Health Policy Commons^™

The Politics Of Trauma System Development, Robert B. Hackey

Health Policy & Management Faculty Publications

No abstract provided.

Introduction, James Jennings

Trotter Review

The Summer 1995 issue of the Trotter Review, "Public Health and Communities of Color: Challenges and Strategies," provides a range of essays and two personal commentaries on facets of public health, race, and ethnicity in urban America. The essays are written by scholars and activists familiar with public health and issues of race, access, and diversity. The first article is the Executive Summary of the Institute of Medicine's national report, Balancing the Scales of Opportunity: Ensuring Racial and Ethnic Diversity in Health Professions. This report focuses on the problem of underrepresentation of Blacks, Latinos, and Native Americans in the …

The Multicultural Mental Health Research Center (Mmhrc), Castellano Turner

Trotter Review

African Americans, Asian Americans, Hispanic/Latino Americans, and Native Americans have had relatively less access to the resources of society compared to white Americans. These resources include such things as educational and employment opportunities, political and economic power, and the goods and services that a prosperous society can produce. Health care is an important resource to which access is not equal for all groups. African Americans and other ethnic minority groups are, by most indices of health care access and utilization, underserved. Mental health services, in particular, have been shown to be less available to ethnic minority populations. Jones and Korchin, …

Disparities In The Health Care Status Of Women: Implications For Research, Marcia I. Wells-Lawson

Trotter Review

Even a cursory review of data on the health status of women reveals striking differences by race. According to data from the National Center for Health Statistics, death rates among Black women from the three leading causes of death (cardiac disease, cancer and cerebrovascular disease) exceed those of white, Asian, Native American and Latina women for each age category from 45-84. With the exception of Black women, the death rates among white women from these diseases exceed those of other ethnic groups of women. Data on two of the risk factors for cardiac and cerebrovascular diseases (hypertension and obesity), show …

Can The Health Needs Of African American Men Be Met Through Public Health Empowerment Strategies?, Deborah Prothrow-Stith, Eric Whitaker

Trotter Review

Health promotion and disease prevention efforts, which use empowerment strategies and emphasize community control, are essential to overcoming the legacy of medical malfeasance and successfully improving the health status of black males. This discussion depicts the legacy of harm and presents the case for empowerment strategies; it also describes one Boston community-based program example of utilizing an empowerment strategy and concludes with a challenge to all health professionals to become enablers of empowerment rather than obstructions to it.

Programmatic Responses To The Aids Epidemic By Communities Of Color In Massachusetts, Ron E. Armstead

Trotter Review

The Centers for Disease Control found that minorities now account for more than half of all the HIV cases in the United States. For African Americans, the rate was more than 5 times as high as that for whites. Further, the disease has equally affected women and children in the African American community; 84% of the AIDS cases involving children age 12 and under can be found in the African American community. AIDS has now become the second leading cause of death for African American women. This essay describes a research project focusing on the factors involved in developing and …

Warning: Urban Living May Be Hazardous To Your Health: A Personal Perspective, Frederick G. Adams

Trotter Review

As a result of remarkable scientific and medical achievements of the 20th century, we now know that full and quality health is within reach for all Americans. Yet, despite these achievements, the burdens of inadequate health services too often falls more heavily on some population groups more so than on others. The fact that this "gap" in health status occurs more frequently among people with low income and people belonging to racial/ethnic minority groups, in particular African Americans, has been well documented nationally. Not only does the "gap" in the health status experienced by these groups include consistently higher excess …

Improving Health Care For Disadvantaged Local Communities: Proposing User Fees Based On Some International Experiences, Saskia Wilhelms

Trotter Review

The fact that national health care reform in the United States has been stalled is not reason for resign. More than ever, one has to design and implement creative options to achieve satisfactory health service at low costs. The political turnover in Congress shifts more responsibility to local governments. This means less funding and less willingness by the national government to be held accountable for health and social services. On the other hand, this situation may carry opportunity to impact social policies on a local level.

The living conditions in some of our communities equal those in so-called third world …

Coalition Building: Moving Toward Effective Coalitional Strategies Of Hiv/Aids Prevention In Communities Of Color, Lisa Roland

Trotter Review

Despite the overwhelming burden carried by blacks and Latinos in terms of AIDS, it has become evident that in keeping with the general and historical pattern of discrimination reflected in funding, allocation of resources, policies etc., communities of color have received insufficient support to effectively address the problem at hand. Further compounding this dilemma, communities of color have fought against each other to secure funding for particular community programs. While looking at our individual, immediate, and entirely valid needs, many of us have at times failed to see the impact of our individual actions and attitudes on a broader picture.

