Public Health Commons^™

Policy Impact Assessment: The “Reasonable Break Time” Provision Of The Patient Protection And Affordable Care Act, Merritt Juliano

21st Century Social Justice

Breastfeeding continues to be the most optimal source of nutrition for infants under 6 months of age, and has been associated with a wide variety of infant and maternal health benefits, including protection against certain illnesses and diseases. Most health organizations recommend exclusive breastfeeding for at least the first 6 months post-birth. Despite these recommendations, breastfeeding women, especially those in lower socioeconomic groups face many challenges in our society. Moreover, maternal employment stands as a significant barrier to successful breastfeeding durations. To counter these problems, Section 4207 of the Patient Protection and Affordable Care Act [ACA] was enacted to offer …

Global Burden Of Disease Study 2010: Interpretation And Implications For The Neglected Tropical Diseases, Peter J. Hotez, Miriam Alvarado, Maria Gloria Basanez, Ian Bolliger, Et Al.

Faculty, Staff and Students Publications

No abstract provided.

The Aca’S Contraceptive Mandate: Religious Freedom, Women’S Health, And Corporate Personhood, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

On June 30 2014 the Supreme Court decided Burwell v Hobby Lobby Stores, Inc, in a deeply divided judgment that engaged religious freedom, women’s health, and corporate personhood. Three closely held for-profit organizations challenged the Affordable Care Act’s contraceptive mandate, objecting to four contraceptive methods that they believe acted as abortifacients, in violation of their Christian beliefs.

The Court held that the contraceptive mandate violated the Religious Freedom Restoration Act of 1993, ruling that the Act’s protections extended to closely held corporations, with the mandate substantially burdening their religious freedoms. The Court acknowledged the federal government’s compelling interest in …

Implications Of The 2014 Quality Family Planning Services Guidelines Issued By Cdc And Opa, Sara J. Rosenbaum, Susan Wood, Merle Cunningham, Tishra Beeson, Peter Shin

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Healthy Living Needs Global Governance, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

It may seem counter-intuitive, but the same factors that drive the spread of infectious diseases also contribute to the dominance of non-communicable diseases (NCDs) in the global burden of disease—urbanization, global markets and harmonized cultures. NCDs have overtaken infectious diseases as the leading cause of morbidity and premature mortality worldwide, with deaths concentrated among the poor due to the growing availability and affordability of highly-processed, unhealthy foods, alcohol and tobacco.

The global response to NCDs has been slow and fractured, with the World Health Organization dedicating scant funding and the United Nations waiting until September 2011 to hold a high-level …

Implications Of The 2014 Quality Family Planning Services Guidelines Issued By The Cdc And The Office Of Population Affairs, Sara J. Rosenbaum, Susan Wood, Merle Cunningham, Tishra Beeson, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Social Actors Fight The Rising Tide Of Hiv In U.S. Southern Poor, Courtenay Sprague, Sara E. Simon

Center for Peace, Democracy and Development Publications

The greatest number of persons living with HIV in the United States are now living in the South, and they face poorer health outcomes and increased AIDS-related deaths as compared to the rest of the country. The southern United States has a disproportionate share of low-income individuals, with many lacking access to health care and health insurance. Health facilities are also comparatively fewer and more difficult to reach than in other areas of the United States. The impacts of this already poor health infrastructure on low-income people living with HIV in the South can be life-threatening.

This policy brief summarizes …

Factors Associated With Quality Of Life Among Mothers Of Children With Autism Spectrum Disorder, Marian Marconyak

Health Services Research Dissertations

The increasing prevalence of Autism Spectrum Disorder (ASD) has levied associated effects upon the quality of life (QOL) of mothers of children with ASD. These mothers are subjected to various influences upon their lives as a result of their role as caregivers to children with ASD. The purpose of this study was to assess the International Classification of Functioning, Disability and Health (ICF) Body Functions and Structures, Activities, Participation, Environmental, and Personal Factors associated with QOL among mothers of children with ASD.

English literate, inhabitants of the United States, mothers over the age of 18, of children with ASD were …

E-Cigarettes, Vaping, And Youth, Lawrence O. Gostin, Aliza Y. Glasner

Georgetown Law Faculty Publications and Other Works

E-cigarettes, a relatively new product, storming the tobacco industry are causing a massive stir among public health advocates. While e-cigarettes have the potential to serve as an effective harm reduction tool for existing smokers, they also may present an equally tempting pathway to first time smoking, particularly among youth. Many fear that e-cigarettes will revive the popular smoking culture that has taken decades to dismantle.

