Public Policy Commons^™

Addressing The Ethical, Legal, And Social Issues Raised By Voting By Persons With Dementia, Jason H. Karlawish, Richard J. Bonnie, Paul S. Appelbaum, Constantine Lyketsos, Bryan James, David Knopman, Christopher Patusky, Rosalie A. Kane, Pamela S. Karlan

Bryan G Kane MD

This article addresses an emerging policy problem in the United States participation in the electoral process by citizens with dementia. At present, health care professionals, family caregivers, and long-term care staff lack adequate guidance to decide whether individuals with dementia should be precluded from or assisted in casting a ballot. Voting by persons with dementia raises a series of important questions about the autonomy of individuals with dementia, the integrity of the electoral process, and the prevention of fraud. Three subsidiary issues warrant special attention: development of a method to assess capacity to vote; identification of appropriate kinds of assistance …

The Impact Of Disability: A Comparative Approach To Medical Resource Allocation In Public Health Emergencies, Katie Hanschke, Leslie E. Wolf, Wendy F. Hensel

Wendy F. Hensel

It is a matter of time before the next widespread pandemic or natural disaster hits the United States (U.S.). The international response to the 2009 H1N1 influenza stands as a cautionary tale about how prepared the world is for such an emergency. Although the pandemic fortunately proved to be less severe than initially anticipated, it nevertheless resulted in shortages of medical equipment, overburdened hospitals, and preventable patient deaths, particularly among young people.

A pandemic will inevitably lead to difficult decisions about the allocation of medical resources, such as who will have priority access to ventilators and critical care beds when …

The Impact Of Disability: A Comparative Approach To Medical Resource Allocation In Public Health Emergencies, Katie Hanschke, Leslie E. Wolf, Wendy F. Hensel

Leslie E. Wolf

It is a matter of time before the next widespread pandemic or natural disaster hits the United States (U.S.). The international response to the 2009 H1N1 influenza stands as a cautionary tale about how prepared the world is for such an emergency. Although the pandemic fortunately proved to be less severe than initially anticipated, it nevertheless resulted in shortages of medical equipment, overburdened hospitals, and preventable patient deaths, particularly among young people.

A pandemic will inevitably lead to difficult decisions about the allocation of medical resources, such as who will have priority access to ventilators and critical care beds when …

The Harmful, Nontherapeutic Use Of Animals In Research Is Morally Wrong, Nathan Nobis

Nathan M. Nobis, PhD

It is argued that using animals in research is morally wrong when the research is nontherapeutic and harmful to the animals. This article discusses methods of moral reasoning and discusses how arguments on this and other bioethical issues might be defended and critiqued. A basic method of moral argument analysis is presented and used to show that common objections to the view that “animal research is morally wrong” fail: ie, common arguments for the view that “animal research is morally permissible” are demonstrably unsound or in need of defense. It is argued that the best explanations why harmful, nontherapeutic research …

The Evolution Of The National Health Security Preparedness Index, Glen P. Mays, Anna G. Hoover, Michael T. Childress

Anna G. Hoover

No abstract provided.

Public Act 231 Of 2008: Proposed Policy Reform To Address The Ever-Increasing Obesity Rates In Michigan, Rachele M. Hendricks-Sturrup

Rachele M Hendricks-Sturrup

In order to address the growing problem of obesity in the state of Michigan, Michigan implemented Public Act 231 of 2008 (Senate Bill 294, Amendment to the Commercial Rehabilitation Act) (hereinafter referred to as “Public Act 231”). Public Act 231 introduces a property tax incentive that seeks to increase access to affordable, healthful foods in rural and low-income urban areas (S. 294, 2008). Given recent facts stating that obesity rates in Michigan have steadily increased between years 2008-2013, it is apparent that the tax incentive under Public Act 231 has had very little impact in effectively tackling the obesity problem …

Addressing The Ethical, Legal, And Social Issues Raised By Voting By Persons With Dementia, Jason H. Karlawish, Richard J. Bonnie, Paul S. Appelbaum, Constantine Lyketsos, Bryan James, David Knopman, Christopher Patusky, Rosalie A. Kane, Pamela S. Karlan

Jason Karlawish

This article addresses an emerging policy problem in the United States participation in the electoral process by citizens with dementia. At present, health care professionals, family caregivers, and long-term care staff lack adequate guidance to decide whether individuals with dementia should be precluded from or assisted in casting a ballot. Voting by persons with dementia raises a series of important questions about the autonomy of individuals with dementia, the integrity of the electoral process, and the prevention of fraud. Three subsidiary issues warrant special attention: development of a method to assess capacity to vote; identification of appropriate kinds of assistance …

Research Translation: Informing Evidence-Based Policies, Anna G. Hoover

Anna G. Hoover

This presentation describes the need for evidence-based policy, outlines strategies for researchers and communities to inform various policy stages, and provides a case study example of research generated specifically to inform policy implementation.

