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PubMed1988

Socio-economic and demographic characteristics of national sport administrators.

Data gathered from a larger study of policy making in selected national sport organizations afforded an opportunity to examine certain key characteristics that sport administrators bring to their jobs. These people were characterized as male anglophones in their mid- to late thirties, who had six years of full-time job experience. Almost 40% came from low socio-economic status (SES) backgrounds. About half stated they were bilingual; most of the rest spoke only English. About half of these sport administrators had completed their secondary school education in Ontario; they typically held a university degree in physical education or a related field. These data are discussed in light of their implications for policy making in national sport organizations related to three current issues in sport, namely, the under-representation of females, francophones, and people from low-SES backgrounds.

Administrative Personnel↗
PubMed2005

Navigating tissue banking regulation: conceptual frameworks for researchers, administrators, regulators and policy-makers.

In the "post-genomic" age of biomedical research, researchers often wish to utilise collections of human tissue. This type of research raises many ethical and legal issues and anyone wishing to use such collections is faced with an enormously complex set of regulatory requirements, many of which are still ambiguous, reflecting ongoing ethical and legal debate. Whilst there is no way of entirely avoiding such regulatory complexity and ambiguity, conceptual frameworks can assist those who wish to use, administer, authorise and generate policy on tissue banking research. Two conceptual frameworks are described here: a taxonomy of tissue banking practices, aimed at assisting those who need to ensure that tissue banks meet ethical and legal requirements; and a "syncretic" approach to policy-making, for those who wish to generate new policy, or streamline existing policy relating to tissue banking research.

Australia↗
PubMed2001

Cost-benefit analysis of road safety measures: applicability and controversies.

This paper discusses the applicability of cost-benefit analysis as an aid to policy making for road safety measures. A framework for assessing the applicability of cost-benefit analysis is developed. Five main types of criticism of cost-benefit analysis are identified: 1. rejecting the basic principles of cost-benefit analysis as not applicable to road safety, 2. excluding some types of issues from the scope of calculation of costs and benefits, 3. setting policy objectives that are not amenable to cost-benefit analysis, 4. rejecting the need for maintaining a separation between policy objectives and policy programmes as required for cost-benefit analysis, and 5. rejecting, or denying the possibility of ever obtaining, acceptably valid and reliable economic valuations of the consequences of alternative policy programmes. It is concluded that rejecting the basic principles of cost-benefit analysis is a difficult position to defend, since these principles are simply a re-statement in economic terms of very general principles of rational choice. These principles are part of the normative basis of all formal techniques designed to aid policy making as well as the democratic system of government. Everybody, including those who advocate the use of cost-benefit analysis, agree that some issues are unsuitable for cost-benefit analysis, in particular those that involve basic human rights and fairness in distribution. There may, however, be disagreement with respect to the perception of a specific policy issue in terms of whether it is mainly about rights and fairness or mainly about the effective use of policy instruments to solve a social problem. Politicians may be tempted to set policy objectives that are ill suited for cost-benefit analysis, but this does not imply that cost-benefit analysis makes unreasonable assumptions. Perhaps the most important issue for the applicability of cost-benefit analysis is whether people in general have sufficiently well ordered preferences for economic valuations based on these preferences to make sense.

Accidents, Traffic↗
PubMed1982

The use of prescribed medication in the schools: a status report on the state policies and guidelines.

The increased use of medication in school systems and the broadened responsibility of educators for the medical/health related needs of students have created a number of concerns. Examples of issues facing school personnel include liability risks, designation of persons to administer medication and drug management procedures to safeguard students receiving drugs during the school day. A review of the literature indicates a paucity of legal documents and policies regarding the use of medication in schools. This study investigates existing state laws, regulations, attorneys general opinions and guidelines concerning the management of medication in the school system. The results show that: (a) the majority of states do not have legislation, regulations or other directives with force of law; (b) major policy statements found most often in legal documents were designated persons permitted to administer drugs, physician's approval, parent's authorization and liability; and (c) many states have apparently deferred policy making to the schools, and have developed state department guidelines to assist local school officials. The major policy and guideline statements may be considered as recommendations for adoption by states wanting to establish responsibility for policy making at the state and local school level.

