Health Policy Commons^™

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.

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 …

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 …

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 …

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, …

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 …

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 …

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 …

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. …

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 …

Quantitative Economic Evaluations Of Hiv-Related Prevention And Treatment Services: A Review, David R. Holtgrave, Ronald O. Valdiserri, Gary A. West

RISK: Health, Safety & Environment (1990-2002)

Dr. Holtgrave and colleagues at the CDC set forth an extensive taxonomy of HIV prevention and treatment services and review reports of efforts to subject some of those services to formal economic evaluation. They find few services thus far to have been so evaluated, no evaluation to have focused solely upon behavioral outcomes and most economic evaluations to lack formal quantitative analyses.

Responsibilities Of Worksite Health Promotion Directors, Anne Bernice Mcgown Patneaude

Dissertations and Theses @ UNI

The purpose of this study was to identify the areas of responsibility that were perceived by worksite health promotion directors as most important to the success of their organization's health promotion program. A survey instrument was designed and mailed to 111 health promotion directors in the state of Iowa, Minnesota, and Wisconsin that were 1992 members of the Association of Fitness in Business (AFB). Subjects were asked to rate the importance that 27 responsibilities associated with four areas of competence receive within their organization. The results are based on the responses of 23 (20.72%) of these directors. Females represented 7 …

Securing Health Or Just Health Care? The Effect Of The Health Care System On The Health Of America, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The author first analyzes why the prevention of illness and promotion of health provide the leading justification for the government to act for the welfare of the population. His analysis focuses principally on the foundational importance of health for human happiness, the exercise of rights and privileges, and the formation of family and social relationships. He explains why health care, although critically important; is not the only, nor even the most important, determinant of health. Most morbidity and mortality in the United States is attributable to environmental conditions, pathogens, and human behavior, which are all more responsive to population-based interventions …

Epa's Map Of Radon Zones, Nebraska, Sharon W. White, Lisa Ratcliff, Kirk Maconaughey, R. Thomas Peake, Dave Rowson, Steve Page, Linda C. S. Gundersen, R. Randall Schumann, James K. Otton, Doug Owen, Russell Dubiel, Kendell Dickinson, Sandra L. Szarzi

United States Environmental Protection Agency: Publications

Sections 307 and 309 of the 1988 Indoor Radon Abatement Act (IRAA) direct EPA to identify areas of the United States that have the potential to produce elevated levels of radon. EPA, the U.S. Geological Survey (USGS), and the Association of, American State Geologists (AASG) have worked closely over the past several years to produce a series of maps and documents which address these directives. The EPA Map of Radon Zones is a compilation of that work and fulfills the requirements of sections 307 and 309 of IRAA. The Map of Radon Zones identifies, on a county-by-county basis, areas of …

Foreword: Health Care Reform In The United States—The Presidential Task Force, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This essay serves as the foreword to Implementing U.S. Health Care Reform, a symposium held in 1993.

The exact specifications of the new health care system depend on the package that President Clinton will send to Capitol Hill and the changes that Congress will make in the reform package. Some of the basic structures and organizing principles of the new system that are being considered by the President are already the subject of intense public scrutiny.

The design being considered would involve new relations between the federal government and the states, between the public and private sectors, and between …

Risk And Rationality: The Centers For Disease Control And The Regulation Of Hiv-Infected Health Care Workers, Mary Anne Bobinski

Faculty Articles

The publicity surrounding the Bergalis case has created a new and powerful fear for some-the fear of contracting a fatal disease while obtaining medical or dental care. Following Bergalis' congressional testimony, Congress passed a bill requiring states to regulate HIV-infected health care workers (HCWs). Responding to constituents' fears, state legislatures had already been debating a wide range of bills designed to confront the risk of HIV transmission in health care settings. Private actors, such as hospitals and insurers, feared litigation or loss of business if the public perceived them to be ignoring the problem of HIV infection among HCWs. As …

Factors In The Non-Recognition Of Overseas Qualifications: The Case Of Medical Practitioners, Christine V. Farag

Theses : Honours

The overseas qualified doctor is a potential threat to the state-sanctioned control practising doctors have over medical knowledge in Australia. The nonrecognition of qualifications of many migrant and refugee doctors, in particular from non-English speaking background (NESB) countries, presses them into a subordinate relationship lo that of registered practitioners. The ownership of medical knowledge is limited lo state-recognised practitioners, thus allowing them to maintain significant economic and social advantage within the general community. The relationship between qualified practitioners and the state is indicative of a particular dynamic in which some individuals are able to exclude others by mechanisms of social …

Health Implications Of Public Policy: Case Studies, Modules & Methodologies, Basu Ghosh

IIMB Management Review

No abstract provided.

Poverty And Health Outcomes Among Hispanics In Massachusetts, Christopher Christian

Gastón Institute Publications

The Hispanic population of Massachusetts is now close to becoming the largest ethnic minority group in the state. The 1990 statewide Census count found that the Hispanic population doubled in the past ten years and now comprises 4.8% of the total state population (287,349 residents) as compared to 2.5% in 1980.

Growth in the Hispanic population has not been coupled with advancements in health status. Hispanic residents are disproportionately affected by many adverse health outcomes, such as high infant mortality, a high incidence of substance abuse, sexually transmitted diseases, homicides, AIDS, and other chronic illnesses. This paper highlights some of …

Update - May 1991, Loma Linda University Center For Christian Bioethics

Update

In this issue:

-- Strategies for Moral Decision-Making: Confessions of a Moral Underling

[ The HIV Status of Health Professionals: Do Patients Have a Right to Know? ]
-- Risk Transmission of HIV form Infected Clinician to Susceptible Patients
-- Does the Patient Have a Right to Know the HIV Status of the Health-Care Worker?
-- Health-Care Professionals With Aids: A Patient's Right to Know?

