Health Policy Commons^™

Happiness In Communities: How Neighborhoods, Cities And States Use Subjective Well-Being Metrics, Laura Musikanski, Carl Polley, Scott Cloutier, Erica Berejnoi, Julia Colbert

Journal of Sustainable Social Impact

This essay, the fourth and last of a series published by the Journal of Social Change, is intended as a tool for community organizers, local policy makers, researchers, students and others to incorporate subjective well-being indicators into their measurements and management of happiness and well-being in their communities, for policy purposes, for research and for other purposes. It provides case studies of community-based efforts in five different regions (São Paulo, Brazil; Bristol, United Kingdom; Melbourne, Australia; Creston, British Columbia, Canada; and Vermont, United States) that either developed their own subjective well-being index or used the Happiness Alliance’s survey instrument …

A Better Calculus For Regulators: From Cost-Benefit Analysis To The Social Welfare Function, Matthew D. Adler

Faculty Scholarship

The “social welfare function” (SWF) is a powerful tool that originates in theoretical welfare economics and has wide application in economic scholarship, for example in optimal tax theory and environmental economics. This Article provides a comprehensive introduction to the SWF framework. It then shows how the SWF framework can be used as the basis for regulatory policy analysis, and why it improves upon cost-benefit analysis (CBA).

Two types of SWFs are especially plausible: the utilitarian SWF, which sums individual well-being numbers, and the prioritarian SWF, which gives extra weight to the well-being of the worse off. Either one of these …

Changing The Tax Code To Create Consumer-Driven Health Insurance Competition, Regina Herzlinger, Barak D. Richman

Faculty Scholarship

Because current tax laws exclude employer-paid health insurance premiums from employees’ taxable wages and income, employer-sponsored insurance remains the primary source of health insurance for most employed Americans. Economists have long blamed the employer-based insurance tax exclusion for inflating health care costs, and, more recently, for constraining income growth and exacerbating income inequality.

We execute a simulation to test the effect of permitting employees to receive their employers’ premium contribution directly and then purchase health insurance themselves, using tax-free funds. Employees could deduct for income tax purposes the amount used for insurance and, if they spend less than the amount …

N.C. Medicaid Reform: A Bipartisan Path Forward, Barak D. Richman, Allison Rice

Faculty Scholarship

The North Carolina Medicaid program currently constitutes 32% of the state budget and provides insurance coverage to 18% of the state’s population. At the same time, 13% of North Carolinians remain uninsured, and even among the insured, significant health disparities persist across income, geography, education, and race.

The Duke University Bass Connections Medicaid Reform project gathered to consider how North Carolina could use its limited Medicaid dollars more effectively to reduce the incidence of poor health, improve access to healthcare, and reduce budgetary pressures on the state’s taxpayers.

This report is submitted to North Carolina’s policymakers and citizens. It assesses …

The Indirect Consequences Of Expanded Off-Label Promotion, Patricia J. Zettler

Faculty Publications By Year

The U.S. Food and Drug Administration’s (FDA) policies have been a battleground for litigation about First Amendment protections for commercial speech. In the last five years, the FDA’s position that “off-label” promotion of approved prescription drugs—when a manufacturer promotes a drug for a use for which the FDA has not approved it—leads to violations of the Federal Food, Drug, and Cosmetic Act has been subject to successful legal challenges. Although the merits of these off-label promotion decisions are well traversed in the literature, this Article explores the potential indirect consequences of recently-recognized protections for off-label promotion. This Article demonstrates that—as …

Adolescent Health: Priorities And Opportunities For Rashtriya Kishor Swasthya Karyakram (Rksk) In Uttar Pradesh [Hindi], Sapna Desai

Poverty, Gender, and Youth

The Government of India in 2014 signaled its commitment to adolescent health through introduction of a national strategy, Rashtriya Kishor Swasthya Karyakram (RKSK). Targeting adolescents aged 10–14 and 15–19, the program aims to ensure universal coverage of health information and services for all adolescents—those in and out of school, married or unmarried, and in vulnerable groups. Envisaged as a paradigm shift to address adolescent health beyond sexual and reproductive health, RKSK spans six domains: nutrition, sexual and reproductive health, mental health, injuries and violence including gender-based violence, substance misuse, and non-communicable diseases. This policy brief presents evidence on adolescent health …

Local Health Department Adoption Of Health Information Technology And Its Impact On Population Health, Tina Yeung

Electronic Theses and Dissertations

Since the enactment of the HITECH Act in 2009, the US has invested billions in building a robust health information technology (HIT) infrastructure that is secure, capable of the electronic transfer of data and allows for real-time access of patient medical data, among others. This empirical study explored the driving forces (coercive, mimetic, and normative) in the adoption of HIT (i.e. EHRs and HIEs) by local health departments (LHDs) and how it has impacted the population health of counties in the US. The researcher conducted a cross-sectional, quantitative study using secondary data sources. The study included data on 505 local …