Drug Prescriptions↗
PubMed2005

Termination of the leprosy isolation policy in the US and Japan : Science, policy changes, and the garbage can model.

BACKGROUND: In both the US and Japan, the patient isolation policy for leprosy /Hansen's disease (HD) was preserved along with the isolation facilities, long after it had been proven to be scientifically unnecessary. This delayed policy termination caused a deprivation of civil liberties of the involuntarily confined patients, the fostering of social stigmas attached to the disease, and an inefficient use of health resources. This article seeks to elucidate the political process which hindered timely policy changes congruent with scientific advances. METHODS: Examination of historical materials, supplemented by personal interviews. The role that science played in the process of policy making was scrutinized with particular reference to the Garbage Can model. RESULTS: From the vantage of history, science remained instrumental in all period in the sense that it was not the primary objective for which policy change was discussed or intended, nor was it the principal driving force for policy change. When the argument arose, scientific arguments were employed to justify the patient isolation policy. However, in the early post-WWII period, issues were foregrounded and agendas were set as the inadvertent result of administrative reforms. Subsequently, scientific developments were more or less ignored due to concern about adverse policy outcomes. Finally, in the 1980s and 1990s, scientific arguments were used instrumentally to argue against isolation and for the termination of residential care. CONCLUSION: Contrary to public expectations, health policy is not always rational and scientifically justified. In the process of policy making, the role of science can be limited and instrumental. Policy change may require the opening of policy windows, as a result of convergence of the problem, policy, and political streams, by effective exercise of leadership. Scientists and policymakers should be attentive enough to the political context of policies.

Journal Article↗
PubMed1980

Health policy and religion: conflict and accommodation in Israeli politics.

The paper focuses on the impact of religious values and organizations on two issues of health policy, abortion and autopsy, both of which have been subjects of deep controversy between religious and nonreligious groups. The comparison between the issues centers on three stages of policy making: problem formation, problem solving and decision making. Two models of influence on public policy are employed: (1) one in which political parties attempt to suppress issues, and (2) a group model which applies to a well articulated, controversial issue which is resolved by groups with direct access to decision makers. The party model is relevant to the abortion issue, which was submerged beneath the surface of the public agenda due to national-religious value orientations. The group model fits the autopsy issue, which has been a subject of controversy between the Medical Association and religious groups. Decision making on these issues was characterized by a pattern of compromise and accommodation which resulted in only slight deviations from norms of behavior previously practiced. The decisions made reflected the intricacies of the Israeli political system, and the salience of religious values in health policy making.

Abortion, Induced↗
PubMed2006

Relationships between community characteristics and municipal smoke-free bylaw status and strength.

BACKGROUND: Municipal smoke-free spaces bylaws are a common population-level intervention to address the prominent health risks associated with exposure to second-hand smoke. In Canada, bylaw prevalence is increasing, but inequities in level of protection across communities remain as bylaws vary from place to place. Little is known about the role of place in this policy disparity. To address this gap, this study examined associations between community characteristics and municipal smoke-free spaces policy outcomes to elucidate how ecological conditions are associated with bylaw status and strength. METHOD: Smoke-free public place and workplace bylaws were obtained from all municipalities with a population of >or=5000 in the provinces of Alberta (N=78) and Ontario (N=245), Canada. Bylaws were assigned a strength score (ranging 0-100) rating the degree of bylaw comprehensiveness, restrictiveness and enforcement provisions. These data were then linked to socio-demographic data from the Canadian Census (1996) and the Canadian Community Health Survey Cycle 1.1 (2000/2001). Logistic and multiple linear regression analyses were used to develop models for municipal bylaw status and strength using community factors including: socio-demographics, municipality type, health region smoking rates, and provincial tobacco control environment. CONCLUSIONS: Study findings suggest that community characteristics play a key role in the status and strength of municipal smoke-free bylaws. As smoking bans continue to emerge world-wide under the Framework Convention on Tobacco Control, knowledge about conditions that promote policy success will be critical for those in need of immediate information to maximize policy-making in their own settings. Use of community profiles that consider socio-demographics along with broader contextual factors can aid decision-makers, public health advocates, and researchers in identifying similar jurisdictions with a successful smoke-free spaces policy and communicating with them about their policy-making experiences. Knowledge about the conditions associated with municipal policy-development may be translated to other jurisdictions where information is sparse, or evidence is newly emerging.

