Health Policy Commons^™

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.

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 …

Foreword, Andrés Torres, James Green

New England Journal of Public Policy

Many important debates about public policy at the national level and in states like Massachusetts have centered on health care and human services, including welfare and the care of children, the abused, the disabled, the elderly, and those suffering from mental and physical illness. In this issue scholars and advocates examine a range of problems in the health care and human service fields from a perspective often lacking in the public policy discussion — that of the workforce and of the labor organizations that represent the workforce.

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 …

Labor's Response To Hospital And Workplace Transformation, Enid Eckstein

New England Journal of Public Policy

The health care industry and the nation's hospitals are in the throes of revolutionary change. The shift to managed care resulted in fundamental changes in the delivery of care and the structure of health care, For the past ten years, hospitals have actively been merging and creating large-scale integrated delivery systems. Employers, eager to expand market share and reduce costs, are engaged in radical reorganization of the hospital and the structure of work from which no group is immune. Physicians, nurses, technicians, and housekeepers are all affected by these changes. Hospitals are reducing their personnel, shifting work outside the hospital, …

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 …

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.

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 …

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 …

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 …

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 …

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.

Medicaid And Medicaid Cost Containment In Massachusetts, Fredric A. Waldstein

New England Journal of Public Policy

The purpose of this article is to describe Medicaid's financial structure and examine cost containment efforts to limit future growth of the program, particularly pertaining to Massachusetts. The principal focus is the Massachusetts Department of Public Welfare and the Massachusetts Medicaid Fraud Control Unit, the two agencies most responsible for Medicaid cost containment in the commonwealth. Because elected officials are unwilling to face directly the troublesome issues surrounding Medicaid and its growth, the government agencies responsible for cost containment have been left to define the scope of the problem, design remedial strategies, and evaluate their success. This process is found …

The Gerontology Institute: The First Years, 1984-1987, Gerontology Institute, University Of Massachusetts Boston

Gerontology Institute Publications

During the first years of its existence, the Gerontology Institute has worked with older people to convert "retirement years" into opportunities for continuous growth and learning, while simultaneously seeking to re-examine social, political, and economic roles for elders in society. It is hoped that through such engagement of older individuals, the Institute has inspired a more positive attitude in society towards its aging population.

The Aids Epidemic: A Prism Distorting Social And Legal Principles, Alec Gray

New England Journal of Public Policy

The AIDS epidemic is affecting American society in far-reaching and unexpected ways. It touches our institutions, our value systems, and our private lives. Social issues seem to change and become distorted by the epidemic 's prismlike effect. This article examines some of the major public health issues raised by the epidemic, ranging from testing to contact tracing and quarantine. It argues that while the civil rights of individuals may have to be sacrificed to stem the spread of the disease, those rights should not be abandoned unless a clear benefit to the public health would result.

Issues of discrimination in …

Aids And New England Hospitals, Jesse Green, Neil Wintfeld, Madeleine Singer, Kevin Schulman

New England Journal of Public Policy

The Centers for Disease Control projects that nine thousand persons with AIDS will be alive in New England in 1991, representing a sevenfold increase from 1986. Our analysis indicates that more than 2 percent of medical/surgical beds in New England will be used for AIDS care by 1991, representing 766 fully occupied hospital beds. The direct cost of providing hospital care to New England's AIDS patients is projected to be $195.2 million in 1991, reflecting 3 percent of all hospital inpatient costs in the region.

AIDS treatment is very unevenly distributed among hospitals in New England. Just twenty hospitals (8 …

U.S. Women And Hiv Infection, P. Clay Stephens

New England Journal of Public Policy

Women are inadequately provided with HIV services and education and are differentially denied access to these. Divisions of race, ethnicity, economic class, and religion, among others, are compounded by sexual discrimination within each of these categories.

Review of current data on women with AIDS reveals that the reporting methods used convey a false impression that women are not at significant risk. Moreover, the persons indirectly affected by AIDS are predominantly women — mothers, sisters, partners, family members, teachers, and human service workers. Thus, AIDS is more of a women's issue than the statistics imply.

Women, as a gender-defined class, face …