Public Policy Commons^™

The Normative Authority Of The World Health Organization, Lawrence O. Gostin, Devi Sridhar, Daniel Hougendobler

Georgetown Law Faculty Publications and Other Works

The World Health Organization (WHO) was born after the devastation of World War II, as a normative agency endowed with unprecedented constitutional powers. But even as it has achieved stunning successes, such as the eradication of smallpox, it has failed to live up to the exalted expectations of the postwar health and human rights movement e exemplified most recently by its inadequate response to the Ebola epidemic. Our aim is to offer innovative ideas for restoring the Organization to its leadership position by exercising its normative authority, even as it faces a crowded and often chaotic global health architecture. Before …

Combating Hiv/Aids In Marginalized Communities: Papua And West Papua Provinces, Indonesia, Bani Cheema

Master's Theses

My study focuses on foreign aid and local initiatives for HIV/AIDS prevention in eastern Indonesia using the provinces of Papua and West Papua as a case study. The two provinces are home to indigenous tribal groups that are socioeconomically marginalized and most affected by the epidemic. My research investigates behavior change communication as a principal strategy undertaken by multiple organizations for HIV/AIDS prevention in this region. I take a qualitative approach by examining the effectiveness of this strategy in local communities and by revealing social and cultural barriers that impede success. Obstacles that negatively impact prevention efforts include structural violence, …

Adults With Intellectual Disability Or Autism Spectrum Disorder. Executive Summary, Kimberly I. Snow Mhsa, Ba, Stuart Bratesman Mpp, Taryn Bowe, Julie T. Fralich Mba

Disability & Aging

This chartbook describes Maine’s historical trends in meeting the needs of adults with ID/ASD through institutional and community based services in comparison to other states; a detailed analysis of the population’s utilization of different types of services and their costs in SFY 2010; the implementation of the Supports Intensity Scale (SIS) as a means of identifying the supports needs of the adults with ID/ASD; and the complement of providers serving this population in Maine.

Aging In Place In Marion: A Community Endeavor, Bernard A. Steinman, Hayley Gleason, Maryam Khaniyan, Ceara Somerville, Jan Mutchler

Gerontology Institute Publications

This report describes collaborative efforts undertaken by the Friends of the Marion Council on Aging (FMCOA) and the Center for Social and Demographic Research on Aging, within the McCormack Graduate School at the University of Massachusetts Boston (UMass Boston). Beginning in Fall 2014, these organizations partnered to conduct a study to investigate the needs, interests, preferences, and opinions of the Town’s older resident population, and the priorities of other stakeholders in the Town, with respect to living and aging in Marion.

In the earliest phase of the project, we met several times with members of the FMCOA to discuss and …

Aging In West County Communities: Coming Together To Age In Place, Bernard A. Steinman, Hayley Gleason, Ceara Somerville, Maryam Khaniyan, Jan Mutchler

Gerontology Institute Publications

This report describes collaborative efforts undertaken by the Towns of Ashfield, Buckland, and Shelburne Consortium of Councils on Aging (hereafter, The Consortium) and the Center for Social and Demographic Research on Aging, within the McCormack Graduate School at the University of Massachusetts Boston (hereafter, UMass Boston). Beginning in Fall 2014, these organizations partnered to conduct a study to investigate the needs, interests, preferences, and opinions of older residents in communities in West Franklin County (hereafter, West County), and priorities of stakeholders who interact with older adults in various capacities.

Early in the project, researchers from UMass Boston communicated with stakeholders …

El Modelo Médico, El Capitalismo Y La Acción Pública: Un Estudio Sobre Discapacidad Y Empleo En La Argentina / The Medical Model, Capitalism And Public Action:A Study Of Disability And Employment In Argentina, Zoe Zakin

Independent Study Project (ISP) Collection

People with disabilities are one of the largest “minority” groups in the world, accounting for approximately 15% of the global population. They are still, however, denied most of their basic rights in countries around the world. While movements have been made around access to education, transportation, and health systems, people with disabilities are still culturally thought of as incapable of being able to work. By being characterized this way, people with disabilities are denied a most basic human right. In Argentina, there has been greater effort in recent years to provide services for people with disabilities, which are a growing …