Determinants Of Hospital Efficiency And Patient Safety In The United States, Madhu Shettian

Electronic Theses and Dissertations

Hospitals engage in undertakings on a continual basis to enhance IT capabilities, diffusion of innovations, hospital-physician integration, and standardization to improve their performance. This empirical study explored the interdependence of three macro-level structural factors and their independent impact on the hospital performance measures efficiency and patient safety, with standardization as an important mediator. The researcher conducted a cross-sectional analysis of multiple data sets from public user files on the acute care hospital industry. The theoretical underpinnings of the study included the structure-process-outcome theory and institutional isomorphism theory. The statistical analysis comprised confirmatory factor analysis (CFA) and covariance structural equation modeling …

Jail Mental Health Innovations: Factors Influencing Mental Health Services Innovations For Jails, Orville Clayton

Electronic Theses and Dissertations

The U.S. is recognized for uniquely high incarceration rates. Over recent decades, there has been a concurrent dramatic increase of jail detainees with mental disorders. Provision of adequate mental health services for jail inmates is constitutionally mandated, and has legal, ethical, quality of care, and fiscal implications for jails, families, communities, and detainees. Significant variation exists in the provision of mental health services across jails, and increased understanding of the factors that influence the adoption of such services may help guide jails to implement beneficial services, and ensure that such services reflect, reflect quality standards. This study used a mixed …

Adolescent Health: Priorities And Opportunities For Rashtriya Kishor Swasthya Karyakram (Rksk) In Uttar Pradesh, Sapna Desai

Poverty, Gender, and Youth

The Government of India in 2014 signaled its commitment to adolescent health through introduction of a national strategy, Rashtriya Kishor Swasthya Karyakram (RKSK). Targeting adolescents aged 10–14 and 15–19, the program aims to ensure universal coverage of health information and services for all adolescents—those in and out of school, married or unmarried, and in vulnerable groups. Envisaged as a paradigm shift to address adolescent health beyond sexual and reproductive health, RKSK spans six domains: nutrition, sexual and reproductive health, mental health, injuries and violence including gender-based violence, substance misuse, and non-communicable diseases. This policy brief presents evidence on adolescent health …

Compte Rendu De La Réunion Régionale Des Comités De Plaidoyer Pour Avortement Médicalisé, Fatou Mbow

Reproductive Health

En partenariat avec le Ministère de la Santé et de l'Action Sociale, particulièrement la Direction de la santé de la reproduction et de la survie de l’enfant et le comité national de plaidoyer pour l’accès à l’avortement médicalisé (Taskforce), le bureau du Population Council du Sénégal a organisé une réunion régionale des comités/associations de plaidoyer pour avortement médicalisé de l’Afrique de l’ouest francophone. La réunion a eu lieu le 24 octobre 2017 à Dakar, Sénégal. Elle avait pour but de discuter des avancées notées dans l’accès à l’avortement médicalisé et mettre en exergue les efforts des pays de la région …

Partnering With The Private Sector To Strengthen Provision Of Contraception, Karen Hardee, David Wofford, Nandita Thatte

Reproductive Health

Family planning is most successful when clients have a variety of methods to choose from and a variety of service delivery sites from which to obtain them. The private sector plays a critical role in family planning and can contribute to a total market approach to providing contraceptives. Among private sector service options, social marketing, social franchising, and pharmacies and drug shops most readily contribute to sustainable markets for contraceptive services. Corporate sector workplace programs also show promise for reaching millions of women. This evidence brief outlines a number of policy and program considerations for countries as they move toward …

Assessment Of The Use Of Overdose Education And Naloxone Distribution By Maine Buprenorphine/Naloxone Prescribers, Stephen Kirsch

Muskie School Capstones and Dissertations

Background: Overdose deaths, specifically related to opioids, have been identified as a public health problem both nationally and in the state of Maine. Overdose Education and Naloxone Distribution (OEND) is an innovative model of patient education that has been shown to be effective in increasing knowledge of overdose risk and has the potential to help reduce opiate related overdose deaths.