Ethnic Minorities And Mental Health: Ethical Concerns In Counseling Immigrants And Culturally-Diverse Groups, Gemima M. Remy

Trotter Review

Between 1980 and 1990 nearly 9 million foreign-born individuals migrated to the United States. In 1993, the Immigration and Naturalization Service recorded the entry of over 900,000 immigrants and refugees. This figure is believed to be higher given the estimated 1.5 to 2.5 million people who enter this country illegally each year. Currently, ethnic minority groups make up one-fourth of the United States population. It is estimated that by the year 2000, one-third of the U.S. population will be comprised of ethnic minorities. As the population of the United States becomes increasingly diverse, considerable attention is being directed to a …

An Economic Profile Of Women In Massachusetts, Randy Albelda

Publications from the Center for Women in Politics and Public Policy

This report provides a profile of women's current economic position in Massachusetts. It examines the age, race, and geographical distribution of women and girls across the state; family structure, income and poverty; and women's labor force participation, occupational and industrial distribution in jobs, and earnings. When relevant 1990s Massachusetts data are compared to national data and to Massachusetts data from the 1970s.

Women across the Commonwealth have experienced tremendous changes in their lives over the last two decades as a result of changes in the economy and family structure. For women, the changes provide new opportunities, but they also exacerbate …

Child Health Supervision: Analytical Studies In The Financing, Delivery, And Cost-Effectiveness Of Preventive And Health Promotion Services For Infants, Children, And Adolescents, Michele R. Solloway, Peter Budetti

Center for Health Policy Research

Contents: Financing and Delivery of Child Health Supervision Services (An Overview of Health Insurance Coverage and Access to Child Health Supervision Services, Private Health Insurance Coverage of Preventive Benefits for Children, A 20-Year Retrospective of Child Health Supervision in Ambulatory Pediatric Settings, Ensuring Adequate Health Care Benefits for Children and Adolescents); Child Health Supervision Services and Medicaid (Informing State Medicaid Providers about EPSDT, Barriers to Full Participation in EPSDT and Possible Strategies for the Maternal and Child Bureau, Medicaid Managed Care: A Briefing Book on Issues for Children and Adolescents; State Implementation of OBRA '89 EPSDT Amendments within Medicaid Managed …

A Case Study Of The Development Of Oregon's 1985 Public Policy In Youth Substance Abuse, Sonja Carol Grove

Dissertations and Theses

Youth substance abuse in Oregon reached epidemic proportions in the early 1980s. A response to this social issue from the Governor's Office, the state legislature, and the Office of Alcohol and Drug Programs during 1983-1985 is the foundation of this case study. Oregon, a small state of three million, was faced with a growing problem of youth and adult substance abuse. Legislative leaders, agency staff, and Governor Atiyeh recognized an opportunity to create public policy to solve problems of substance abuse including crime. The focus on substance abuse included streamlining several budgets with substance abuse monies in various state agencies. …

Doing More With Less: The Marie Stopes Clinics In Sierra Leone, Nahid Toubia, Grace Ebun Delano

Poverty, Gender, and Youth

This edition of Quality/Calidad/Qualité reports on the Marie Stopes Sierra Leone (MSSL) organization which pursues its goals with compassion and ambition, despite seemingly insurmountable economic hardships. MSSL has established a service model that many programs in richer countries should try to imitate. Several particularly important lessons emerged, including: creative, skillful management, well-organized and flexible financial administration, and human motivation and perseverance can enable an organization to overcome financial difficulties; family planning is an integral part of people's reproductive and general health concerns and can dovetail with concern for development in useful and practical ways; men appreciate being involved in the …

Behavioral And Community Impacts Of The Portland Needle Exchange Program, Kathleen Joan Oliver

Dissertations and Theses

Research questions were: 1: Will Drug Injectors Use An Exchange In A StateWhere Syringes Are Legal? 2: Will Drug Injectors Using An Exchange Decrease Risky Behavior? 3: Will Frequent Clients Change Risk Behaviors More Than Infrequent Clients? 4: Will Drug Injectors Using An Exchange Change Risk Behaviors More Than A Comparison Group Not Using An Exchange? 5: Does An Exchange Have An Impact On The Number Of Discarded Syringes On The Streets? 6: Is There A Difference In The Rate Of Spread Of HIV Infection Among Users And Non-Users Of The Exchange. Drug injectors will use needle exchange programs, even …