The President’S National Security Agenda Curtailing Ebola, Safeguarding The Future, Lawrence O. Gostin, Henry A. Waxman, William Foege

Georgetown Law Faculty Publications and Other Works

A clear lesson of the Ebola epidemic in West Africa is the need for strong public health systems globally, including in the United States. Ebola has highlighted the dangers of weak public health systems, from the immense shortage of health workers in West Africa to the budget cuts at the U.S. Centers for Disease Control and Prevention. In response to Ebola and the broader threat of infectious disease, President Obama has proposed a $6.2 billion supplemental funding request to Congress. The supplemental would surge resources for containing and treating Ebola in West Africa -- including a reserve of funds to …

Filling In The Blanks On Reducing Tobacco Product Addictiveness In The Fctc Partial Guidelines For Articles 9 & 10, Eric N. Lindblom

Georgetown Law Faculty Publications and Other Works

The existing Partial Guidelines for Implementation of Articles 9 & 10 of the WHO Framework Convention for Tobacco Control includes a strategy for regulating tobacco products to reduce their attractiveness, but does not yet provide any guidance for reducing either the toxicity or the addictiveness of tobacco products. Section 1.2.1.2, “Addictiveness (dependence liability),” states only that: “This section has been left blank intentionally to indicate that guidance will be proposed at a later stage.” A related footnote says that the blanks will be filled “as new country experience, and scientific, medical and other evidence become available. . . [and] will …

Health Information Exchange: Growth And Patient Privacy, Niam Yaraghi

Brookings Scholar Lecture Series

Health Information Exchanges (HIE) provide the electronic movement of health-related information among organizations according to nationally recognized standards. The goal of health information exchange is to facilitate access to and retrieval of clinical data to provide safer, timelier, efficient, effective, equitable, patient-centered care. HIEs are becoming integral parts of the national healthcare reform efforts, chiefly owing to their potential impact on cost reduction and quality enhancement in healthcare services. However, the potential of a HIE platform can only be realized when its multiple constituent users actively participate in using its variety of services. In this research, Yaraghi models HIE systems …

Is The United States Prepared For Ebola?, Lawrence O. Gostin, James G. Hodge Jr., Scott Burris

Georgetown Law Faculty Publications and Other Works

The West African Ebola epidemic is a humanitarian crisis and a threat to international security. It is not surprising that isolated cases have emerged in Europe and North America, but a large outbreak in the United States, with its advanced health system, is unlikely. Yet the handling of the first domestically diagnosed Ebola case in Dallas, Texas, raised concerns about national public health preparedness. What were the critical health system vulnerabilities revealed in Dallas, and how can the country respond more effectively to novel diseases in a globalized world?

Ebola: A Crisis In Global Health Leadership, Lawrence O. Gostin, Eric A. Friedman

Georgetown Law Faculty Publications and Other Works

At the core of the present Ebola crisis in West Africa is a lack of global health leadership. WHO should be the global health leader, following its constitutional charge, yet it is significantly under-resourced, having a direct effect on its rapid response capacity. The Organization's response to this crisis has been constantly behind, from low funding appeals to its delay in declaring this outbreak to be a Public Health Emergency of International Concern under the binding International Health Regulations (2005) (IHR). The IHR themselves have proven insufficient, as countries have failed to cooperate in building the public health capacities that …

An Analysis Of Political And Legal Debates Concerning Medicaid Expansion In Virginia, Rick Mayes, Benjamin Paul

Political Science Faculty Publications

The Supreme Court’s historic June 2012 ruling regarding the Affordable Care Act (ACA) in National Federation of Independent Business v. Sebelius set the stage for a massive federalism battle over Medicaid expansion in the United States. The original language of the Act was intended to nationalize Medicaid by having every state expand their program’s eligibility to all individuals up to 138% of the federal poverty level. This would have significantly reshaped Medicaid, a joint federal-state health insurance program, into a universal entitlement for all low-income citizens. Currently, Medicaid eligibility varies dramatically from state to state. The Court held that the …

