Health Policy Commons^™

Update - June 2005, Loma Linda University Center For Christian Bioethics

Update

In this issue:

-- Universal Access to Health Care and Religious Basis of Human Rights

Akinbola E. Akinwumi On Sickness And Wealth: The Corporate Assault On Global Health By Meredith Fort, Mary Anne Mercer And Oscar Gish (Eds). Cambridge: South End Press, 2004. 237pp., Akinbola E. Akinwumi

Human Rights & Human Welfare

A review of:

Sickness and Wealth: The Corporate Assault on Global Health by Meredith Fort, Mary Anne Mercer and Oscar Gish (eds). Cambridge: South End Press, 2004. 237pp.

The Impact Of Program Changes On Enrollment, Access, And Utilization In The Oregon Health Plan Standard Population, Matthew J. Carlson, Bill J. Wright

Sociology Faculty Publications and Presentations

In February 2003, in an effort to expand Medicaid coverage within tight fiscal constraints, the Oregon Health Plan (OHP) underwent a significant redesign of benefits, cost-sharing and premium structure. The OHP2 redesign resulted in two tiers of coverage, OHP Plus and OHP Standard, and a premium subsidy program. The OHP Plus benefit package and cost sharing structure is similar to the original OHP and serves the federally-mandated Medicaid populations: children and pregnant women, low-income elderly and individuals meeting the SSI definition of disability. OHP Standard, designed for Oregon’s expansion population,1 includes a reduced benefit package, expanded co-pays and increased premiums. …

Public Policy In Connecticut: Challenges And Perspectives, Gary L. Rose Ed.

Sacred Heart University Press Books

Public Policy in Connecticut examines ten of the key policy challenges that currently confront Connecticut lawmakers. Following an overview essay by the editor, discussing the recent transfer of power to state governments and outlining the policy challenges faced by lawmakers, each of these challenges is taken up in a separate essay by the volume's contributors. The first challenges considered, associated with economic growth, transportation, environmental protection, ethnic diversity, and ethics in politics, affect the Connecticut public at large. The remaining issues discussed are health care, services for the aged, prison overcrowding and recidivism, inner-city education, and higher education affect more …

Reducing The Transmission Of Hiv And Sexually Transmitted Infections In A Mining Community: Findings From The Carletonville Mothusimpilo Intervention Project: 1998 To 2001, Lewis Ndhlovu, Catherine Searle, Johannes Van Dam, Yodwa Mzaidume, Bareng Rasego, Solly Moema

HIV and AIDS

The Horizons program, in collaboration with the Center for Scientific and Industrial Research, the South African Institute for Medical Research, and the London School of Economics, conducted an intervention study in the mining town of Carletonville, South Africa to examine the social determinants of the HIV epidemic, and to assess the impact of a targeted program of HIV and STI prevention and service delivery. The project did not reduce STI prevalence or HIV prevalence, as changing sexual behavior is far more complex than educating individuals about HIV. The report recommends interventions to support behavioral change education, STI treatment, the role …

Programming For Hiv Prevention In South African Schools: A Report On Program Implementation, Priscilla Reddy, Shegs James, Ann P. Mccauley

HIV and AIDS

An evaluation study conducted in KwaZulu Natal, South Africa, provides important insights into whether learners who participated in a fact-based, interactive course had more knowledge about HIV risks, prevention, and care practices; more positive attitudes toward prevention practices and people living with HIV and AIDS; and a higher prevalence of reported safe behaviors than comparable learners who did not participate in the course. Results show that the Life Skills Grade 9 Curriculum had a positive impact of students’ knowledge of HIV/AIDS, attitudes about abstinence, and intention to use condoms. There was, however, no evidence of increased adoption of such protective …

Understanding The Hiv/Sti Risks And Prevention Needs Of Men Who Have Sex With Men In Nairobi, Kenya, Washington Onyango-Ouma, Harriet Birungi, Scott Geibel

HIV and AIDS

Despite increasing awareness of the role men who have sex with men (MSM) can play in the dynamics of HIV transmission in Africa, research on MSM in Kenya has been limited. In response to this gap, researchers from the Institute of African Studies at the University of Nairobi and the Horizons and FRONTIERS programs of the Population Council undertook a study of MSM in Nairobi. The overall goals of the study were to understand the extent to which MSM are at risk of HIV and other STIs, identify the factors associated with risk behaviors, and identify MSM sexual health needs …

The Effect Of Community Nurses And Health Volunteers On Child Mortality: The Navrongo Community Health And Family Planning Project, Brian Wells Pence, Philomena Nyarko, James F. Phillips, Cornelius Debpuur

