Medicine and Health Sciences Commons^™

Climate Change And Human Rights: Shaping The Narrative For Reflexive Responses From Civilization’S Leadership To Counter And Abate Climate Change And Enhance The Role Of Human Rights In The Rule Of Law, Michael Donlan

New England Journal of Public Policy

This article offers a bold new legal process for enhancing and upgrading the rule of law to enable civilization to cope with and counter the mounting damage and injustice caused by climate change. Climate change, once an unimaginable threat, is now a brutal, ubiquitous game changer that is leading inexorably to the demise of all humanity. Only by enhancing the rule of law and melding international law with domestic law can civilization fashion a coherent, global action plan for survival.

For almost three centuries greenhouse gases have been emitted around the world by the burning of fossil fuel, and—most alarming—these …

Black Is Decidedly Not Just Black: A Case Study On Hiv Among African-Born Populations Living In Massachusetts, Chioma Nnaji, Nzinga Metzger

Trotter Review

Black or African American is a racial category that includes the descendants of enslaved Africans as well as members of foreign-born black communities who migrated to the United States from places abroad, such as Africa, the Caribbean, and Latin America. Grouping native-born and foreign-born blacks into a single homogeneous racial category may make it easier to track disease and health outcomes; however, it masks the different cultural experiences, histories, languages, social and moral values, and expectations that influence health beliefs, attitudes, practices, and behaviors. It also ignores such factors as migration, which forces foreign-born populations to examine both their traditional …

Online Predators: Myth Versus Reality, Janis Wolak, Lindsey Evans, Stephanie Nguyen, Denise A. Hines

New England Journal of Public Policy

Media stories about “online predators” who use the Internet to gain access to young victims often give inaccurate impressions of Internet-initiated sex crimes. Most such crimes involve adult men who use the Internet to meet and seduce adolescents into sexual encounters. Most offenders are open about their ages and sexual motivations. Most are charged with statutory rape (i.e., nonforcible sexual activity with victims who are too young to consent). Internet-initiated sex crimes account for a salient but small proportion of all statutory rape offenses and a relatively low number of the sexual offenses committed against minors overall. Victims are often …

Trends In Youth Victimization And Well-Being, And Implications For Youth Policy, Lisa M. Jones, David Finkelhor, Rashmi Nair, Michelle Collett

New England Journal of Public Policy

Youth victimization concerns have engaged educators, public health officials, and the media for many years. Cases of child victimization regularly make headlines, and in recent years public concern has focused in particular on sexual abuse, child abductions, online predators, school shootings, bullying, and cyberbullying. But little attention has been given to evidence for substantial declines in child victimizations over the past 20 years. Even for internet victimization, an area of high current public anxiety, trend data do not suggest a growing epidemic but instead find that some types of online victimization have declined over the past decade.

The failure to …

Food Insecurity Among Children In Massachusetts, Stephanie Ettinger De Cuba, Deborah A. Frank, Maya Pilgrim, Maria Buitrago, Anna Voremberg, Harris Rollinger, Denise A. Hines

New England Journal of Public Policy

This article focuses on the prevalence among Massachusetts children and families of food insecurity, inadequate access to enough nutritious food for an active and healthy life. It summarizes research findings on the association of food insecurity with less optimal children’s health and development from the prenatal period through adolescence. Food insecurity also correlates with other material hardships, such as housing and energy insecurity. Data show families’ participation in public nutrition and other assistance program is associated with decreased prevalence of food insecurity and with mitigation of its impact on children’s health and well-being. The article concludes with recommendations for policy …

Children And Homelessness In Massachusetts, Donna Haig Friedman, Katherine Calano, Marija Bingulac, Christine Miller, Alisa Zeliger

New England Journal of Public Policy

In Massachusetts, more than half a million children (15% of all children) live in poverty, 30% of all children live with parents who lack secure employment, and 41% live in households with high housing cost burdens. This article examines the root causes of poverty and its links to child homelessness in the state. Though the state has a long-standing progressive political legacy, the well-being of low-income families with children continues to decline. The article offers evidence about the extent of child homelessness and its profound effects on Massachusetts children and youth. The interconnectedness of what are usually thought of as …

Aids: An Overview, Loretta Mclaughlin

New England Journal of Public Policy

"We stand nakedly in front of a very serious pandemic, as mortal as any pandemic there ever has been," said Halfdan Mahler, director-general of the World Health Organization (WHO). "I don't know of any greater killer than AIDS, not to speak of its psychological, social and economic maiming. Everything is getting worse and worse with AIDS and all of us have been underestimating it, and I in particular. We're running scared. I cannot imagine a worse health problem in this century." When asked to compare AIDS to other epidemics, such as smallpox, that have infected and killed over the course …