Mainecare Health Homes Enrollment In The First Year Of Implementation, Kimberley S. Fox Mpa, Carolyn E. Gray Mph, Katherine Rosingana

Population Health & Health Policy

The MaineCare Health Homes Initiative is designed to improve care coordination for MaineCare members with complex chronic medical conditions. The program is being implemented in two stages: Health Homes (HH), which began in January 2013, focuses on members with chronic health conditions. Behavioral Health Homes (BHH), which began in April 2014, is designed to meet the needs of people with Severe Mental Illness (SMI) or Serious Emotional Disturbances (SED).

The HH first stage builds off the State’s existing multi-payer Patient Centered Medical Home (PCMH) Pilot project and Medicare Advanced Primary Care Practice (MAPCP) Demonstration by providing addon payments to qualifying …

The Ebola Epidemic: A Public Health Emergency Of International Concern, Lawrence O. Gostin, Daniel Lucey, Alexandra Phelan

Georgetown Law Faculty Publications and Other Works

On August 8, 2014, the World Health Organization (WHO) Director-General Margaret Chan declared the West Africa Ebola crises a “public health emergency of international concern,” triggering powers under the 2005 International Health Regulations (IHR).

The most affected West African states have attempted classic public health measures with varied success, including quarantine and isolation, social distancing, risk communication, and travel restrictions. These have involved a trade off between population health and human rights; sometimes to the disadvantage of both. At the same time, the countries’ health systems and human resources are fragile, impeding an effective response.

Beyond the public health and …

The Historic Role Of Boards Of Health In Local Innovation: New York City’S Soda Portion Case, Lawrence O. Gostin, Belinda H. Reeve, Marice Ashe

Georgetown Law Faculty Publications and Other Works

Childhood and adult obesity pose major risks for cancer, diabetes, and cardiovascular disease, with the poor and racial minorities suffering from disproportionately high burdens of obesity and chronic disease. With current policies failing, cities and states have moved forward with creative prevention measures–-with boards of health driving policy innovation in many local jurisdictions. The New York City Board of Board of Health’s (NYCBH) soda portion limit pushed the boundaries of innovation, but was struck down on June 26, 2014 by New York State’s highest court, which held that the Board trespassed on the City Council’s authority.

The Court’s decision ignored …

Virus Sharing, Genetic Sequencing, And Global Health Security, Lawrence O. Gostin, Alexandra Phelan, Michael A. Stoto, John D. Kraemer, K. Srinath Reddy

Georgetown Law Faculty Publications and Other Works

The WHO’s Pandemic Influenza Preparedness (PIP) Framework was a milestone global agreement designed to promote the international sharing of biological samples to develop vaccines, while that ensuring poorer countries would have access to those vaccines. Since the PIP Framework was negotiated, scientists have developed the capacity to use genetic sequencing data (GSD) to develop synthetic viruses rapidly for product development of life-saving technologies in a time-sensitive global emergency—threatening to unravel the Framework. Access to GSD may also have major implications for biosecurity, biosafety, and intellectual property (IP).

By rendering the physical transfer of viruses antiquated, GSD may also undermine the …

Ebola: Towards An International Health Systems Fund, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The current outbreak of Ebola virus disease (EVD) in West Africa is spiraling out of control, but it never had to happen. What can the international community do now to bring the epidemic under control, and how can we prevent the next one?

The counties most affected by Ebola (Guinea, Liberia, and Sierra Leone), rank among the lowest in global development, lacking essential public health infrastructure. If the affected countries had adequate public health systems, they probably would have contained Ebola within rural settings, avoiding the first outbreak in major urban areas.