Poverty, Gender, and Youth

This report presents the child mortality impact of a trial of primary health-care service-delivery strategies in rural Ghana. After adjustment for sociodemographic factors, under-five mortality in areas with village-based community-nurse services fell by 16 percent during the five years of program implementation compared with mortality before the intervention. Reductions were observed in infant (6 percent), early child (20 percent), and late child (41 percent) mortality. Community involvement and training of a local health volunteer were associated with an 11 percent increase in mortality, primarily driven by a 124 percent increase in early child mortality. Areas with both nurses and volunteers …

The Challenge Of An Aging Population, Nicole Cauvin, Elaine B. Davis

Sociology Faculty Publications

In chapter seven of Public Policy in Connecticut, Nicole X. Cauvin and Elaine B. Davis discuss the policy challenges associated with an aging or "graying" state population. Demographic data clearly demonstrate that Connecticut's population, similar to the population of other states, is becoming older. The authors propose innovative public policies designed to accommodate the long-term health care and social service needs of the state's elderly.

Science-Based Organic Farming: A Resource For Educators, Charles A. Francis, Mindi Schneider, Brad Kindler

Publications from the Center for Applied Rural Innovation (CARI)

Organic farming is an important and growing part of the United States food system. The organic sector has grown by at least 20% per year for the past two decades, and currently shows no indication of slowing in this growth. There is increasing consumer concern about where and how food is produced, and people want to be assured access to safe and healthy food products. Interest and concern about food security, and discussion about the merits of a local food system as compared to the vulnerable globalized marketplace are also becoming increasingly important. In Nebraska we have only limited local …

Review Of Field Experiences: Integration Of Family Planning And Pmtct Services, Naomi Rutenberg, Carolyn Baek

HIV and AIDS

The Population Council and its research partners have been addressing several key questions about prevention of mother-to-child HIV transmission (PMTCT) services and how well they function in field settings. The World Health Organization asked the Population Council to provide a review of field experiences regarding the integration of family planning and PMTCT services. This report provides conclusions and recommendations as input into a WHO/UNFPA-sponsored consultative meeting on "The linkages between reproductive health and HIV/AIDS: Family planning and prevention of mother-to-child transmission."

Maximizing Resources To Meet Client Needs: Evaluation Of A Comprehensive Hiv/Aids Care And Support Model In India, Yrg Care, Horizons Program, International Hiv/Aids Alliance

HIV and AIDS

To examine the benefits and feasibility of service delivery, the Horizons program and the International HIV/AIDS Alliance undertook a multifaceted operations research study of YRG CARE, a nongovernmental organization which offers services to PLHA in southern India. Data from this study suggest that comprehensive care and support services have had a positive impact on perceived quality of life, serostatus disclosure, number of illness episodes, and household expenditures for those patients who participated in the study. The results of this component of the study support the value of scaling-up the YRG CARE service model to other NGOs in India to expand …

Expanding The Care Continuum For Hiv/Aids: Bringing Carers Into Focus, Jessica Ogden, Simel Esim, Caren Grown

HIV and AIDS

This review by the International Center for Research on Women explores the specific issues that cluster around the provision of care in the context of the global HIV/AIDS pandemic. With the support of the Population Council’s Horizons program, this review applies the care economy lens to two key sectors, health and social protection, and finds that while important strides are being made, much more needs to be known and done to enable individuals, families, and households to survive in a world shaken by AIDS. The report documents the challenges faced by family care providers, who are primarily women and unlinked …

Expanding Care And Support In South India: Scaling Up Yrg Care's Patient-Centered Approach, Yrg Care, Horizons Program, International Hiv/Aids Alliance

HIV and AIDS

This study examines the experiences of YRG CARE, a Chennai-based NGO, which provides an integrated continuum of prevention, care, and support services for PLHA in South India. In this Horizons report, the authors examine the process of scaling up YRG CARE’s patient-centered approach and how this led to the enhanced provision of care and support services at four selected sites. Networking and collaboration among providers at all sites were essential parts of the strategy. At the end of project workshop, scale-up participants and YRG CARE affirmed their intention to continue collaboration in order to build on the successes of the …

Succession Planning In Uganda: Early Outreach For Aids-Affected Children And Their Families, Horizons Program, Makerere University Department Of Sociology, Plan Uganda

HIV and AIDS

This publication reports on an intervention study that evaluated the effectiveness of a succession planning (SP) program in Uganda. Unlike most other programs for AIDS-affected children, succession planning reaches children and their families while their HIV-positive parents are still living and in a position to plan for their children’s long-term well-being. Research carried out by the Department of Sociology at Makerere University (Kampala) and the Population Council Horizons program suggests that succession planning is a promising approach: despite AIDS-related stigma and cultural resistance to acknowledging illness and death, qualitative research indicates that the approach met with a high degree of …