Mentally Ill Persons In Emergency And Specialized Shelters: Satisfaction And Distress, Russell K. Schutt, Stephen M. Goldfinger

Russell K. Schutt

Emergency and specialized mental health shelters represent different service philosophies and are meant to appeal to different segments of the homeless and homeless mentally ill population. This article describes the different characteristics and needs of users of emergency and specialized mental health shelters for homeless persons in Boston. Service satisfaction is described in relation to these characteristics and needs as well as in terms of shelter type. Implications are identified for social and mental health service policies for the homeless.

Sexual Rights For Marginalized Populations, Louis Graham, Mark Padilla

Louis F Graham

Governance And Transparency At Pepfar, Matthew Kavanagh, Brook Baker

Matthew M. Kavanagh

The US President's Emergency Plan for AIDS Relief (PEPFAR) has been one of the most effective foreign aid programmes in history. It reached 6·7 million people with antiretroviral therapy in 2013, and has also strengthened country health systems, provided billions of dollars in aid to biomedical and behavioural prevention programmes, and helped to drive declines in morbidity and mortality in many countries in sub-Saharan Africa. PEPFAR began as an emergency response, after relative inaction by wealthy nations, and rapidly built disease-response capacity by funding non-governmental organisations.

The Politics Of Transition & The Economics Of Hiv: Aids & Pepfar In South Africa, Matthew M. Kavanagh

Matthew M. Kavanagh

AIDS poses a unique and unprecedented challenge to South Africa. The country has the largest HIV epidemic in the world—with 6.4 million people living with HIV—and one of the largest TB epidemics in the world as well. The country’s recent AIDS response has generated enormous optimism, both in South Africa and internationally. The biggest change, in many ways, has been political—dramatic shifts in ideology and motivation at the highest levels of government have moved the country from denialism and inaction to a bold national mobilization to bring anti-retroviral treatment to scale. Meanwhile, the approach of the U.S. government has evolved …

Governance And Transparency At Pepfar, Matthew M. Kavanagh, Brook K. Baker

Brook K. Baker

The US President's Emergency Plan for AIDS Relief (PEPFAR) has been one of the most effective foreign aid programmes in history. It reached 6·7 million people with antiretroviral therapy in 2013, and has also strengthened country health systems, provided billions of dollars in aid to biomedical and behavioural prevention programmes, and helped to drive declines in morbidity and mortality in many countries in sub-Saharan Africa. PEPFAR began as an emergency response, after relative inaction by wealthy nations, and rapidly built disease-response capacity by funding non-governmental organisations.

Emergency Preparedness And Public Health: The Lessons Of Hurricane Sandy, Tia Powell, Dan Hanfling, Lawrence O. Gostin

Dan Hanfling, M.D.

When Hurricane Sandy hit downtown Manhattan, three neighboring hospitals each made different decisions about when to evacuate. Across the metro region, more than five hospitals and over 20 nursing and assisted living facilities were evacuated, making this the central public health challenge of this calamitous event. It is a familiar story—a super storm comes ashore, infrastructure is overwhelmed, and healthcare facilities evacuate patients, with major delays in returning to normal functioning. Afterwards, policy makers evaluate lessons learned for the next disaster, but similar missteps are often repeated. Although not identical, it is instructive to compare Hurricane Katrina with the still …

Spillovers Of Veterans Hospice Care: The Economic And Social Impact Of Palliative Care, Maximiliano Mendieta, Bruce D. Mcdonald Iii

Bruce D. McDonald, III

In exchange for military service in the United States, soldiers are promised a benefits package inclusive of health and education after the completion of their service. While the economic effects of the defense-growth relationship are well known, this study takes a unique approach to understanding the relationship between veterans and society by investigating the social and economic spillovers of veterans hospice care. This study shows that as an early adopter of hospice care, the U.S. Department of Veterans Affairs maximized its efficiency through sponsoring innovative research on geriatric care, introducing competition into the health sector, and legitimizing death and dying …

Nonpunctuated And Sweeping Policy Change: Bhutan Tobacco Policy Making From 1991 To 2009, Michael S. Givel