Alberta↗
PubMed2001

OMERACT: economic evaluations and health policy.

The aim of this paper is to review how decisions are made about the delivery of health care. Limited resources and increasing health care costs have resulted internationally in a growing necessity to understand the economic consequences of health care delivery. Rheumatology remains underfunded because the societal impact of chronic conditions is not well appreciated in the current policy-making context. Although health policy development varies with the care delivery systems, economic evaluation can be used for incremental system-wide reform to prioritize spending across multiple diseases and interventions. It is important to understand how policy and funding decisions are made in order to see how they might be influenced.

Cost-Benefit Analysis↗
PubMed1992

Residential care for the elderly.

This article maps variations in a standardized way in residential care for elderly people in three Western nations. Measured by the number of available places per person aged sixty-five and over and by the number of staff members per bed in nursing homes, the United Kingdom has the most highly developed standards. The United States ranks second, with Germany lagging considerably behind. The variations are explained by four variables: the pressure of the problem, as defined by the percentage of the population aged sixty-five and over; the caretaker potential in the family system, which alleviates this pressure; the structure and financing of the supply of residential care; and decision-making procedures in health care policy-making. My analysis emphasizes the last two variables. In the United Kingdom and the United States, the public and private providers who supply care have either political or market incentives to expand their services. Germany's mix of public and private, by contrast, is dominated by voluntary associations that are neither responsible to an electorate nor allowed to make profits. Thus, their clients do not have opportunities to articulate their needs. Health care decision making in Germany takes place through a collective bargaining process between the sickness funds and the providers. In such a system, the interests of groups who are not represented at the negotiation table--such as the elderly--tend to be neglected. A national health system of the British type links political decision makers via the election mechanism more closely to the concerns of the public. As older people represent growing proportions of the electorate, their needs find more adequate consideration in the policy process. In the United States, political officeholders also have to pay attention to the needs of increasingly organized older people, since the tax-financed and federally regulated Medicaid system is largely responsible for financing long-term care for the elderly.

Aged↗
PubMed2005

Altruistic living kidney donation challenges psychosocial research and policy: a response to previous articles.

BACKGROUND: Policies with respect to altruistic living kidney donation to strangers (both nondirected and directed donation) should, in addition to medical criteria, preferably be based on valid attitude research data. However, deciding on what data are relevant is a normative issue. The challenge for both research and policy making is to bring together empirical and normative issues. METHODS: By comparing two recent surveys, the authors shed light on the complex methodologic and ethical questions surrounding altruistic living kidney donation. RESULTS: The authors found that the main methodologic issues were the distinction between the willingness to donate and the acceptability of the offer, the difference between public attitudes observed in surveys ("facts") and well-considered moral judgments ("norms"), and biases caused by a misperception of central moral concepts (e.g., discrimination and injustice). The authors argue that transplantation centers have a good case for applying or initiating altruistic living donation programs. Centers should seek to influence public attitudes if these attitudes are shown to be biased by prejudice and misunderstanding. CONCLUSIONS: The authors advocate an interaction between research and policy making. Social research can best influence transplantation policies in altruistic living donation by in-depth interviews into the complicated background beliefs underlying personal preferences. In addition, the public should be encouraged to judge the immanent issues in a morally responsible way. In the end, a fair balance should be established between the impartial requirements of social justice and the partial motivations of individuals involved in altruistic living donation. Although discriminatory acts should be rejected categorically, donation policies should be willing to consider, support, and accept motivations based on personal loyalties.

