Medicine and Health Sciences Commons^™

The Long-Term Effects Of Japan’S Traumatic Experience In The Second World War And Its Implications For Peace In Northeast Asia, Eugen Koh, Tadashi Takeshima

New England Journal of Public Policy

This article is an introductory report on the work of a Japanese study group whose primary aim is peacemaking, which it seeks by promoting a greater understanding of the long-term effects of their country’s traumatic experience of the Second World War. The group does not adopt a position of victimhood but seeks to understand the full picture of Japan’s role in the war, including its role as perpetrator. We came together with the shared assumption that the country’s inability to take responsibility for its role of the war is inextricably tied to its own traumatization. If this assumption is true, …

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 …

Cultural Work In Addressing Conflicts And Violence In Traumatized Communities, Eugen Koh

New England Journal of Public Policy

There is a growing appreciation that conflict and violence in many communities have their origins in a history of traumatic experiences. Why this link exists and how it comes about is still unclear. We have no unified psychology of traumatized communities, and little is known about how to address these traumatic origins collectively in these communities. This article proposes a psychodynamic model of collective trauma and a psychoanalytically informed approach to working with traumatized communities to address their issues of conflict and violence. It highlights the impact of collective trauma on the culture of a community, which is its collective …

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 …

The Road To Universal Health Coverage In Massachusetts: A Story In Three Parts, John E. Mcdonough

New England Journal of Public Policy

In 1988, the Massachusetts Legislature passed a new law, a “play or pay” employer mandate, requiring all employers with six or more workers to provide health insurance coverage for their employees. A few years later, with Medicaid identified as a “Budget Buster,” the Weld administration sought deregulation as the way to cut costs and expand access by establishing MassHealth, which dropped the employer mandate and expanded Medicaid, and eventually distinguished Massachusetts as the state with the greatest percent of covered citizens. But MassHealth enrollment has declined as premium costs have risen, and the Uncompensated Care Pool is once again faced …

The Citizens Health Prescription: Coping With Rising Drug Costs, Shannon Cadres

New England Journal of Public Policy

Prescription drug prices have climbed to unaffordable levels in recent years, creating a serious public policy problem for lawmakers at both the state and federal levels. The U.S. Medicare program only covers the costs of inpatient prescription drugs, and only seventy-five percent of beneficiaries are receiving coverage through some other means. But because of the tremendous power of the pharmaceutical industry on Capitol Hill, lawmakers in Washington have been unable to agree upon a workable solution. As a result, many states are experimenting with different strategies to provide some relief. Massachusetts has attempted to solve the problem through the Prescription …

Editor's Note, Padraig O'Malley

New England Journal of Public Policy

This issue of the journal can be summed up in one word: provocative. At least two articles break new ground. Anthony Robbins and Phyllis Freeman explore the ways in which environmentally oriented public health is uniquely suited to help organized medical care in providing health and in restraining expenditures. Janet Farrell Smith challenges policymakers to look at what will soon become a hot issue — the medical use of genetic information. The genetic testing of children, now becoming prevalent in the foster care and pre-adoptive stage in order to facilitate placement and satisfy prospective parents’ “need to know,” is already …

Environmental Public Health Awaits Rediscovery, Anthony Robbins, Phyllis Freeman

New England Journal of Public Policy

Preventing environmental exposures that threaten human health remains among the best but least attended to opportunities to improve everyone’s health. For more than a decade, medical care concerns, exacerbated by voracious competition among medical empires and the implacably growing number of uninsured, have often been misconstrued as constituting a complete agenda for health system reform. The authors explain the predicament from an historical perspective — how defining events moved U.S. health policy away from protecting the public against dangerous exposures toward unrealistic expectations that doctors will fix whatever goes wrong, at least for individuals with ample medical insurance. They explain …

Genetic Testing: A Cautionary Tale Of Foster And Pre-Adoptive Children, Janet Farrell Smith