Methods: A 28-item web-based survey examining clinician attitudes, OEND practices and characteristics was distributed to 196 Maine based physicians with a Drug Enforcement Agency waiver to prescribe burprenorphine/naloxone. Facilitators and barriers to the provision of OEND were also assessed. Surveys …

Cairing4carlisle: A Community Health Needs Assessment, Caitlin Coyle

Center for Social and Demographic Research on Aging Publications

Caring4Carlisle (C4C) is a community initiative aimed at addressing the social, emotional, spiritual and physical health of Carlisle residents. Community Health Network Areas (CHNAs) were created by the Massachusetts Department of Public Health in 1992. There are 27 CHNAs in the Commonwealth, and Carlisle belongs to CHNA 15. In July of 2016, Carlisle was awarded a planning grant ($20,000) from CHNA 15 to engage in a community needs assessment process with the intention of identifying priority community health needs to be addressed in Carlisle.

The Carlisle Board of Health served as the lead Town Department with the Gleason Public Library, …

The Role Of Neighborhood Characteristics In Late Stage Melanoma Diagnosis Among Hispanic Men In California, Texas, And Florida, 1996-2012, Valerie M. Harvey, Clinton W. Enos, Jarvis T. Chen, Hadiza Galadima, Karl Eschbach

Community & Environmental Health Faculty Publications

Background. Hispanics diagnosed with cutaneous melanoma are more likely to present at advanced stages but the reasons for this are unknown. We identify census tracts at high risk for late stage melanoma diagnosis (LSMD) and examine the contextual predictors of LSMD in California, Texas, and Florida. Methods. We conducted a cross-sectional study using geocoded state cancer registry data. Using hierarchical multilevel logistic regression models we estimated ORs and 95% confidence intervals for the impact of socioeconomic, Hispanic ethnic concentration, index of dissimilarity, and health resource availability measures on LSMD. Results. We identified 12,493 cases. In California, late …

Poison In Pink, Sydney V. Cook

Graduate Student Theses, Dissertations, & Professional Papers

Humans slather, spray, mist, and cleanse their bodies with personal care products like lotion, hairspray, cologne, and shampoo every day. Our cupboards are stocked full of them, but few of us understand what is in those jars and bottles. We trust that if it’s on the shelf at the store, it’s safe. However, this is not always the case, and many personal care products contain chemicals that are harmful to human and environmental health.

My multi-disciplinary Environmental Studies thesis project combines evidenced-based research, interviews, nonfiction narrative, and science communication to create part of a book manuscript intended to educate general …

Assessment Of The Current Reporting Requirements Of The Kentucky Immunization Registry, Lindsey Lewis

MPA/MPP/MPFM Capstone Projects

Immunizations are essential to societal health and wellbeing. Throughout one’s lifespan, immunizations are to be administered incrementally to decrease the prevalence of preventable diseases. Despite this, there are disparities in the rates of vaccinations across the country. Numerous guidelines and regulations have been published regarding the administration and scheduling of vaccines. Certain vaccinations are mandatory in order to be able to attend school or hold certain occupational positions and normally proof of administration is required.

Immunization registries were created to monitor and record patient-specific data about administered vaccines. These confidential reporting systems were developed to improve population health by allowing …

Comparative Storage And Utilization Analysis Of Insulin Across Inpatient Hospital Settings, Tristan A. Moorman

MPA/MPP/MPFM Capstone Projects

Insulin is the primary medication used by health systems across the nation to provide glucose control to those patients who need it. As this medication is generally available in a multi-dose vial, proper administration techniques should be used to minimize waste and optimize the cost effectiveness of the drug. Even though dosing guidelines for hospital use of insulin exist each institution has the opportunity to choose their administration technique. In this paper I will to identify administration characteristics utilized by four different hospitals in the central Kentucky area, compare and contrast those techniques through data collection, and analyze the findings …

Underutilization Of Federal Benefits In Oregon: Programs And Strategies, Raúl Preciado Mendez

National Policy Consensus Center Publications

The report results demonstrate the dependence low-income Oregon families have on the six federal programs and the challenges families face when attempting to access federal resources. The barriers to access are often structural in that they are embedded in the procedures and structure of the program. Based on its analysis, the report presents a series of reforms and support activities that Oregon state agencies and nonprofits could adopt to improve family access for each program.

Racial And Ethnic Differences In Receipt Of Immediate Breast Reconstruction Surgery: Do Hospital Characteristics Matter?, Jaya Shankar Khushalani

Theses and Dissertations

Immediate Breast Reconstruction Surgery (IBRS) is associated with better quality of life among women who undergo a mastectomy. Despite insurance coverage for IBRS, utilization of IBRS remains low. Data from publicly available sources for 2010-2012 are used to examine the association between hospital characteristics receipt of IBRS by patients. Minority-serving status, low bed size, for-profit ownership, non-teaching status, high competition, low density of plastic surgeons in the market and non-metropolitan location are associated with lower likelihood of receipt of IBRS.

Racial and ethnic minorities are less likely to receive IBRS. A mixed effects logistic regression model with interactions between Black/Hispanic …