Physical And Environmental Features That Contribute To Satisfaction With Hospice Facilities, Arezu Movahed

Dissertations and Theses

Improving the quality of remaining life for individuals who are terminally ill and their families is an issue that has become increasingly important in recent years. This issue has evolved from perceived deficiencies of conventional health care institutions in meeting the needs of people who are in the final stages of their life, when curative measures are no longer deemed appropriate. In response to deficiencies in care of the terminally ill and their families, there has been a movement toward humanizing conventional health care and making it more holistic. Hospice care, which is consistent with this movement, has evolved as …

The Rhetoric And The Reality Of Health Care Reform Legislation, Marilyn Moon

Center for Policy Research

A plethora of political autopsies have been performed on the Clinton Administration's failed health care reform of 1994--it was too much; it was too late; there was too much pandering; there was too little pandering. Such critiques of this complex undertaking are at least partially correct. It was probably hubris to believe that such a comprehensive health care reform package could be proposed and passed in a single year. But much of the instant analysis of its failure has repeated the rhetoric of the debate rather than stepping back and placing the events of 1994 in perspective. Here I focus …

The Importance Of Health Insurance Reform, Nancy Landon Kassebaum

Maine Policy Review

In her commentary, Republican Senator Nancy Kassebaum of Kansas outlines a proposed bipartisan health insurance reform act which she will introduce in the Senate next year.

Is Equal Access The Prescription For Equity?, Victor Sidel, Dorothy E. Roberts, Jennifer Dohrn, Kathy Anastos, Nitza Milagros Escalera, Peter Holland, Sylvia Kleinman, Sylvia Law, Jack O'Sullivan, Robert Padgug, Dennis Rivera, Beth Weitzman

All Faculty Scholarship

No abstract provided.

The Genetic Tie, Dorothy E. Roberts

All Faculty Scholarship

No abstract provided.

Does Pro-Choice Mean Pro-Kevorkian? An Essay On Roe, Casey, And The Right To Die, Seth F. Kreimer

All Faculty Scholarship

No abstract provided.

Health Information Privacy, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Thoughtful scholarship in the area of informational privacy sometimes assumes that a significant level of privacy can coexist with the development of a modern health information infrastructure. Some commentators suggest that we can have it both ways: that adequate legal protection of informational privacy will eliminate the need to significantly limit the collection of health data. This article demonstrates that there is no such easy resolution of the conflict between the need for information and the need for privacy. Because significant levels of privacy cannot realistically be achieved within the health information infrastructure currently envisaged by policymakers, we confront a …

Tuberculosis And The Power Of The State: Toward The Development Of Rational Standards For The Review Of Compulsory Public Health Powers, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This article uses tuberculosis as the paradigm for exploring rational standards for the exercise of compulsory public health powers. Extant doctrine in disability and constitutional law provides a lens for examining judicial review of state interventions. The author first sets out the central epidemiological and biological aspects of tuberculosis to demonstrate the strength of the governmental interest in curtailing the epidemic. Second, he examines the interventions of testing, screening, and confinement of persons with tuberculosis, where he focuses on two congregate settings--correctional and health care facilities--that present substantial health risks and are principal foci for the exercise of state intervention. …

Genetic Privacy, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Human genomic information is invested with enormous power in a scientifically motivated society. Genomic information has the capacity to produce a great deal of good for society. It can help identify and understand the etiology and pathophysiology of disease. In so doing, medicine and science can expand the ability to prevent and ameliorate human malady through genetic testing, treatment, and reproductive counseling.

Genomic information can just as powerfully serve less beneficent ends. Information can be used to discover deeply personal attributes of an individual's life. That information can be used to invade a person's private sphere, to alter a person's …

The Resurgent Tuberculosis Epidemic In The Era Of Aids: Reflections On Public Health, Law, And Society, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The resurgence of tuberculosis and the rise in drug-resistant cases is neither inexplicable nor unexpected, but rather is the predictable outcome of a complex configuration of biological, social, and behavioral factors that have converged in America over the past decade. This article examines the biological, social, and behavioral causes of the epidemic, and suggests a comprehensive public health strategy for curtailing tuberculosis and other infectious diseases. When thoughtfully conceived, public health strategies can be implemented that are consistent with the limitations that both constitutional law and disability law place on the authority of the state. While traditional concepts of public …