Finding The Fastest Way To Her Heart: Linking Clinical And Policy Pathways, Paula Johnson, Brian R. Schuetz, Shelley M. Stark, Dora Tovar

New England Journal of Public Policy

The Mary Horrigan Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital in Boston, integrates research, clinical practice, and policy analysis with practical application to emerging women’s health issues. Recently, an interdisciplinary team of practitioners examined pathways to improving women’s heart health. Beginning with the evidence that a heart-healthy diet leads to improved health outcomes for women with cardiovascular disease, the Connors Center team charted a course of intellectual exploration that culminated in a broader community dialogue on how to improve access to healthy and affordable food. Through clinical experiences, research activities, and an ongoing interchange …

The Travels Of Our Bodies, Ourselves, Jane Pincus

New England Journal of Public Policy

The women’s health book, Our Bodies, Ourselves: A Book by and for Women, was first printed in 1970 by the small, radical New England Free Press. Published by the group of women soon too become the Boston Women’s Health Book Collective, it was advertised solely by word of mouth. Successive newsprint editions reached a quarter of a million people in the United States through colleges and an extensive network of “underground” bookstores. The book placed female sexuality firmly within the framework of women’s health and combined vividly experienced medical encounters with available health and medical information. It critiqued prevailing cultural …

Rubella Vaccine And Medical Policymaking: Fetal Rights And Women's Health, Jacob Heller

New England Journal of Public Policy

U.S. vaccine policies, to all appearances, are based on assumptions about cost effectiveness, safety, and public health needs. Analysis of the peer review health professions’ discourse about rubella vaccine between 1941 and 1999 challenges this view. There were four justifications for the development of the vaccine: (1) cost-benefit projections about vaccine use versus anticipated birth defects; (2) the desire to prevent “fetal wastage” by vaccinating women; (3) a professional imperative to ensure healthy babies; and (4) a bias among vocal vaccine advocates against “unnecessary” abortion. The role of a fifth consideration, the “cultural provenance” of vaccines for American medicine, though …

Nursing Homes To Medicare Waiver Programs In Vermont, Joseph Murray

New England Journal of Public Policy

This research examines the differences between nursing home residents and those who were able to leave nursing homes with the help of the Medicaid Waiver Program in Vermont. Ninety individuals who reentered the community with the aid of such waivers were compared with a random sample of nursing home residents through the use of the Nursing Home Minimum Data Set. The researchers found divergence in four key areas: cognition, continence, treatment categories, and desire to return to the community. Typically, those who left nursing homes for the community were cognitively intact, had moderate continence, received rehabilitative or clinically complex treatments, …

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.

A National Minority Organ/Tissue Transplant Education Program: The First Step In The Evolution Of A National Minority Strategy And Minority Transplant Equity In The Usa, Clive O. Callender, Alvina S. Bey, Patrice V. Miles, Curtis L. Yeager

Trotter Review

In 1978, members of the Southeastern Organ Procurement Foundation approached us concerning the disparity between the large number of African American patients, 50% to 70% of all patients on dialysis (artificial kidney machines), and the small number of African American donors (3%), and asked us why and what could be done about it? From my perspective as an African American transplant surgeon at Howard University, these observations piqued my curiosity and I agreed to investigate them. Our investigation took us into three areas: 1. An evaluation of the data regarding transplantation in patients at the Howard University Hospital Transplant Center …

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 …

Homeless Children Having Children, Yvonne M. Vissing

New England Journal of Public Policy

Homeless teenagers who have babies pose a significant population of concern for those in health and human services. This article explores demographic, structural, and economic changes for homeless young and single-parent families. It proposes that their homelessness is due to these barriers and the problems that result. Case studies illustrate the process of troubled teens becoming homeless women with babies. Policy recommendations for assisting these youngsters are offered.