Michael S. Givel

This paper examines policy outputs associated with the 2004 Bhutan antitobacco law, including 2009 amendments, to determine if the law is congruent with punctuated equilibrium or social policy realism theories of policy change. There was no direct and sudden tobacco policy output change in Bhutan due to a shock to the policy system contrary to what punctuated equilibrium theory would predict. Rather, policy change was sweeping but nonpunctuated. This paper reconfirms prior findings of social policy realism theory that various and complex policy output patterns occur due to a mixture of contingent and complex factors. Under social policy realism, a …

Bureaucratic Advocacy And Ethics A State-Level Case Of Public Agency Rulemaking And Tobacco Control Policy, Michael S. Givel, Andrew Spivak

Michael S. Givel

Before 2001, the Oklahoma Department of Health achieved little to protect the public from the dangers of secondhand tobacco smoke. In an ongoing effort between 2000 and 2003, the department joined with health groups to lobby for stronger requirements, resulting in a new Oklahoma administrative rule in 2002 and legislation in 2003 regulating secondhand tobacco smoke. This action was congruent with the American Society of Public Administration's Code of Ethics for interactive democratic policymaking, in which administrators are required to serve the public interest with compassion, benevolence, fairness, and optimism.

What Is A Reasonable Compromise On Health Care Reform?, Peter Dreier

Peter Dreier

No abstract provided.

Progress Delayed: State Of Tobacco Control Policymaking In Oklahoma From 2005-2011, Michael Givel, Ami Stearns, Andrew Spivak

Michael S. Givel

EXECUTIVE SUMMARY • Oklahoma’s 1987 Smoking In Public Places Act required the inclusion of smoking sections in restaurants and pre-empted more stringent local anti-tobacco laws with state regulations. • With the 2001 arrival of an aggressive new Commissioner of Health, Dr. Leslie Beitsch, the tide turned with new legislation (Senate Joint Resolution 21 in 2003) that prohibited smoking inside public places and restaurants were allowed to build separately-ventilated “smoking rooms.” • In 2004, State Question 713 increased the cigarette tax by 80 cents per package. • Dr. Beitsch resigned in 2003 and since that time, efforts toward clean air have …

In Search Of The Less Hazardous Cigarette, Michael Givel

Michael S. Givel

Since the 1950s, despite considerable and long-term tobacco industry and government efforts, attempts to develop a less risky cigarette that reduces harmful ingredients, generally or specifically, have failed. Moreover, even under ideal conditions with adequate scientific testing, the efficacy of purportedly reducing the severe health effects cannot be scientifically verified for up to 20 years after the introduction of a product on the market. A key and central provision in the 2009 U.S. Food and Drug Administration (FDA) legislation is to reduce the risk or harm of cigarettes. Because creating a less risky cigarette is not currently possible, this renders …

Deconstructing Social Constructionist Theory In Tobacco Policy: The Case Of The Less Hazardous Cigarette, Michael Givel

Michael S. Givel

Scholars in tobacco control have utilized a social construction approach to test and explain tobacco control policy and advocacy. Some recent tobacco control policy research has contended that Philip Morris's support of the U.S. Food and Drug Administration (FDA) regulation of tobacco (including purportedly reducing the harm of cigarettes) is to obtain the social construction goal of a socially responsible company. However, the primary motivation for Philip Morris's support of proposed FDA regulation and harm reduction for cigarettes was to maintain the company's market stability and profitability implemented by U.S. political process and institutions. In tandem with this, Philip Morris …

Archetypal Energies, "Psychic Politics", And The Transformative Potential Of The Health Care Debate, Carroy U. Ferguson

Carroy U "Cuf" Ferguson, Ph.D.

In a previous message, I spoke of “Archetypal Energies, The Emergence of Obama As A Practical Idealist, and Global Transformation” (February/March 2009). I suggested that at issue is what I called “psychic politics for global transformation, nurtured by practical idealism and the Archetypal Energies.” To reiterate, I have described Archetypal Energies as Higher Vibrational Energies, operating deep within our individual and collective psyches, which have their own transcendent value, purpose, quality, and “voice” unique to the individual. We experience them as “creative urges” to move us toward our Highest Good or Optimal Realities. I use easily recognized terms to evoke …

The Evolution Of The Theoretical Foundations Of Punctuated Equilibrium Theory In Public Policy, Michael S. Givel

Michael S. Givel

Punctuated equilibrium theory in public policy replicated from biological punctuated equilibrium theory has concluded that public policies alternate between stasis and punctuation. However, recent research on Pacific Northwest forest policy, U.S. state tobacco policy, and U.S federal auto efficiency policy have found no punctuations despite an attempt to do so. What is the efficacy of using biological punctuated equilibrium theory to also explain punctuated equilibrium in public policy? Significant differences exist between biological and public policy punctuated equilibrium theory including time frames for change, what constitutes outside disturbances of equilibrium, venues of punctuated equilibrium, levels of analysis for change, and …

Tobacco Use Policymaking And Administration In Bhutan, Michael S. Givel

Michael S. Givel

No abstract provided.