Combining Community Approaches And Government Policy To Prevent Hiv Infection In The Dominican Republic, Deanna Kerrigan, Luis Moreno, Santo Rosario, Bayardo Gomez, Hector Jerez, Ellen Weiss, Johannes Van Dam, Eva Roca, Clare Barrington, Michael D. Sweat

HIV and AIDS

A recent Horizons study conducted jointly with two Dominican NGOs assessed the impact of two environmental-structural models in reducing HIV-related risk among female sex workers in the Dominican Republic and compared their cost-effectiveness. In the two cities studied, there were improvements from pre- to post-intervention in the key outcome variables, however the type and level of these changes varied by intervention approach. Based on our findings, program planners and policymakers involved in the study in the Dominican Republic agree that the integrated solidarity and policy model in conjunction with ongoing peer education and community mobilization activities is an appropriate, cost-effective, …

Involving Young People In The Care And Support Of People Living With Hiv/Aids In Zambia, Eka Esu-Williams, Katie D. Schenk, Joseph Motsepe, Scott Geibel, Anderson Zulu

HIV and AIDS

The Population Council, in collaboration with CARE International and Family Health Trust, conducted a study in Zambia to determine which care and support needs of people living with HIV and AIDS and their families could be met by trained youth, and to establish whether youth engaged in formalized care and support activities would increase their adoption of protective behaviors or reduce the stigma faced by members of AIDS-affected households. Discussions with caregivers and clients demonstrated that trained youth are able to meet a range of the needs of clients and orphans and vulnerable children, and that their efforts may be …

A Rapid Situation Analysis Of The Access To Care Project In Northern Thailand, Ratana Panpanich

HIV and AIDS

A rapid situation analysis (RSA) study, supported by the Horizons program, was undertaken to understand the strengths and weaknesses of the Thai government’s Access to Care (ATC) project in northern Thailand. The ultimate aim of the study was to make recommendations for action that will improve the quality of the antiretroviral (ARV) therapy that clients receive and to enhance their adherence to HAART. The RSA has shown high levels of support for the ATC project from health providers, HAART clients, their relatives, and even those who had dropped out of the program. However, the RSA has also shown that there …

Transitions To Adulthood In The Context Of Aids In South Africa: The Impact Of Exposure To Life Skills Education On Adolescent Knowledge, Skills, And Behavior, The Transitions To Adulthood Study Team

HIV and AIDS

This study is a collaborative research project of the University of Natal-Durban, the Horizons program, and Tulane University. One objective of the study was to contribute to understanding the effectiveness of life skills education in changing behavior in South Africa. The findings indicate substantial short-to-medium-term effects of exposure to life skills education on certain areas of sexual and reproductive health-related knowledge, confidence to use condoms, and condom use behavior. Further research is needed to assess whether the observed effects are transitory or long-term in nature, whether the observed behavioral changes have an impact on HIV infection rates among youth, and …

Using Incentives To Encourage Aids Programs And Policies In The Workplace: A Study Of Feasibility And Impact In Thailand, Simon Baker, Srisuman Sartsara, Patchara Rumakom, Philip Guest, Katie D. Schenk, Anthony Pramualratana, Suparat Suksakulwat, Surachai Panakitsuwan, Sikarat Moonmeung

HIV and AIDS

A recently completed Horizons study in Thailand examined the question of how to encourage the private sector to become actively involved in developing and improving workplace HIV/AIDS programs. The study found that the AIDS-response Standard Organization (ASO) initiative mobilized a moderate proportion of different types of companies to develop and improve HIV/AIDS workplace policies and programs. The data also reveal that companies that were eligible for the insurance discount made the greatest improvements. Thus a financial incentive combined with efforts to tap into managers’ willingness to respond to the epidemic can be important motivators for certain companies to improve their …

Back To The Future: The Future Of Long-Term Care In Massachusetts, Deborah H. Thomson, John J. Ford

Gerontology Institute Publications

The state of Massachusetts, like the rest of the United States, is facing an approaching crisis in long-term care. Over the next few decades the number of Massachusetts residents age 65 and older will soar. As these numbers increase, so will the need for long-term care.

Massachusetts is ill prepared to provide the services that will be needed. Our current system of health care benefits leaves many elders with gaps in coverage. Those individuals who need long-term services often impoverish themselves and their spouses before the state pays for their care. Others languish on waiting lists to receive services. Our …

The Impact Of Program Changes On Health Care For The Ohp Standard Population: Early Results From A Prospective Cohort Study, Matthew J. Carlson, Bill J. Wright, Charles Gallia

Sociology Faculty Publications and Presentations

The purpose of this study is to assess the impact of benefit changes on the Oregon Health Plan (OHP) Standard Population across three domains: Enrollment; Access to care; Utilization

Human Rights And Health, Paul Hunt

Human Rights & Human Welfare

Introduction to Topical Research Digest section.

