PubMed · 16379216
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Daniel W Varga. 2005. Conquering doubt.. https://pubmed.ncbi.nlm.nih.gov/16379216/
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Drawing upon the broader health, social, and political geography literature, this paper outlines a framework for considering place-based processes through which syringe exchange availability may be understood. It is argued that the geographic distribution of syringe exchange programs (SEPs) in the United States is linked to the social and political conditions of particular localities through three place characteristics: (1) structural constraints; (2) social and spatial distancing of injection drug users; and (3) localized action. Although SEPs remain controversial and face ongoing obstacles from the government, law enforcement and local communities, they continue to operate through the efforts of grassroots organizations and local activists. Action on this issue occurs locally, and the characteristics of place-based factors affect whether particular areas adopt SEPs.
More than three decades ago, the report A New Perspective on the Health of Canadians (1974) highlighted the significance of other determinants than the healthcare system. The adoption of healthy public policy was identified in the Ottawa Charter (1986) as one of five strategies aiming to promote health. It must now be acknowledged that even if we have a better understanding of health determinants, the latter are not necessarily taken into consideration when developing public policies. The purpose of this paper is to help foster a better understanding of the healthy public policies by presenting a conceptual framework that is inspired by the Advocacy Coalition Framework developed by Sabatier and Jenkins-Smith (1999). On the one hand, this paper intends to show the relevance of the notion of subsystem of public policies in healthy public policy process. On the other, it aims to convince that it is necessary to channel the analysis around the decision-making process, the prospective evaluation of public policies and the knowledge transfer and appropriation process. Finally, the purpose of this paper is to contribute to the ongoing debate about the role of knowledge, values or beliefs in the formulation and adoption of public policies. After briefly summarizing the theoretical developments in studies on public policies, the logic and components of the ACF are introduced. The main criticisms regarding the ACF are then examined, followed by an introduction of the conceptual framework that is adapted to the reality of healthy public policies. The notions of the subsystem of public policy(ies), of process and of learning process are central to this framework.
This discussion examines the use of litigation as a strategy to protect the public health. The history of tobacco litigation provides a model to evaluate potential litigation strategies against other industries that pose a threat to public health, particularly the food industry. This paper demonstrates that although legislation would be a preferable solution, lessons from the tobacco wars suggest that effective national legislation is unlikely at the present time. Based on the differences and similarities between the tobacco and food industries, it predicts the effectiveness of particular kinds of obesity litigation and the food industry's likely response. The tobacco industry has vigorously fought individual injury lawsuits and has had remarkable success in resisting such cases. The food industry is likely to successfully employ a similar "scorched earth" litigation strategy in individual injury cases. However, the tobacco industry did agree to the Master Settlement Agreement in the lawsuits brought by the state attorneys general because they were a unique kind of litigation with a finite number of plaintiffs. Likewise, state lawsuits under consumer protection acts may be a distinct type of litigation that permits cases to focus on deceptive advertisements while avoiding complicated causation issues. Such lawsuits have the potential to be a useful tool to fight obesity and enlist the efforts of the food industry in resisting the epidemic. Understanding the lessons of tobacco can save public health advocates much time and many resources and thus allow tobacco litigation to benefit public health in new ways.