The Mirror Effect, The Law Of Attraction, And "Points Of Attraction" That Can Nurture The Evolution Of Human Consciousness, Carroy U. Ferguson

Carroy U "Cuf" Ferguson, Ph.D.

This message has several purposes. First, I want to express my immense joy that Chip Baggett and I are serving as Co-Presidents of AHP since August 16, 2009. In my view, Chip and I are long-time friends, who have a transcendent connection and synergistic energies. My desire and intent is for our co-presidency to mirror the effect(s) of synergistic collaboration as a “point of attraction” that can assist in the evolution of human consciousness across often “perceived personal and societal boundaries” (e.g., race, culture, ethnicity, class, individual and collective belief systems, and dogma). More generally, however, this message is intended …

Social Policy, Imperiled Communities, And Hiv/Aids Transmission In Prisons: A Call For Zero Tolerance, Louis F. Graham, Henrie Treadwell, Kisha Braithwaite

Louis F Graham

HIV/AIDS and African-American male imprisonment contribute to the destruction of African-American communities. African-American men and HIV/AIDS are disproportionately represented throughout all sectors of the criminal justice industry, including the juvenile justice system. The criminal justice system contributes to unacceptably high African-American male imprisonment rates and HIV prevalence directly via the ‘war on drugs’ and lax enforcement of institutional policy among other things, and indirectly through perpetuation of economic hardship which further exacerbates imprisonment rates, thus closing the loop of a vicious cycle of revolving prison doors and HIV contraction. This article briefly introduces surrounding socio-political issues that contextualizes the ensuing …

Neoliberal And Public Health Impact Of Not Adopting Osha’S Proposed National Secondhand Tobacco Smoke Rule, Michael Givel

Michael S. Givel

From the early 1980s to the present, neo-liberal doctrine has called for governmental policies of privatization, funding cutbacks, and deregulation of public health and other domestic social programs in the belief that the market can best organize and distribute crucial societal services rather than the public sector. Proponents of a neoliberal and deregulatory mixed approach of command and control and self-regulation argue this approach provides the most adequate means to conduct regulation in the legalistic and adversarial United States regulatory process. In April 1994, the Occupational Safety and Health Administration issued a proposed rule to eliminate tobacco smoking in most …

Mental Health Care In Rural Communities: The Once And Future Role Of Primary Care., David Lambert

David Lambert

The provision of mental healthcare in rural communities has been a vexing challenge for clinicians and patients for many years. There is a chronic shortage of specialty mental health providers, particularly psychiatrists and sychologists, which has shifted much of the burden of care to primary care. Primary care clinicians have historically lacked the training and time within their busy practices to feel comfortable providing mental healthcare, particularly since the shortage of specialty mental health clinicians deprives them of consultation and referral sources.

Calamity, Catastrophe, And Horror: Representation Of Natural Disaster, 1885-2005, Richard Steven Salkowe, Graham A. Tobin, S Elizabeth Bird

Richard Steven Salkowe

An examination of disaster literature from the late 19th and early 20th centuries revealed social, political, and economic vulnerability issues that parallel many current concerns. A modern model of comprehensive emergency management was used to comparatively address selected issues of vulnerability found in these texts; looking specifically at emergency response and initial recovery, perception, and attitudes towards different groups. Emergency response has made significant advances with the development of more sophisticated intervention protocols and the involvement of a vast array of governmental and non-governmental organizations. However, disasters remain deterministic and/or probabilistic in the eyes of many and recovery inevitably incorporates …

Punctuated Equilibrium In Limbo: The Tobacco Lobby And U.S. State Policy Making From 1990 To 2003, Michael S. Givel

Michael S. Givel

Since the mid-1980s, U.S. tobacco policy has been an intense and acrimonious issue between antitobacco advocates and the tobacco industry. In the United States, the tobacco industry has responded to heightened state antitobacco litigation, adverse public opinion, and public health advocacy by aggressively mobilizing against tobacco taxes and regulations. This article examines whether these tobacco policy trends can be generalized to punctuated equilibrium theory ideas that policy monopolies are stable over long periods and usually change because of sharp and short-term exogenous shocks to the policy system. From 1990 to 2003, there was a sharp mobilization by health advocates in …