Health Policy Commons^™

Hiv And Partner Violence: Implications For Hiv Voluntary Counseling And Testing Programs In Dar Es Salaam, Tanzania, Suzanne Maman, Jessie K. Mbwambo, Margaret Hogan, Gad P. Kilonzo, Michael D. Sweat, Ellen Weiss

HIV and AIDS

This study explored the links between HIV infection, serostatus disclosure, and partner violence among women attending a VCT clinic in Dar es Salaam, Tanzania. Men and women both perceive HIV testing as a way to plan for the future but are motivated to undergo testing by a number of different individual, relationship, and environmental factors. The women in our study described more barriers to HIV testing than did men, and women who have communicated with their partners about VCT before seeking services are significantly more likely to share their HIV test results than those who have not talked with their …

Toward Improved Support For Research On Delivery Of Home- And Community-Based Long-Term Care, Francis G. Caro

Gerontology Institute Publications

Stronger and more consistent support is needed for research on long-term care. A greater investment in research will strengthen the ability of public and private organizations to provide effective and efficient assistance to people with disabilities and their informal caregivers. This paper provides a rationale for stronger research funding for the field and outlines several options to strengthen research.

The Americans With Disabilities Act And Academic Libraries In The Southeastern United States, Linda Lou Wiler, Eleanor Lomax

E-JASL: Electronic Journal of Academic and Special Librarianship (1999-2009, Volumes 1-10)

Individuals with disabilities are one of the fastest-growing segments of United States society. In 1970, 11.7% of the United States population was limited in activity, a major factor in measuring and identifying people with disabilities. In 1990, because of the aging of America, 13.7 % of the population could be so identified. By 1994, 15% of the population fell into this group. During this latter period, the older population stayed fairly stable but children and younger adults with disabilities increased greatly. Many different figures, depending upon the method of counting, e.g., age groups included, or whether residence was in a …

Providing Low-Cost Assistive Equipment Through Home Care Services: The Massachusetts Assistive Equipment Demonstration, Alison S. Gottlieb, Francis G. Caro

Gerontology Institute Publications

This report describes the Massachusetts Assistive Equipment Demonstration, a collaborative project funded by the Robert Wood Johnson’s Home Care Research Initiative and carried out collaboratively by the Gerontology Institute at the University of Massachusetts Boston and the Executive Office of Elder Affairs (EOEA). The purpose of the demonstration was to systematically encourage the use of low-cost assistive equipment among elderly clients through existing case management resources, thereby extending the effectiveness of the Massachusetts home care program by supplementing formal services with expanded use of assistive equipment.

Adolescent Girls' Livelihoods. Essential Questions, Essential Tools: A Report On A Workshop [Arabic], Carey Meyers

Poverty, Gender, and Youth

This report, co-published by the Population Council and the International Center for Research on Women, describes a workshop convened in Cairo in 1999 to learn more about the nature of both younger and older adolescents' work experience, differentiate the particular needs and potentials of adolescent girls, and identify programs and policies that might have promise for supporting them.

Nursing Home Ownership And Public Policy: An Historical Analysis, K. R. Kaffenberger

Graduate Doctoral Dissertations

In the early days of the United States, care of the disabled elderly outside the home meant the public almshouse. By the 1920s, private, nonprofit homes for the aged were prevalent. More recently, private, for-profit facilities have grown to dominate the field.

For-profit ownership has been controversial. Underlying the controversy is the concern that quality might be lowered in order to enhance profit.

This study asks why most nursing homes are privately owned and why most privately owned nursing homes are operated for profit. It does so with reference to The Nonprofit Economy, in which Burton Weisbrod describes a …

The Professional Decline Of Physicians In The Era Of Managed Care, Aimee E. Marlow

New England Journal of Public Policy

Physicians have long enjoyed prestige, power, and autonomy, but the rise of managed care organizations has drastically changed their status. Many doctors are in thrall to the financial well-being of the corporations that employ them, their knowledge and expertise controlled and manipulated in the interest of profit maximization. This article investigates the professional decline of physicians, citing the use of gag clauses, incentives to withhold care, and the breakdown of their authority. In an effort to regain some measure of control, physicians have taken their concerns to the public, supporting state and federal legislation that attempts to curb questionable managed …