Altruism↗
PubMed2002

Effect of news coverage on the prevalence of drunk-driving behavior: evidence from a longitudinal study.

OBJECTIVE: To examine the proposition that antidrunk driving messages in the news media contributed indirectly to the decline in drunk driving over the past two decades through their impact on related policy making processes. METHOD: Time series regression techniques are applied to longitudinal data to examine the causal association between drivers' involvement in drunk-driving behavior, the volume of news coverage devoted to the drunk driving issue, and related policy making. RESULTS: Results show a significant contribution of news coverage to drunk-driving-related policy actions, which in turn are associated with a reduction in drunk driving among young and high-risk drivers. There was no evidence of a direct causal association between news coverage and change in drunk-driving behavior. CONCLUSIONS: News coverage of alcohol-related risky behaviors seems to provide a cost-effective way of reducing the prevalence of these practices by attracting institutional attention and prompting related environmental changes. Future interventions may benefit from actively seeking to influence news coverage of risky behaviors.

Accidents, Traffic↗
PubMed2005

Co-management: concepts and methodological implications.

Co-management, or the joint management of the commons, is often formulated in terms of some arrangement of power sharing between the State and a community of resource users. In reality, there often are multiple local interests and multiple government agencies at play, and co-management can hardly be understood as the interaction of a unitary State and a homogeneous community. An approach focusing on the legal aspects of co-management, and emphasizing the formal structure of arrangements (how governance is configured) runs the risk of neglecting the functional side of co-management. An alternative approach is to start from the assumption that co-management is a continuous problem-solving process, rather than a fixed state, involving extensive deliberation, negotiation and joint learning within problem-solving networks. This presumption implies that co-management research should preferably focus on how different management tasks are organized and distributed concentrating on the function, rather than the structure, of the system. Such an approach has the effect of highlighting that power sharing is the result, and not the starting point, of the process. This kind of research approach might employ the steps of (1) defining the social-ecological system under focus; (2) mapping the essential management tasks and problems to be solved; (3) clarifying the participants in the problem-solving processes; (4) analyzing linkages in the system, in particular across levels of organization and across geographical space; (5) evaluating capacity-building needs for enhancing the skills and capabilities of people and institutions at various levels; and (6) prescribing ways to improve policy making and problem-solving.

Community Participation↗
PubMed2001

Local level sustainability policies in the Baltic Sea area: Local Agenda 21 within the Union of the Baltic Cities network.

Local Agenda 21 (LA21) processes have 2 central goals. i) On the basis of some of the empirical evidence in this study, the primary goal is to improve democratic (environmental) policy-making processes in such a manner that a larger share of the population will be able to participate in planning and decision making and will also be able to understand the consequences of these decisions. ii) The LA21 processes seek to improve (at least indirectly) the broadly defined environmental situation locally in a manner that takes into account both the local and the global contexts. The first part of this article discusses the concept and methods of LA21 and sheds light on the different action areas that are central to the Baltic LA21 processes. In addition, the study will describe and display the LA21 situation within one network of cities, the Union of the Baltic Cities (UBC). Networking, including transfer of information, models and ideas, has been among the main tools for the diffusion of LA21 ideas especially into newly democratized societies. Finally, the article will conclude with an overall assessment of the LA21 situation on the Baltic rim.

Baltic States↗
PubMed2003

The human face of decentralisation and integration of health services: experience from South Africa.