An Alternative Public Health Vision For A National Drug Strategy: "Treatment Works", Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This article returns to a war waged virtually throughout this century--a war between the theories of punishment and rehabilitation in curtailing the drug epidemic. Today, the terms of the war are recast as supply-side policies based upon law enforcement; destroying crops in source countries; interdiction and increased sentencing; and demand reduction based upon prevention, education, and treatment. The war on drugs has reached a feverish pitch. New policies and statutes have tightened the grip of supply-side policies, with images of battle and hate mongering which go beyond the vilified drug lords and governments which harbor them, to the middle men, …

Genetic Discrimination: The Use Of Genetically Based Diagnostic And Prognostic Tests By Employers And Insurers, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This paper analyzes the law, ethics and public policy concerning "genetic discrimination," defined as the denial of rights, privileges or opportunities on the basis of information obtained from genetically based diagnostic and prognostic tests. The Human Genome Initiative will enhance the ability to gather and organize information that may predict a person's future potential and disabilities. Enormous human benefits may ensue from understanding the etiology and pathophysiology of genetic disorders, including disease prevention through genetic counseling, and treatment of the disorders through genetic manipulation. This information will help clinicians understand and eventually treat many of the more than 4,000 diseases …

The Interconnected Epidemics Of Drug Dependency And Aids, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Drug dependence and human immunodeficiency virus (HIV) are America's two most pressing epidemics, interconnected by a cycle of urban poverty, physical dependence and a culture of sharing needles and syringes. Extant political strategies to curb these interconnected epidemics involve two traditional approaches. The first--law enforcement and interdiction--is designed to limit the supply of illicit drugs to the marketplace. This strategy is advanced by broad criminal sanctions against importing, selling, distributing, medically prescribing, or possessing illicit drugs or drug paraphernalia. The second strategy to combat the drug and HIV epidemics involves reducing the demand for illicit drugs. Education, counseling, and treatment …

Ethical Principles For The Conduct Of Human Subject Research: Population-Based Research And Ethics, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This paper provides a halting first step in organizing a set of ethical guidelines for the conduct of population-based research, surveillance and practice. These principles are not distinct from, but an expansion of, traditional ethics. Research ethics, which matured significantly from the Nuremberg Code through to the Helsinki IV and the Council for International Organizations of Medical Sciences (CIOMS) guidelines, nourished the individual human spirit. Ethical principles should have a similarly profound impact in the development of science and the protection of human populations in the 1990s and beyond.

Long-Term Care Policy: Where Are We Going?, Gerontology Institute, University Of Massachusetts Boston, Omb Watch

Gerontology Institute Publications

Millions of Americans suffer from physical or mental conditions that make it difficult for them to live fully independent lives. These are the frail elderly, disabled and chronically ill persons of all ages, and many mentally ill or mentally retarded persons. They need help to manage daily activities, whether they live in their own homes or in nursing homes.

Such care can be extremely expensive, since it often must be provided for many years, even a lifetime. Today, those costs are met largely by the individuals themselves or by their families and by public programs for low-income persons.

For many …

Alcoholism: A Barrier To Empowerment For Women, Marion Brink

New England Journal of Public Policy

Women's increasing economic power has encouraged the promotion of their drinking as fashionable. However, women are more vulnerable to the impact of alcohol, and the stigma attached to alcoholism is greater for them than it is for men. As a consequence, a woman — and those around her — will deny her alcoholism until she has lost much more than her male counterparts. When, or if, she seeks help for this devastating disease, she finds a lack of woman-specific programs and facilities. This article notes the barriers to recovery for women and offers some suggestions for breaking them down. Two …

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.

A Decade Of A Maturing Epidemic: An Assessment And Directions For Future Public Policy, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The author's goal in this article, is not merely to propose public health strategies for the future, but also to examine why government has been so slow, so equivocal, in its public health response to the acquired immune deficiency syndrome (AIDS) epidemic. He argues that there has been a fundamental ambivalence in perceptions of the epidemic. For some, AIDS is perceived as a disease, with sympathy for sufferers. Once AIDS is viewed as a disease, like other catastrophic diseases, it follows that public policy will be based upon science and epidemiology--health education, research and treatment.

For others, AIDS is caused …

Trends In Hospital And Nursing Home Care Expenditures, Maine, 1982 To 1986, Maine Department Of Human Services

Maine Collection

Trends in Hospital and Nursing Home Care Expenditures, Maine, 1982 to 1986

Maine Department of Human Services - Office of Data, Research, and Vital Statistics

John R. McKernan, Jr., Governor, Rollin Ives, Commissioner, Brenda Smith, Planning and Research Associate, May, 1989.

"This report produced under Appropriation No. 1310-4010."

Contents: Introduction / Hospital Care Expenditures / Nursing Home Care Expenditures / Comparison of Hospital and Nursing Home Care Expenditure Trends / Concluding Remarks / References

Blue Ribbon Commission On The Regulation Of Health Care Expenditures, State Of Maine, 113th Legislature

Maine Collection

Blue Ribbon Commission on the Regulation of Health Care Expenditures

State of Maine, 113th Legislature (January, 1989)

Office of Policy and Legal Analysis, Room 101, State House--Sta. 13, Augusta, Maine 04333.

Contents: Preface / Executive Summary of Recommendations / Introduction and Background / Detailed Recommendations