Aids And The Homeless Of Boston, James J. O'Connell, Joan Lebow

New England Journal of Public Policy

Homeless persons with AIDS and HIV infection face significant health hazards during the daily struggle for survival on the streets and in the crowded shelters of our cities. This article offers a historical perspective on the evolution of the AIDS epidemic within the homeless population of Boston and examines the demographics, risk behaviors, and survival statistics of that epidemic. The Boston Health Care for the Homeless Program is presented as a model of service delivery that offers quality health care to homeless persons with AIDS while addressing the special needs of those bound by the immediacy of the next meal …

Health Care: An Economic Priority, Dolores L. Mitchell

New England Journal of Public Policy

Economic advancement for women may be inextricably linked to the state of their health and access to health care. This article warns that the debates and public policy dilemmas over health care delivery systems, their costs, who pays, and issues of coverage and utilization demands weigh greatly on women and their families. The author suggests that women especially must be careful consumers of health care plans and outlines some qualities they should seek in choosing such plans.

Lead Poisoning: A Health Epidemic In The Black Community, Wornie L. Reed

Trotter Review

Lead poisoning in humans has been identified as a cause of high blood pressure, heart disease, birth defects, complications in pregnancies and developmental problems in infants. It is a health problem of epidemic dimensions in the black community. This serious health problem is yet another example of the production of “illth” in the modern society. As the means of production create wealth for some sectors of society they also create illth.

Commentary: The Lead Poisoning Epidemic, Wornie L. Reed

Trotter Review

It is more dangerous than some forms of cancer — yet it is virtually ignored by the American public. It has seriously afflicted a much higher segment of the population than some diseases that were called “epidemics” — yet it has received little public attention. What we have here is a public failure, a failure to recognize that this disease — lead poisoning — is a serious threat to our health. It has already permanently damaged tens of thousands of babies, children and adults in this nation. And the list of victims is still growing.

Editor's Note, Padraig O'Malley

New England Journal of Public Policy

On occasion, the New England Journal of Public Policy will devote an entire issue to consideration of a public policy matter of major importance. The AIDS epidemic is such a matter, with a likely impact of overwhelming consequence well into the twenty-first century. The epidemic raises fundamental questions regarding the nature of individual freedom, our responsibilities to others, the always delicate balance between private rights and the public interest, and society's obligation to its "out" groups — whose members it has stigmatized, discriminated against, ridiculed, and treated as less than full and equal citizens. Indeed, it requires us to ask …

The Acquired Immunodeficiency Syndrome In New England: An Epidemiological Review Of The First Six Years, Laureen M. Kunches, Jeanne M. Day

New England Journal of Public Policy

Between 1981 and 1987 — the six-year period following initial recognition of the acquired immunodeficiency syndrome (AIDS) — 1,475 cases were reported among residents of the six New England states. Of nearly 40,000 cases nationwide, 3.8 percent occurred among New England residents, though the region 's population represents 5.5 percent ofthe total United States population. The groups most affected include homosexual or bisexual men (65 percent) and intravenous drug users (20 percent). However, in the two southernmost states — Rhode Island and Connecticut — 32 to 40 percent of all cases have used intravenous drugs. In these states, the male:female …

The Quest For An Aids Vaccine, Robert T. Schooley

New England Journal of Public Policy

More than fifty thousand cases of AIDS have been reported in the United States since the disease wasfirst described in 1981. Many times this number of people are infected with human immunodeficiency virus (HIV), which has been identified as the agent responsible for the illness. The seriousness of the disease, coupled with the relatively rapid spread of HIV, has fueled the effort for development of an effective vaccine.

Much is now known about the life cycle of the virus, and about its structural components. This information, and information about methods of transmission of the virus, form the basis for a …

Aids: Prophecy And Present Reality, Victor De Gruttola, William Ira Bennett

New England Journal of Public Policy

Mathematical modeling of the AIDS epidemic can be useful for policymakers even though precise projections are not possible at this time. Models are useful in establishing ranges for current and future prevalence of HIV infection and incidence of AIDS, as well as in predicting the effect of a given intervention strategy. Most decision makers are using models implicitly when they use epidemiological information as a basis for policy; formulating a model explicitly permits examination of the underlying assumptions. By creating and testing a variety of models, an investigator can determine whether the models reflect more the underlying assumptions or the …

Understanding The Psychological Impact Of Aids: The Other Epidemic, Marshall Forstein

New England Journal of Public Policy

HIV has created two epidemics, one of disease, the other the consequence of the psychological response to that disease. Thus far, behavioral change is the only effective means of interrupting the transmission of HIV. The underlying psychological dimensions of the societal and individual responses to AIDS are discussed, with suggestions for how both rational thinking and irrational fears and anxiety contribute to the development of public policy. Examples are given of how short-term solutions to reduce anxiety may actually create long-term problems, potentially increasing the risk of transmission of HIV. Specific psychological mechanisms that contribute to the epidemic of fear …