Nutrition, Health And Human Rights, Monica Fish

Human Rights & Human Welfare

The last half-century has seen the development of a range of international instruments whose chief concern is the declaration and codification of basic human rights norms as agreed upon by the international community. Collectively these documents provide a normative and legal foundation for the human right to adequate food and nutrition, and freedom from malnutrition. A brief sampling of relevant language from these documents follows:

Long-Term Care: Informed By Research, Francis G. Caro

Gerontology Institute Publications

Health services research has contributed to health policy and service developments that have led to major improvements in the quality of long-term care in the United States. This policy brief highlights a few areas in which publicly and privately funded research has informed the long-term care field.

Expanding Self-Direction In Services For The Aged And People With Disabilities, Ruth A. Burgess

Theses, Dissertations and Capstones

Medicaid-funded long-term care services are traditionally delivered in nursing homes. States may apply for waivers which allow them to provide home and community based services with Medicaid funds. Because these services are by definition an alternative to nursing home care, waiver services are generally based upon a medical model which emphasizes medical deficits and tends to restrict consumers’ movements to inside the home. Recent developments such as the Olmstead Decision and federal New Freedom Initiatives have caused states to recognize that consumers desire and have a legal right to be part of a community rather than institutionalized or homebound. These …

Reproductive Health Services In Kwazulu Natal, South Africa: A Situation Analysis Study Focusing On Hiv/Aids Services, Lewis Ndhlovu, Catherine Searle, Robert A. Miller, Andrew A. Fisher, Ester Snyman, Nancy L. Sloan

HIV and AIDS

This Horizons report examines the readiness of reproductive health services in South Africa, which are primarily geared to women, to deliver HIV and AIDS treatment, care, and prevention services. The goal of the study was to obtain information from a representative sample of provincial health care facilities offering reproductive health services in KwaZulu Natal to meet the growing demand for HIV/AIDS-related services. Ninety-eight hospitals, community health centers, and clinics participated in the situation analysis that identified gaps in service delivery and determined priorities for service integration. Results of the study were presented to a large audience of Department of Health, …

Empowering Communities To Respond To Hiv/Aids: Ndola Demonstration Project On Maternal And Child Health: Operations Research Final Report, Hope Humana, Linkages, National Food And Nutrition Commission, Ndola District Health Management Team, Horizons Program, Zambia Integrated Health Project

HIV and AIDS

A pre–post intervention study conducted in Zambia by Horizons and local NGOs and governmental organizations demonstrated that HIV voluntary counseling and testing (VCT) and infant feeding counseling (IFC) to mothers attending maternal and child health (MCH) clinics are vital components of any mother-to-child transmission (MTCT) reduction strategy, whether or not antiretrovirals (ARVs) are available. These interventions enable mothers to make informed and healthy decisions. Data from the Ndola Demonstration Project yielded encouraging results from efforts to improve the capacity of mothers to make informed decisions about their own health and the health of their infant. The interventions succeeded in raising …

Microfinance And Households Coping With Hiv/Aids In Zimbabwe: An Exploratory Study, Carolyn Barnes, Erica Keogh, Nontokozo Nemarundwe, Loveness Nyikahadzoi, Ellen Weiss

HIV and AIDS

This study, conducted in Zimbabwe, sought to better understand the relationship between a microfinance program, Zambuko Trust, and how microentrepreneurs’ households cope with the impact of HIV/AIDS. The study examined how HIV/AIDS is affecting Zambuko’s operations and what microfinance institutions (MFIs) can do to lessen the impact of HIV/AIDS on their clients and operations. The findings indicate several small yet important ways that MFI programs help microentrepreneurs and their families respond to these impacts through access to credit and business management training. Participation in a microfinance program led to income smoothing and better financial management, which can help households mitigate …

The Concept Of Healthy Ageing In Hong Kong, Mei Lan, Mandy Chiu

Lingnan Theses

The purpose of this study is to explore the concept of ‘Healthy Ageing’ in Hong Kong. The research attempts to explore the historical base from which ‘Healthy Ageing’ has been conceptualized in both Western and Chinese societies. This study also tries to provide an overview of literature that relevant to the ‘Healthy Ageing’ concept, and to provide an initial theoretical framework of ‘Healthy Ageing’ in a Hong Kong Chinese context.

This study mainly adopts a qualitative approach in exploring the meaning of the concept. Since that ‘Healthy Ageing’ is likely to be conceptualized from the concept of health and ageing, …