In April 2014, the FDA issued proposed rules to “deem” or extend its authority over tobacco products to regulate electronic cigarettes, cigars, pipe tobacco, nicotine gels, waterpipe (hookah) tobacco, and orally ingested dissolvable tobacco products. …

How Medicaid Expansions And Future Community Health Center Funding Will Shape Capacity To Meet The Nation’S Primary Care Needs: A 2014 Update, Leighton Ku, Julia Zur, Emily Jones, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

Global Rules For Global Health: Why We Need An Independent, Impartial Who, Devi Sridhar, Julio Frenk, Lawrence O. Gostin, Suerie Moon

Georgetown Law Faculty Publications and Other Works

Over the past few years the World Health Organization (WHO) has been undergoing a significant reform process. The immediate trigger was a budget crisis in 2010 that spurred massive lay-offs at the global agency. But at a more fundamental level, deeper systematic changes in global health governance have made reform imperative. While WHO reform draws relatively little attention outside diplomatic circles in Geneva, at stake are critical issues that will impact public health everywhere. This article’s key messages are:

• Recent outbreaks of MERS highlight the need for a global response to infectious disease
• The WHO has had a crucial role …

Participation, Information, Values, And Community Interests Within Health Impact Assessments, Nicole Iroz-Elardo

Dissertations and Theses

Health impact assessment (HIA) has emerged in the U.S. as one promising process to increase social and environmental justice through addressing health equity issues within planning. HIA practice is guided by values such as democracy and equity and grounded in broad social determinants of health. The most readily applied definition of democracy is problematic because it implies an element of direct, participatory engagement with the public. This is at odds with HIA practice that largely relies on stakeholder engagement strategies.

This dissertation critically examines the engagement strategies of three transportation planning HIA cases to more fully understand how the HIA …

Access To Healthcare For Vulnerable Asian Subgroup Populations In The United States, Deborah Kim-Lu

Dissertations, Theses, and Capstone Projects

Objectives: This dissertation examines the barriers for access to healthcare for the top four most uninsured Asian American subgroups (Bangladeshi, Cambodian, Korean, and Pakistani communities). Methods: Combining quantitative and qualitative approaches, this study consisted of: (1) an in-depth review of the Health Services Research literature; (2) qualitative interviews with 24 national health experts and advocates on Asian American health; (3) a survey of a non-probability sample of 107 Koreans in the tri-state region (Connecticut, New Jersey, and New York) using the Access to Healthcare Survey for Koreans in the U.S. instrument, which includes a Likert scale with 21 barrier questions …

In The Words Of The Medical Tourist: An Analysis Of Internet Narratives By Health Travelers To Turkey, Margaret E. Ozan-Rafferty, James Allen Johnson, Gulzar H. Shah, Attila Kursun

Health Policy & Management: Faculty Publications (2006-2018)

Background: Patients regularly travel to the West for advanced medical care, but now the trend is also shifting in the opposite direction. Many people from Western countries now seek care outside of their country. This phenomenon has been labeled medical tourism or health travel. Information regarding health travelers’ actual outcomes, experiences, and perceptions is lacking or insufficient. However, advanced Internet technology and apps provide information on medical tourism and are a vehicle for patients to share their experiences. Turkey has a large number of internationally accredited hospitals, is a top tourism destination, and is positioning itself to attract international patients. …

Limiting What We Can Eat: A Bridge Too Far?, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Innovative mayors across America are seeking to shape personal decisions about diet and physical activity, taking a page from tobacco control. But attempts to limit personal choices of what to eat have drawn the ire of vocal critics and sometimes the rebuke of judges, with former New York City mayor Michael Bloomberg’s limit on soda portions becoming a key flash point. The public broadly accepts state power to control infectious diseases, but often draws a line at limiting dietary choices. The author wants to dispel some of the well-worn arguments in the obesity wars.

