Medicine and Health Sciences Commons^™

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 …

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 …

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 …

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 …

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.