New England Journal of Public Policy

Genetic testing of children in the foster care and pre-adoptive stage may be thought to facilitate child placement and satisfy prospective parents’ need to know. But, the policy analysis in this paper recommends great caution, especially given eugenic attitudes in the history of adoption and the risk of creating a second tier of un-adoptable children. Testing should be done only when two conditions are satisfied: test information is medically useful for childhood onset diseases; test information supports and does not diminish the child’s access to present and future healthcare (or the child’s future insurability). Public policy needs to make a …

How Hollywood Films Portray Illness, Robert A. Clark

New England Journal of Public Policy

The author speaks about Hollywood's depiction of medicine and illness if often wrong and breaks down his analysis in this article.

From Correctional Custody To Community: The Massachusetts Forensic Transition Program, Stephanie W. Hartwell, Donna Haig Friedman, Karin Orr

New England Journal of Public Policy

Offenders with mental illness who are serving correctional sentences are released to the community.Without support systems linking their transition to community-based programs following release from prison, the services necessary for their community reintegration are often fragmented and attenuated. Nearly two thirds of all inmates return to prison, and offenders with mental illness face major challenges during reintegration and have an even more difficult time living in the community without specialized, informed services. This article describes a Massachusetts program designed to bridge the transition of offenders with mental illness from incarceration to the community.The authors review historical and recent trends that …

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, …

Spirituality And Rehabilitation: Intimate Views From Insiders, Dierdre Woody

New England Journal of Public Policy

The author became interested in spirituality and rehabilitation during her summer 1999 employment at the Pennsylvania State Correctional Institute-Graterford and as a legal intern in the law firm of Woody and Falkenbach, which specializes in criminal defense work, during the summers of 1991 to 1998. The article focuses on the role of spirituality in rehabilitation processes in correctional settings. It pays special attention to the sources offaith and inner strength, the nature of spiritual guidance, the roles of values, beliefs, and moral commitments, and the effects of cultural, social, political, and economic forces.

Job Mobility Of Entry-Level Workers: Black And Latina Women In Hospital Corridors, Maria Estella Carrión

New England Journal of Public Policy

Based on data from interviews with fifteen black and fifteen Latina women in entry-level jobs, this article discusses job access strategies, patterns of job mobility, and barriers to upward job mobility for low-income minority women in the hospital industry. Concentrated in the lowest wage levels and job tiers, they are quite diverse in subgroup composition, in age, and in training requirements. The research confirms that deficiencies in schooling and skills remain the major obstacles minority women confront when they apply for hospital jobs and restrict their opportunities once they are within the hospital labor market. Efforts to provide training and …

Labor's Response To Hospital And Workplace Transformation, Enid Eckstein

New England Journal of Public Policy

The health care industry and the nation's hospitals are in the throes of revolutionary change. The shift to managed care resulted in fundamental changes in the delivery of care and the structure of health care, For the past ten years, hospitals have actively been merging and creating large-scale integrated delivery systems. Employers, eager to expand market share and reduce costs, are engaged in radical reorganization of the hospital and the structure of work from which no group is immune. Physicians, nurses, technicians, and housekeepers are all affected by these changes. Hospitals are reducing their personnel, shifting work outside the hospital, …

We Are The Roots: The Culture Of Home Health Aides, Ruth Glasser, Jeremy Brecher

New England Journal of Public Policy

This article focuses on the contributions of its workers' culture to the success of Cooperative Home Care Associates (CHCA). It examines what the home healthaides bring to the culture of the company, how their contribution develops through their experience with the company, and how their heritage contributes to their CHCA work and to the company as an organization. This is one segment of a larger study that will deal with the background and history of CHCA, the vision of the founders and its implementation, the role of organizational policy, and the contribution of management philosophy to its accomplishment.

