5 6 However, the results of individual studies are mixed, 7 and the challenge remains to identify those for whom different forms of self-management are suitable and to develop and optimise ways of delivering available interventions to maximise effectiveness and safety.
Although not currently able to deliver the very low pollution required to minimize adverse health effects, available interventions can substantially reduce exposure and incidence of important diseases.
Health care and health systems are among the SDH, and an immediate imperative is to make more resources available to deliver key interventions.
This process ensures new staff are exposed to the delivery of CRA and CRAFT in practice while they are undertaking the certification process, and increases the number of staff available to deliver the interventions.
Two studies [ 26, 29] used available technology to deliver the interventions, one via the Internet and one through videoconferencing (tele-health).
In the UK, another response to the scarcity of mental health resources available to deliver Motivational Interviewing interventions has been to shift the focus away from individualized support outside clinic time, towards weaving the ideas into the routine consultations with regular practitioners, taking a population rather than an individual approach (DEPICTED) 65.
Other was used when a patient was deemed not suitable for reasons other than those listed (eg, not admitted to a stroke unit, lower limb fractures) or when no treating therapists were available to deliver the intervention.
It was assumed that an appropriate workforce was available to deliver the intervention to the recruited population, meaning that no provision was made for costs associated with the recruitment, orientation and training of more staff.
Second, the current level of education of health professionals is excluded; if the skills required to deliver an intervention are available in the country under study, training costs to develop those skills are not included in the programme costs since a reallocation of health system resources does not affect these costs.
If, for example, few women in a particular country give birth in health facilities, even if these are widely available, delivering packages of interventions via facilities is unlikely to be the most effective approach to reaching MDGs 4 and 5 [14].