More than 130 health workers have died from …

The Fatherhood Factor: The Impact Of The Father-Child Relationship On The Social, Interpersonal, And Recidivism Risk Factors Of Previously Incarcerated Men, Larissa A. Maley

Seton Hall University Dissertations and Theses (ETDs)

Of the men who return home from prison, nearly 7 out of 10 will be re-arrested and sent back within 3 years of their release (Travis, Solomon, & Waul, 2001). This trend has large- scale implications, not just for individuals, but for their families and communities as well. Clearly, understanding the factors that contribute to a man’s success or failure in staying out of prison is extremely important in constructing policy and programs to assist these at-risk individuals and communities. Of the few studies that have explored the lives of previously incarcerated men, some have found fatherhood to be a …

The Importance Of Access To Benefits Under The Family Medical Leave Act For Low-Income Families For Bonding And Attachment Facilitation With A Fragile Infant And The Role Of The Social Worker, Theresa Stewart Moran

21st Century Social Justice

Lack of universal family leave discriminates against low-income families with infants who require care in the Neonatal Intensive Care Unit. Birth complications tend to occur more frequently in families living with low socioeconomic status, placing a disproportionate burden on an already vulnerable population. Parents in this group tend to be employed in jobs that do not include the benefit of parental leave. Considering that attachment relationships form as the result of bonding transactions during a critical time in development, limiting contact curtails secure attachment. This, combined with other risk factors, increase the odds of lifelong negative outcomes. Family leave policy …

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 …

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 …

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. …

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 …

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.

Characteristics Of Working Supplemental Nutrition Assistance Program Recipients In Maine, According To The 2011 American Community Survey, Victoria Ryan

Muskie School Capstones and Dissertations

The Supplemental Nutrition Assistance Program (SNAP) is a federal program administered by the United States Department of Agriculture (USDA). SNAP is designed to provide assistance in purchasing food to low income households in the United States. In Maine, individual benefits are administered by the Maine Department of Health and Human Services. Formerly (and still colloquially) known as the Food Stamp program, SNAP makes a dollar-value benefit, based on income, household size, household expenses, and a host of other factors, available to households via a debit or Electronic Benefit Card for the purchase of unprepared food from grocery and convenience stores, …

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 …

Umass Boston Coasts And Communities Igert Program, Robyn Hannigan, Maria Ivanova, Maria Petrova

Office of Community Partnerships Posters

The Coasts and Communities IGERT (Integrative Graduate Education and Research Traineeship) Program starting in 2014 at the University of Massachusetts Boston provides PhD students with the skills to understand the interactions between natural and human systems and to develop appropriate policy solutions for urban and urbanizing environments. By emphasizing interdisciplinary collaboration and communication, this program aims to enable trainees to apply innovative and sustainable solutions across geographical, political, and economic contexts.

A Study On Generic Prescription Substitution Policy As A Cost Containment Approach For Michigan’S Medicaid System, Khandaker Nayeemul Islam

Dissertations

Increasing health care costs have made management of Medicaid services to provide low-income families through Medicaid programs critical in the recent times. The number of Medicaid beneficiaries in Michigan has increased over the years mainly due to the downsizing of auto sectors. Currently, states spend almost 16% of their budget for Medicaid, making it the second largest item in the budget for most (Kaiser Foundation, 2010). Prescription drugs are a significant part of Michigan’s Medicaid costs. Higher costs caused a tremendous fiscal burden on Michigan in administering the program and providing prescription drugs for its patients. Michigan has implemented several …

Women’S Municipal Leadership In Massachusetts: Snapshot Of Cape Cod, Center For Women In Politics And Public Policy, University Of Massachusetts Boston

Publications from the Center for Women in Politics and Public Policy

The center tracks the status of women at all levels of government in New England. It also provides dynamic web resources to inform and support the public leadership of women of color.

Financial Security Scorecard: A State-By-State Analysis Of Economic Pressures Facing Future Retirees, Christian Weller, Nari Rhee, Carolyn Arcand

Public Policy and Public Affairs Faculty Publication Series

As Americans increasingly worry about their retirement prospects, states play an important and growing role in retirement security policy. States already manage long-term care programs for the elderly through Medicaid. Concerned about the impact of future elder poverty on state and local budgets and their local economies, a number of states are exploring the creation of low-cost and low-risk retirement savings plans for private sector workers who lack access to pensions or 401(k)s on the job. Some states have developed programs to help older workers find work.

This report presents the Financial Security Scorecard, designed to inform state-level stakeholders and …