing ‘stunted child and overweight/obese mother (SCOWT) pairs’ in Kerala households. We included 344 pairs of children below 5 years of age and their mothers, with anthropometric measurements. We also performed the Pearson’s Chi–square test to study the association of SCOWT pairs with socio-economic variables. The prevalence of SCOWT pairs was 10.7% for Kerala. The bivariate analysis showed no significant association for SCOWT pairs, irrespective of their socio-economic status. It is clear that the DBM is prevalent in Kerala and cannot be addressed exclusively by policies focusing on over-nutrition.

Economic sanctions and HIV/AIDS in women Abstract HIV/AIDS has disproportionately affected women worldwide. Several studies focus on economic sanctions and the health of populations, but little attention has been paid to the effects of sanctions on HIV rates. This study examines the influence of economic sanctions on HIV in women and finds that sanctions increase women’s HIV rate by decreasing female labor participation. These findings are in line with previous findings that sanctions negatively affect public health in general as well as women in particular. All these findings suggest that policy makers need to consider more carefully the scourge of HIV/AIDS among women when formulating their policies toward target countries.

Correction to: The Federation’s Pages Switzerland, a Haven for the Tobacco Industry Due to an unfortunate oversight the article title “Switzerland, a haven for the tobacco industry” has been omitted.

Thanks to Reviewers

WFPHA: World federation of public health associations www.wfpha.org

Homicide in pregnant and postpartum women worldwide: a review of the literature Abstract We review the international literature on a neglected aspect of maternal mortality: maternal homicide. Reported rates range from 0.97 to 10.6 per 100,000 live births. Women murdered in the perinatal period constituted a highly vulnerable group: they were younger, more likely to be from minority ethnic groups, and unmarried. Domestic violence was a significant risk factor for attempted and completed homicide. Compared to other countries, pregnancy-associated homicide rates were highest in the US. It is unclear how much of the difference to attribute to better case identification or to actual risk. Our review demonstrates pregnancy-associated homicide is an important contributor to maternal mortality, with rates comparable to suicide. Central to any prevention strategy will be identification of those at risk. The predictions are very weak because definitions, data collection, and analysis are so variable from study to study. Our findings reinforce the importance of screening for current and previous domestic violence.

The importance of insulin donations for children in 43 low- and middle-income countries Abstract Diabetes mellitus is rapidly becoming one of the major diseases affecting people’s health globally. Over half of 100 million diabetes patients who need insulin to survive, especially in low- and middle-income countries (LMIC), are not able to get this medicine and die prematurely. Since 2000, insulin-producing companies have started support programmes with a component of insulin donations to children and youth with type 1 diabetes in 43 LMIC. Based on their experiences we conclude, contrary to common belief, that the diagnosis, treatment, and prevention of fatal complications in children with type 1 diabetes in LMIC are very possible in practice, with large improvements in survival, mean body weight, mean glucose levels, and frequency of complications. Medicine donations can never offer a sustainable solution and we now propose a ten-step transition process towards a fully sustainable national diabetes care and prevention programme for children and youth with diabetes type 1.

Multilevel governance, public health and the regulation of food: is tobacco control policy a model? Abstract Campaigns against risk factors for non-communicable diseases (NCDs) caused by smoking and obesity have become increasingly common on multiple levels of government, from the local to the international. Non-governmental actors have cooperated with government bodies to make policies. By analysing the policies of the World Trade Organization, the World Health Organization, the European Union, and the United Kingdom and United States governments, we identify how the struggles between public health advocates and commercial interests reached the global level, and how the relatively successful fight to ‘denormalize’ tobacco consumption has become a model for anti-obesity advocates. It highlights three factors important in policy change: framing the policy problem, the policymaking environment and ‘windows of opportunity’—to analyse the struggle between ‘harm regulation’ and ‘neoprohibition’ approaches to an international obesity prevention regime.

Contemporary vaccination policy in the European Union: tensions and dilemmas Abstract This paper seeks to contribute to a more nuanced discourse on vaccination policy. Current polarization between either mandatory and entirely voluntary is misleading, as virtually all immunization programs feature a combination of instruments that comprise mandatory and voluntary elements. We develop this argument by presenting five case studies from the European Union (EU). By systematically acknowledging the nuances of political and institutional varieties, we build the case for reframing the terms of the debate in the EU and beyond.