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 …

Downsizing The Massachusetts Mental Health System: The Politics Of Evasion, Richard A. Hogarty

New England Journal of Public Policy

For the past three decades the topic of the proper role of state mental hospitals has been vigorously debated as a major public policy issue in Massachusetts. The state has had two runs at hospital closings: the first between 1973 and 1981, when the deinstitutionalization policy flourished, the second between 1991 and 1993, when the privatization policy was developed. In making the case for this seismic shift, a governor's special commission concluded that the state had too many hospitals for too few patients at too high a cost. This study provides a detailed analysis of the problems that beset the …

Flyer: “Protecting Our Seniors.” President Bill Clinton. Clinton/Gore. August 21, 1996., Clinton/Gore '96 Primary Committee, Inc

Saffy Collection - All Textual Materials

A Flyer detailing Clinton's policies on protecting Medicare and Medicaid, quality health care, and other issues related to senior citizens' concerns.

Flyer: “Safeguarding And Strengthening Medicare And Medicaid.” President Bill Clinton. Clinton/Gore. August 21, 1996., Clinton/Gore '96 Primary Committee, Inc.

Saffy Collection - All Textual Materials

A Flyer promising that Clinton will maintain and extend Medicare and Medicaid support.

Puerto Ricans' Access To Health Care, Ralph Rivera

New England Journal of Public Policy

The shift toward cost containment in health policy over the past decade has had negative consequences for the most vulnerable populations in the country, namely, ethnic minorities, the poor, and the uninsured. The Puerto Rican population is significantly affected by this shift, yet little is known of their health care usage. This study investigates the extent to which Puerto Ricans' health care use is determined by the relationship between predisposing variables, enabling variables, need, and other contextual variables and probes the implications of the findings for health policy. The adult Puerto Rican subsample (n = 1598) of the Hispanic Health …

Foreword, Martha Montero-Sieburth, Ralph Rivera

New England Journal of Public Policy

These articles echo the issues of today that will have an impact on the future and help us understand how current thinking about ethnicity, education, and health within Latino populations presents opportunities for the coming century. The Latino presence in the United States will certainly make itself known. As Richard Rodriguez poignantly reminds us, "We will change America, even as we will be changed."

Understanding Latino Ethnic Identity Development: A Review Of Relevant Issues, Azara Rivera-Santiago

New England Journal of Public Policy

One of the most promising areas in cross-cultural psychology is the development of identity among various ethnic groups in the United States. This article has a twofold purpose. First, it offers the concept of ethnic identity as defined and studied within the social sciences — sociology, anthropology, and psychology — including a review of some of the recent work on ethnic identity development proposed by leading investigators in the field of psychology. The author discusses their generalizability across ethnic groups. Second, it presents a number of dimensions considered important in conceptualizing and studying Hispanic ethnic identity development. These include acculturation, …

The Health Status And Lost Earnings Of Hispanic And Non-Hispanic Women, Janis Barry Figueroa

New England Journal of Public Policy

Based on data from the 1990 early release file of the Latino sample of the Panel Study of Income Dynamics (PSID), this article examines the loss of earnings suffered by disabled or health-limited Hispanic women workers. For comparative purposes, the author created an identical analysis based on a sample of black and white non-Hispanic women from the 1989 original-sample PSID. The research also considers the prevalence of poor health among Latinas to ascertain whether their lower labor-force participation, earnings, and number of hours worked can be associated with episodes of poor health. The empirical results show that Hispanic women are …

Ethnic Minorities And Mental Health: Ethical Concerns In Counseling Immigrants And Culturally-Diverse Groups, Gemima M. Remy

Trotter Review

Between 1980 and 1990 nearly 9 million foreign-born individuals migrated to the United States. In 1993, the Immigration and Naturalization Service recorded the entry of over 900,000 immigrants and refugees. This figure is believed to be higher given the estimated 1.5 to 2.5 million people who enter this country illegally each year. Currently, ethnic minority groups make up one-fourth of the United States population. It is estimated that by the year 2000, one-third of the U.S. population will be comprised of ethnic minorities. As the population of the United States becomes increasingly diverse, considerable attention is being directed to a …

Warning: Urban Living May Be Hazardous To Your Health: A Personal Perspective, Frederick G. Adams