How Will Public Health And Primary Care Come Together In Massachusetts?, Javier Crespo

Public Affairs Capstones Collection

The Patient Protection and Affordable Care Act aims to place public health and prevention practice closer to the clinical care delivery system by mandating basic preventive services and creating a national prevention plan. The Massachusetts health care system has a number of elements that can help foster closer linking of public health practices in the primary care setting. This research set out to examine whether the current healthcare system in Massachusetts will enable public health and primary care integration as intimated upon by the Affordable Care Act. This study will assess the current connection between public health and primary care …

Using Chipra Immunization Measures For Primary Care Quality Improvement: Leveraging Registry Data From The State Of Maine’S Immunization Information System To Calculate Practice-Level Quality Measures, Kyra Chamberlain

Muskie School Capstones and Dissertations

This report describes key challenges and successes of a federally-funded, cross-organizational effort to use registry data from the State of Maine’s Immunization Information System to calculate childhood and adolescent immunization measures in support of a nine-month, multi-practice learning collaborative which resulted in significant increases in immunization rates and adoption of recommended immunization-related office system procedures. Also highlighted are lessons learned about promoting the use of standardized immunization measures for quality improvement (QI), supporting primary care practices in using and understanding data for QI activities, and emphasizing the value of public-private collaboration in achieving shared goals.

Assessing The Potential Impact Of The Affordable Care Act On Uninsured Community Health Center Patients: An Update, Peter Shin, Jessica Sharac, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

Paying For Prescribed Drugs In Medicaid: Current Policy And Upcoming Changes, Brian K. Bruen, Katherine Young

Health Policy and Management Issue Briefs

Since the early 2000s, state Medicaid programs have made concerted efforts to control the cost of prescription drug spending. One crucial aspect in doing so is using a pharmacy reimbursement methodology that best reflects actual drug costs. Currently, states set pharmacy reimbursement policy within broad federal guidelines, resulting in a complex mix of reimbursement rules. Many states use list prices to set reimbursement levels, and these list prices increasingly have been criticized as not accurately reflecting the cost of the drug. Specifically, there are concerns that some benchmarks lead to inflated reimbursement levels. As a result, the federal government has …

The Impact Of School-Connected Behavioral And Emotional Health Interventions On Student Academic Performance, Olga Acosta Price, M. Biehl, C. Solomon, M. Weir

Health Policy and Management Faculty Publications

This annotated bibliography provides a systematic review of current literature published between 2001 and 2013 and summarizes findings on the relationship between prevention-focused behavioral health interventions, such as social and emotional (SEL) learning programs, and their impact on academic outcomes.

Political Determinants Of Health: Lessons For Pakistan, Rashid Jooma, Guido Sabatinelli

Section of Neurosurgery

There is much concern about the capacity of the health system of Pakistan to meet its goals and obligations. Historically, the political thrust has been absent from the health policy formulation and this is reflected in the low and stagnant public allocations to health. Successive political leaderships have averred from considering healthcare is a common good rather than a market commodity and health has not been recognized as a constitutional right. Over 120 of world's nation states have accepted health as a constitutional right but the 1973 Constitution of Pakistan does not mandate health or education as a fundamental right …

An Evaluation Of The East Indianapolis Food Desert, Angelina Qin

Undergraduate Honors Thesis Collection

The Indy East Food Desert (IEFD) appears to suffer from many common conditions noted by various scholars as food desert identifiers. Yet, its situation still remains unique. Though there is a prevalence of minority populations, low-income households, and low-education attainment levels, there are also factors of low-access, poor food options (within the limited food outlets in the neighborhoods), and poor eating habits which shape the situation of the community. In an attempt to alleviate the food desert problems, the Indy East Food Desert Coalition (IEFDC) was formed. IEFDC partnered with Butler University's Center for Urban Ecology in order to assess …

Global Health And The Law, Lawrence O. Gostin, Devi Sridhar

Georgetown Law Faculty Publications and Other Works

The last two decades have brought revolutionary changes in global health, driven by popular concern over AIDS, novel influenzas, and maternal mortality. Given the rapid globalization that is a defining feature of today’s world, the need for a robust system of global health law has never been greater. Global health law has been defined as the legal norms, processes, and institutions designed primarily to attain the highest possible standard of physical and mental health for the world’s population. Global health law is not an organized legal system, with a unified treaty monitoring body, such as the World Trade Organization. There …

Power To The People? An Evaluation Of State-Level Environmental Justice Policies, Angela Michelle Hines

