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Countries with better health systems have better football teams
Roger Dobson BMJ 2002;325;1378 doi:10.1136/bmj.325.7377.1378/b

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Downloaded from on 11 November 2008

In brief
Onchocerciasis eliminated from west Africa: Officials from the World Health Organization last week celebrated the elimination of onchocerciasis, or river blindness, as a public health threat in west Africa. The organisation’s onchocerciasis control programme, which began in 1974, sprayed larvicide in the area to eliminate the disease’s vector, the black fly, and distributed the anti-parasite drug ivermectin. More details can be accessed at CHI to investigate Manchester mental health trust: The Commission for Health Improvement (CHI) has announced an investigation into Rowan ward at Manchester Mental Health and Social Care NHS Trust after concerns about the standard of care for older patients with mental illness. More information can be accessed at Primary care trusts to start receiving performance ratings: Primary care trusts and mental health trusts will receive performance ratings for the first time next year. Performance indicators have previously been issued only for acute, specialist, and ambulance services. Breast cancer rates rise in Hong Kong: A study by the Chinese University of Hong Kong has shown that breast cancer rates in Hong Kong have risen 25% since 1983. The incidence rose from 30.9 per 100 000 women in 1983 to 40.8 per 100 000 in 1999 (Public Health and Epidemiology Bulletin 2002;11:57-68). Doctors’ helpline will be open over Christmas period: The Doctors’ SupportLine, which started in December 2001, funded by a grant from the Department of Health, will be open over the Christmas period to provide a listening service. It is staffed by volunteers, all of whom are doctors. It will be open in the evenings of Christmas week 6 pm to 10 pm, except Boxing Day and Saturday. It is also open on Tuesday mornings from 10 am until 2 pm and Sundays from 10 am to 10 pm. The number is 0870 7650001.

UK royal colleges publish competency based curriculums
Susan Mayor London
134, 276, 136, 363

Areas of competence for general physicians
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Training for UK doctors in higher medical training is set to become more structured and systematically evaluated, with the publication this week of competency based curriculums by the three royal colleges of physicians of the United Kingdom. The new curriculums represent a complete restructuring of training and assessment for specialist registrars working in 29 specialties and subspecialties and are based on achieving a range of competencies considered necessary for doctors to work as independent consultants. They cover the final stage of training before doctors become consultants, which generally takes four to six years, depending on the medical specialty. They set out the knowledge, skills, and attitudes required for each com-

petency and define how these will be assessed. At each stage of learning, assessment will be both continuous and “on the job,” with tutors at the trainee’s hospital cross checking their knowledge and experience. The new curriculum for general (internal) medicine is based on the need to function in several roles, including clinical, counselling, educating, leading, and managing roles. It sets out areas of competence needed to perform these roles effectively. The new curriculums were developed by the Joint Committee for Higher Medical Training—the umbrella body for higher medical training for three of the royal colleges of the United Kingdom—the Royal College of Physicians of Edinburgh, the Royal College of Physicians and

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Ability to establish effective relationships with patients Leadership and personal management skills Organisation, planning, and service management skills Education and mentoring abilities Quality standards, effectiveness, research, and development skills

Surgeons of Glasgow, and the Royal College of Physicians of London. They are part of a wider overhaul of the colleges’ training curriculums, designed to update medical training in the United Kingdom.
The new curriculums—Higher Medical Training: Generic Curriculum Higher Medical Training and Curriculum for General (Internal) Medicine— are available at

Countries with better health systems have better football teams
Roger Dobson Abergavenny
218, 217,

When Bill Shankley, past manager of Liverpool Football Club, famously remarked that “some people think football is a matter of life and death . . . I can assure them it is much more serious than that,” he might just have had a point. New research has found a link between the health system of a nation and the performance of its soccer team. If a national team does well, according to the data, the country is also likely to have a good health system. This conclusion is based on a comparison of official football statistics of the Fédération Internationale de Football Association (FIFA) with health statistics from the World Health Organization. France, for instance, ranks number one in the health league and is second in the world ranking for soccer success. Italy is ranked number six for football and two for health, while Norway comes in at number nine at soccer and 11 for health. There are outliers, of course. Brazil,

possibly the best footballing side, does not appear in the top 20 health nations. In the study, reported in the Journal of Health Service Research and Policy (2002;6:2205), researchers from the University of York and the King’s Fund in London compared the rankings for the international teams of 176 countries against the ranking for the same countries on the WHO health performance index. One of the authors, John Appleby, chief economist of the King’s Fund, said that any relation between FIFA and WHO rankings was entirely spurious. “But comparison of the two indices illustrates problems with the WHO exercise, including measurement difficulties.” The other author, Andrew Street of the Centre for Health Economics at York University, explained that the paper started as a joke. “The intention was to sow doubt about supposedly sophisticated attempts by the World Health Organization to

Zinedine Zidane with World Cup

measure health system performance. But there are some serious messages. The most notable is that data can be misused to prove almost anything you like—such as that countries with better football teams will have better health systems. Just because the WHO analysis looks sophisticated, it does not mean it is right,” he said. Like the late Bill Shankley’s football, health systems are about more than just life and death. Cost, quality, and accessibility also need to be taken into account.
Health System Goals: Life, Death … and Football is at inst/che/street.htm




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