Young T Kue, Fedkina Natalia, Chatwood Susan, Bjerregaard Peter
a School of Public Health , University of Alberta , Edmonton , Canada.
b Institute for Circumpolar Health Research , Yellowknife , Northwest Territories , Canada.
Int J Circumpolar Health. 2018 Dec;77(1):1492825. doi: 10.1080/22423982.2018.1492825.
The eight Arctic States exhibit substantial health disparities between their remote northernmost regions and the rest of the country. This study reports on the trends and patterns in the supply and distribution of physicians, dentists and nurses in these 8 countries and 25 regions and addresses issues of comparability, data gaps and policy implications Methods: We accessed publicly available databases and performed three types of comparisons: (1) among the 8 Arctic States; (2) within each Arctic State, between the northern regions and the rest of the country; (3) among the 25 northern regions. The unit of comparison was density of health workers per 100,000 inhabitants, and the means of three 5-year periods from 2000 to 2014 were computed.
The Nordic countries consistently exceed North America in the density of all three categories of health professionals, whereas Russia reports the highest density of physicians but among the lowest in terms of dentists and nurses. The largest disparities between "north" and "south" are observed in the Northwest Territories and Nunavut of Canada for physicians, and in Greenland for all three categories. The disparity is much less pronounced in the northern regions of Nordic countries, while Arctic Russia tends to be oversupplied in all categories.
Despite efforts and standardisation of definitions by international organisations such as OECD, it is difficult to obtain an accurate and comparable estimate of the health workforce even in the basic categories of physicians, dentists and nurses . The use of head counts is particularly problematic in jurisdictions that rely on short-term visiting staff. Comparing statistics also needs to take into account the health care system, especially where primary health care is nurse-based. List of Abbreviations ADA: American Dental Association; AHRF: Area Health Resource File; AMA: American Medical Association; AO: Autonomous Okrug; AVI: Aluehallintovirasto; CHA: Community Health Aide; CHR: Community Health Representative; CHW: Community Health Worker; CIHI: Canadian Institute for Health Information; DO: Doctor of Osteopathic Medicine; FTE: Full Time Equivalent; HPDB: Health Personnel Database; MD: Doctor of Medicine; NOMESCO: Nordic Medico-Statistical Committee; NOSOSCO: Nordic Social Statistical Committee; NOWBASE: Nordic Welfare Database; NWT: Northwest Territories; OECD: Organization for Economic Co-operation and Development; RN: Registered Nurse; SMDB: Scott's Medical Database; WHO: World Health Organization.
八个北极国家最北部的偏远地区与该国其他地区之间存在巨大的健康差距。本研究报告了这8个国家和25个地区医生、牙医和护士的供应与分布趋势及模式，并探讨了可比性、数据缺口和政策影响等问题。方法：我们访问了公开可用的数据库，并进行了三种类型的比较：（1）在8个北极国家之间；（2）在每个北极国家内部，北部地区与该国其他地区之间；（3）在25个北部地区之间。比较单位是每10万居民中的卫生工作者密度，并计算了2000年至2014年三个5年期间的平均值。
北欧国家在所有三类卫生专业人员的密度方面一直超过北美，而俄罗斯医生密度最高，但牙医和护士密度在所有国家中处于最低水平。在加拿大的西北地区和努纳武特地区，医生方面“北部”与“南部”之间的差距最大，而在格陵兰岛，所有三类人员的差距都很大。北欧国家北部地区的差距则不太明显，而俄罗斯北极地区各类人员往往供应过剩。
尽管经合组织等国际组织做出了努力并对定义进行了标准化，但即使在医生、牙医和护士等基本类别中，也难以获得准确且可比的卫生人力估计数。在依赖短期访问工作人员的司法管辖区，使用人员总数尤其成问题。比较统计数据时还需要考虑医疗保健系统，特别是在以护士为基础的初级卫生保健地区。缩写列表：ADA：美国牙科协会；AHRF：地区卫生资源文件；AMA：美国医学协会；AO：自治区；AVI：芬兰地方行政监察局；CHA：社区卫生助理；CHR：社区卫生代表；CHW：社区卫生工作者；CIHI：加拿大卫生信息研究所；DO：整骨医学博士；FTE：全职等效人员；HPDB：卫生人员数据库；MD：医学博士；NOMESCO：北欧医学统计委员会；NOSOSCO：北欧社会统计委员会；NOWBASE：北欧福利数据库；NWT：西北地区；经合组织：经济合作与发展组织；RN：注册护士；SMDB：斯科特医学数据库；世卫组织：世界卫生组织。