Graduate Theses and Dissertations

Communities of color in America lacking economical, educational, and political power have been largely invisible in the process of making major policy decisions. This is lack of access to decision-making venues has been viewed by many as the reason behind marginalized populations bearing the brunt of many societal burdens. The Environmental Justice Movement legitimized the claims of inadequate access to the decision-making process concerning environmental conditions in which African-Americans lived and worked. Through the use of disruptive actions reminiscent of those used throughout the Civil Rights Movement, the plight of communities plagued by the daily presence of hazardous waste gained …

Sentiments Of Community Stakeholders Living In Southern Nevada Neighborhoods, Erin Sheehy

UNLV Theses, Dissertations, Professional Papers, and Capstones

Community stakeholders provided insight to their local neighborhoods and shared their thoughts about the potential redevelopment of their neighborhoods. This study utilized data from the Southern Nevada Strong ethnographic research project. Ethnographic research was conducted over ten weeks in Summer 2013. Neighborhood observations and interviews with community stakeholders were conducted to understand how neighborhoods are utilized, how residents feel about potential redevelopment, and what areas of the neighborhoods residents would like to see improved in the future. Photographs were also collected to further examine the characteristics, aesthetics, and spatial landscape of the neighborhoods. The purpose of this qualitative research project …

Caregiving And The Experience Of Health And Illness In Children Living With Hiv/Aids In Gulu District Northern Uganda: An Ethnographic Research Narrative, Constantine S.L. Loum Phd

Patient Experience Journal

In this paper we discuss the experience of caregiving for children living with HIV in a resource poor environment in Gulu municipality in northern Uganda; the main research questions of the study were: what are the perceptions of caregivers on the care of children with HIV, and what barriers and enablers exist that undermine or promote better care for children respectively? The experience of caregivers and their perceptions on managing HIV in children is believed to shape the health seeking behaviour towards treatment and efforts to cope with its negative impact on the body. Women and children are the greatest …

The Role Of Governing Boards In Improving Patient Experience: Attitudes And Activities Of Health Service Boards In Victoria, Australia, Marie Bismark, Susan Biggar, Catherine Crock, Jennifer M. Morris, David M. Studdert

Patient Experience Journal

The authors sought to determine the attitudes of public health service board members and senior executives toward patient experience and to describe the governance activities of the boards in this area. The study was based on an online survey of 322 board members from 85 public health services and semi-structured interviews with 35 board members and senior executives from 13 public health services in Victoria, Australia. The results showed that while some health service boards had high aspirations and clear plans for improving patient experience, others remained sluggish or even cynically resistant to changing their existing models of care. Interviewees …

Patients’ Experiences In The Uk: Future Strategic Directions, Sophie Staniszewska, Neil Churchill

Patient Experience Journal

Over the last decade policy has emphasised the importance of a good patient experience as a cornerstone of high quality health and social care in the UK, with many initiatives attempting to develop patient-centred practice. More recently, the Francis Inquiry has addressed the significant failings in care identified at Mid Staffordshire NHS Foundation Trust in England and has been pivotal in raising the importance of patient experience.¹ The Francis report made 290 recommendations, with many emphasizing the importance of patient experience through their focus on specific ways in which the quality of experiences can be enhanced, for example, by …

What Matters Most To Patients? Participative Provider Care And Staff Courtesy, Andrew H. Van De Ven

Patient Experience Journal

Although there is growing recognition of the importance of having satisfied patients, we know little about what aspects of care matter most to patients. The sources of patient satisfaction and how care delivery can influence them need more empirical study. The objective of this study was to identify which aspects of a patient’s experience of care are most important to patient satisfaction, and how dimensions of care relate to clinic size, economic performance, and employee job satisfaction. To explore our question, longitudinal survey data were obtained on patients and employees over two years (1996 and 1997). Relationships between patient satisfaction …

Psychometric Properties Of The New Patients’ Expectations Questionnaire, Ann Bowling Bsc, Msc, Phd, Gene Rowe Phd

Patient Experience Journal

The authors explore the development of the Patients’ Expectations Questionnaire (PEQ) and examination of psychometric characteristics it encompasses by reviewing surveys of primary care and hospital outpatients before and after their clinic visit. Three scales were developed for Pre-visit Ideal and Realistic expectations, and Post-visit Experiences (met expectations), based on literature review, semi-structured interviews, and subsequently piloted and refined. Patients completed the questionnaire about their ideal and realistic expectations before they saw the doctor, and were asked if their expectations had been met afterwards. The results show the scales met acceptability criteria for reliability (Cronbach’s alphas exceeded α 0.70), administration …