This paper explores the processes of policy-making, budgeting and service implementation in three provinces of South Africa, drawing on interviews with health managers at different levels of government. It illustrates how the process of decentralisation creates disjunctures between the policy-making authority of higher levels of government and the implementation capacity of service provision levels. It also explores the complex dynamics between those responsible for specific policies, such as reproductive health policies, and those responsible for managing the integrated delivery of all policies, with their resultant contestations over authority and resources. The pace of change in South Africa and the enormous capacity it requires, both in relation to financial management and the technical skills needed for specific programmes, has created a sense of frustration and demoralisation. Whilst shortage of financial resources, particularly as reflected in shortage of staff, is frequently assumed to be the biggest constraint in this context, most managers identified other issues, particularly staff morale, as greater barriers to the delivery of high quality health services. The paper concludes that it is the complexity of experience and feelings described by health managers that may determine the extent and quality of service delivery. For this reason, both practice and research need to give greater attention to issues of power relations and personal experience of change.

Attitude of Health Personnel↗
PubMed1987

Research and Social Security policy in the United States.

This article is adapted from a paper presented at a conference that investigated the role of policy research in shaping public policy. The conference focused on how studies of economic and social forces and their relationship with public problems and programs affect the decisions of public policymakers. The author contends that research has the potential to inform policy-making in any of its five stages: problem identification, option development, passage of new laws or development of new procedures, implementation, and evaluation. She notes that different players in the policy-making process use research differently, from the senior government official who needs a quick review of what is known relating to a "hot" issue to the interest group lobbyist who wants access to raw data. The article concludes that research can best achieve its potential when (1) it anticipates policymakers' information needs, (2) it is disseminated in an accessible form understandable to nonresearchers, and (3) the policy analyst is willing to engage in the policy process as an advocate for efficiency.

Eligibility Determination↗
PubMed2004

SESy-Europe: a multi-language database dedicated to cancer screening monitoring.

Cancer is the second cause of death in developed countries. Many efforts to educate the public to more tumor free life-style and screening practice have been therefore adopted. Considering the high costs of diagnostic procedures and educational programs a cancer prevention/screening practice monitoring system is required to reduce costs, to assist health making policy decisions, and to tailor more targeted interventions whenever indicated. We, therefore, realized a computerized data-base able to assist medical personnel in health intervention monitoring and making policy at community level with a focus on the European region. An international medical board provided the translation of medical-related contents in English, French, German, Greek, Italian, Rumanian, Spanish and Turkish. The electronic system recognizes and finds relationships between screening events or secondary prevention tests and various causes of medical examinations (symptoms, diseases, professions, presence and type of health insurance, sex, age, medical history, family history, educational level, knowledge about cancer screening and prevention, patient location, type of community, region of provenance, etc). Due to its multi-language standardized characteristics its application may bridge European countries in cancer screening monitoring policy.

Computers↗
PubMed1997

State-to-state variations in newborn screening policies.

BACKGROUND: Population-based newborn screening for genetic and metabolic disorders is standard practice in all states in the United States. Policies governing newborn screening are determined at the state level; however, and thus, a great degree of variability exists between states regarding many facets of such screening. OBJECTIVE: To gather information relating to the processes, content, and outcomes of policy making affecting newborn screening programs across the United States. METHODS: We surveyed the directors of newborn screening programs for each of the 50 states using a postal questionnaire. The questionnaire solicited information about the specific tests incorporated in each state's panel of screening tests and information pertaining to the policy-making processes by which decisions are reached regarding this testing. RESULTS: Substantial variation exists across states regarding both the processes of policy formulation and the outcomes of decisions made about newborn screening. All states currently screen for phenylketonuria and congenital hypothyroidism. Extensive variation exists across states in testing for other disorders. The processes by which state policy makers arrive at decisions in this area are extremely diverse. Almost three fourths of the states have standing expert advisory bodies who issue recommendations regarding screening program modifications, but the authority granted to these panels varies substantially. Some regional cooperation in this area exists. CONCLUSIONS: Further development of regional cooperation could offer some states greater efficiency in both laboratory testing and screening policy formulation. From the standpoint of an individual state. Wisconsin's approach to policy development in this area is described as a model worthy of consideration.

Health Policy↗