Distance Learning In Retrospect, Kathryn C. Cauble, Judith D. Burnett, S. Suzanne Roche

New England Journal of Public Policy

This article describes the design and implementation of a long-term education project, a joint effort of the Service Employees International Union, Bunker Hill Community College, and nine Massachusetts community hospitals. The object was to offer an associate degree in medical radiography to eleven participants. Details of the funding source, admission process, curriculum, student support services, quality assurance, and problems and solutions are outlined. The authors offer recommendations for future replication.

Performance And Accountability In Human Services: Ownership And Responsibility Of Professionals, Anna-Marie Madison

New England Journal of Public Policy

The recent frenzy of grant makers and government agencies in requiring impact evaluations of all grant recipients has created consternation among human service providers. To ensure their agencies' survival and worker job security, the leaders are faced with meeting the demands offunder-driven programming. Agencies seeking funding must comply with funder-defined needs and accountability criteria rather than their public missions. This article describes the use of mission-based performance evaluation rather than funder compliance to demonstrate accountability for mission accomplishment.

Improving Workforce Conditions In Private Human Service Agencies: A Partnership Between A Union And Human Service Providers, James Green

New England Journal of Public Policy

In 1995 the Service Employees International Union Local 509 and four Massachusetts human service providers signed an unusual agreement to forge a partnership in which employers would remain neutral while the union approached its workers with an offer to advocate in the state legislature for greater funding for private human service employees and to promote cooperative relations with their employers. This study examines the context of the agreement and the pressures on public employee unions and small human service providers whose workforce copes with low wages, high turnover, meager benefits, and poor public image as well as the give-and-take between …

From Welfare To What?: The Limitations Of Low-Income Work, Lande Ajose

New England Journal of Public Policy

The premise of the welfare law enacted by Congress is that people living in poverty could vastly improve their economic status if only they were employed. The author argues that economic security for welfare recipients will not be realized simply by increasing the labor-force attachment. Home health aides comprise an occupation that could absorb many of the large pool of workers expected to join the labor market because demand for their services is high and barriers to entry are low. However, as this survey shows, the home health field offers limited promise to welfare recipients because, significantly for women rolling …

Workplace Education At The Bottom Rungs, Andrés Torres

New England Journal of Public Policy

In the late 1980s, observers of the Massachusetts hospital industry were predicting a severe shortfall in skilled technical workers. The Worker Education Program (WEP) emerged as one of several responses to this projected labor shortage. It was premised on the idea of an internal solution to the need for workforce development, shifting the focus from external recruitment to upgrading of incumbents — nutrition, maintenance, clerical, and secretarial staff— and from traditional classroom training to workplace education. Other features of the WEP model made it an extremely interesting experiment: it was operated by labor-management partnership, it was located statewide in nine …

The Potential Impact Of Workforce Development Legislation On Cbos, Edwin Meléndez

New England Journal of Public Policy

The proposed congressional legislation revamping the employment and training system will result in budget cuts, program consolidation, and block grants for the states. These changes are potentially harmful to community-based organizations (CBOs) because (J ) they eliminate categorical funding that traditionally has required contracting with organizations which specialize in servicing the disadvantaged, and (2) they introduce stricter performance standards that may be unattainable for many small-scale operations. However, the adoption of best practices in serving non-English-speaking and poor populations, increasing connections to emerging government intermediaries in labor markets, and establishing greater linkages to postsecondary educational institutions may offer CBOs the …

Nursing: A New Day, A New Way, Lin Zhan, Jane Cloutterback

New England Journal of Public Policy

The U.S. health care environment is changing rapidly. Its structure, financing, and delivery are being reconfigured toward an integrated system based on managed care. Increasingly, national interest in health promotion and disease prevention is moving care away from a disease-oriented, institutionally based model to a population-focused, wellness-oriented, and community-based system. Health care consumers are diversifying in age, ethnicity, and socioeconomic status. The approach emerging from these changes and others requires nursing to rethink, redesign, and retool its workforce to meet new challenges. This article analyzes nursing education, practice, and operations. The authors discuss the dilemmas and complexity of developing an …