Trotter Review

As a result of remarkable scientific and medical achievements of the 20th century, we now know that full and quality health is within reach for all Americans. Yet, despite these achievements, the burdens of inadequate health services too often falls more heavily on some population groups more so than on others. The fact that this "gap" in health status occurs more frequently among people with low income and people belonging to racial/ethnic minority groups, in particular African Americans, has been well documented nationally. Not only does the "gap" in the health status experienced by these groups include consistently higher excess …

Coalition Building: Moving Toward Effective Coalitional Strategies Of Hiv/Aids Prevention In Communities Of Color, Lisa Roland

Trotter Review

Despite the overwhelming burden carried by blacks and Latinos in terms of AIDS, it has become evident that in keeping with the general and historical pattern of discrimination reflected in funding, allocation of resources, policies etc., communities of color have received insufficient support to effectively address the problem at hand. Further compounding this dilemma, communities of color have fought against each other to secure funding for particular community programs. While looking at our individual, immediate, and entirely valid needs, many of us have at times failed to see the impact of our individual actions and attitudes on a broader picture.

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.

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 …

An Economic Profile Of Women In Massachusetts, Randy Albelda

Publications from the Center for Women in Politics and Public Policy

This report provides a profile of women's current economic position in Massachusetts. It examines the age, race, and geographical distribution of women and girls across the state; family structure, income and poverty; and women's labor force participation, occupational and industrial distribution in jobs, and earnings. When relevant 1990s Massachusetts data are compared to national data and to Massachusetts data from the 1970s.

Women across the Commonwealth have experienced tremendous changes in their lives over the last two decades as a result of changes in the economy and family structure. For women, the changes provide new opportunities, but they also exacerbate …

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 …

Older Americans' Attitudes Toward The Medicare Catastrophic Coverage Act Of 1988, Christine L. Day

Political Science Faculty Publications

Congress repealed the Medicare Catastrophic Coverage Act of 1988, which expanded Medicare benefits, after vigorous protests by groups of older people nationwide. Surveys show, however, that older Americans were deeply divided in their opinions. This study examines four explanations for divisions among the elderly on this issue: symbolic politics, socioeconomic status, distrust in government, and direct self-interest. The results of probit analysis indicate that high income, younger age (under 75), Republican partisanship, and distrust in government all contributed to older Americans' opposition to government catastrophic health care coverage. Direct self-interest—that is, perceived direct impact on one's own taxes and benefits—was …

The Older Population In Massachusetts, 1980-1990, Gerontology Institute, University Of Massachusetts Boston

Gerontology Institute Publications

Massachusetts and the nation are aging! People 65 and older are growing in numbers more rapidly than other younger segments of the population, and the unprecedented growth of this group has created new demands on and new opportunities for every major sector of American life. But if we are to make constructive plans for an aging society, we must have sound information on the major changes in the make-up of the population.

This report shows how the older populations in Massachusetts and in the United States have changed in the decade between 1980 and 1990. It is designed to serve …

Attitudes & Opinions Of Circuit Court Judges On The Issue Of Substance Abuse During Pregnancy, Michelle Degeorge

Masters Theses & Specialist Projects

The purpose of this study was to determine the attitudes and opinions of circuit court judges in Kentucky concerning the issue of pregnancy and substance abuse. A questionnaire was mailed to all 90 circuit court judges in Kentucky. The questionnaire, consisting of both a Likert scale and open-ended questions, dealt with concerns relating to the criminalization of pregnant substance abusers, fetal rights, state intervention in the case of pregnant substance abusers, and mothers rights. The ages of the judges, as well as their years of experience on the bench, were used to determine their attitudes on these issues. Results showed …

Living Our Faith: Pastoral Letter Of The Catholic Bishops Of Malawi, The Catholic Bishops Of Malawi, James Chiona, Felix E. Mkhori, Mathias A. Chimole, Alessandro Assolari, Allan Chamgwera, Gervasio M. Chisendera, Gamba

Pastoral Letters from Malawi

In March 1992, The Catholic Bishops of Malawi published a pastoral letter titled "Living Our Faith." This Lenten letter discusses educational services, health services, and the AIDS epidemic. It also calls for the publics participation in civic life, examines issues within the justice system, and details the state of specific freedoms in the country such as expression, worship, and association.