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PubMed2001

Contaminated sites: the Canadian situation in an international context.

Over the last 2 decades, policy-makers have been giving increasing attention to the remediation and redevelopment of contaminated sites, especially those located in urban areas commonly referred to as brownfields. Traditionally, private developers have tended to ignore these sites on account of a series of obstacles of a structural-political nature, including variability in regulatory processes, lack of information on soil quality, impractical clean up standards, fear of liability, and limited funding resources for clean ups. This paper examines the types of policy-making measures that are currently being taken in Canada to overcome these obstacles, comparing them to those being taken in the US and Europe. It is argued that the contaminated site-related policies and programs employed to overcome each obstacle, both within Canada and internationally, are converging in style and content as governments are becoming more aware of the types of costs and risks they must share in order to solve the problem effectively. It is also argued that this trend is unfolding in a relatively predictable way, and that policy-making in Canada is evolving more slowly than it is in the other jurisdictions examined.

Canada↗
PubMed2001

Democracy and the governance of uncertainty. The case of agricultural gene technologies.

The use of genetically modified organisms (GMOs) in agriculture and food production is the object of an intense and divisive debate. Drawing on a study on the public perception of agricultural gene technologies carried out in five European countries, the article deals with the policy aspects of the issue, and more precisely on the relation between institutions, experts and the public in a context of deep uncertainty. A theoretical framework is developed and compared with the study findings, suggesting that issues like the GMOs one represent a strong case for a more participatory policy-making. My conclusions suggest a style of governance based on the principles of deliberative democracy, as a suitable approach to the confrontation of different viewpoints and forms of knowledge. This appears to be the best way to improve the overall quality of policy-making: in this I include its legitimacy, the degree of public trust, and also the actual quality of its products. Strengthening the role of the public sphere seems more effective than simply increasing direct decision-making by the populace, and it offers an alternative to the 'elitist' solutions to the crisis of representative democracy.

Agriculture↗
PubMedDate not supplied

"Could we all be a little more quiet, please?" A behavioural-science commentary on research for a quieter Europe in 2020.

European noise research and policy-making overall not so effective thus far is considered from a behavioural science perspective. First, an overview is given of a recent strategy paper by the EU's CALM network1, focused on perception-related and emission-related research. After a summary of noise effects on human well-being, environmental noise problems are discussed as socio-technical problems where the social part is just as important as the technical part. The behavioural and social components of noise emission, transmission, exposure and effect are explicated. Environmental stress is considered as a double-sided phenomenon involving subjects' threat appraisal and their coping appraisal, each comprising specific underlying variables. From the wider perspective explained, several comments are given on the research strategy CALM is proposing. It is argued that: increasing motorisation undermines noise abatement; dose-response relationships reflect only part of the problem; more attention is needed for the causative behaviour of noisy actors; technical noise-reduction measures are necessary but insufficient; and that noise as a daily stressor should be treated in the context of people's overall quality of life. Specific suggestions are listed for EU noise research and policy-making. One conclusion is that more effective and visionary European noise policies may well be started tomorrow and need not depend on 15 years more research as envisaged in the CALM strategy paper.

Adaptation, Psychological↗
PubMed2002

Evidence-based medicine as an instrument for rational health policy.

This article tries to present a broad view on the values and ethical issues that are at stake in efforts to rationalize health policy on the basis of economic evaluations (like cost-effectiveness analysis) and randomly controlled clinical trials. Though such a rationalization is generally seen as an objective and 'value free' process, moral values often play a hidden role, not only in the production of 'evidence', but also in the way this evidence is used in policy making. For example, the definition of effectiveness of medical treatment or health care service is heavily dependent on dominant individual or social views about the goals of the particular treatment or service. There is also a concern that a reliance on EBM in health policy will occur at the expense of widely shared social values like equity and solidarity. Moreover, there is a concern that when economic considerations and rational procedures become more influential, various 'outside' groups third parties like insurance companies and policy makers will get a stronger influence on medical practice which may lead to a change in the patient-provider relationship. The authors conclude that social values and patient preference should be explicitly addressed when health policy making is based on economic and other scientific evidence.

Cost-Benefit Analysis↗
PubMed1997

A citizens' AIDS Task Force: overcoming obstacles.

This article analyzes the experience of a state-wide Task Force on AIDS using grassroots techniques to construct policy responsive to the needs of people living with HIV. The four primary obstacles to effective policy making were the need (1) to include disenfranchised groups; (2) to avoid the domination of governmental bureaucracy so that community-based organizations could offer solutions, as well as services; (3) to overcome resistance to anonymous testing; and (4) to reach "hard to reach" populations. Task Force members' perspectives colored what were deemed appropriate policies. Members tended to polarize into two groups: those community-based groups and individuals who focused on the needs of people with HIV on one side, and on the other side, more institutional players who wanted to identify and isolate "HIV carriers." The article closes by analyzing the resulting HIV Omnibus Bill. Those who focused on the needs of people with HIV seized the opportunity to draft and successfully pass an omnibus bill through the Arizona Legislature. This success demonstrates that highly organized communities can affect policy making, even to the extent that it offsets more institutionalized power.

AIDS Serodiagnosis↗
PubMed1999

Making vaccination policy: the experience with rubella.

The massive rubella epidemic of 1962-1965 stimulated the development of rubella vaccine. Once vaccines were developed, the U.S. vaccination program, initially focused on infants and children, reduced both rubella and congenital rubella. However, later extension of vaccination to certain older age groups achieved significantly better control. While rubella clearly is not the perfect model for pertussis, a review of its history is illuminating. Current rubella vaccination policies resulted from an evolution in scientific understanding. Controversies, including those related to communicability, reactivity, and teratogenicity of the rubella vaccine virus, duration of immunity following vaccination, and protection following reinfection, led countries to use different approaches for national immunization programs. These differences were eventually resolved by clinical and epidemiological research coupled with rigorous scientific debate. Increased scientific understanding of pertussis, its epidemiology, and the effects of the new pertussis vaccines will similarly enable informed decision making on whether to extend pertussis immunization to adolescents and adults.

Adolescent↗
PubMed2003

Managing animal trypanosomosis in Africa: issues and options.

This paper discusses past and present approaches to managing tsetse-transmitted animal trypanosomosis in Africa and describes the three main weaknesses of these approaches, i.e., inappropriate objectives, inadequate links between research and policy-making and a lack of recognition that trypanosomosis should be high up on the social science research agenda. Making progress in managing trypanosomosis has been difficult and the authors argue that the weaknesses of the approaches must be corrected if Africa is to benefit from the few advances made so far, and for the continent to make further sustained efforts to combat the disease. The authors explain that this can be achieved by replacing the current widespread preoccupation among researchers and policymakers with controlling (or eradicating) trypanosomosis with a focus on managing (or coping with) the disease. In addition, ways of achieving greater coherence between research and policy-making must be explored. Finally, the social science issues raised by the question of which practical steps need to be taken to manage trypanosomosis in Africa should be placed at the forefront of research efforts.

Africa↗
PubMed1993

Directory of socio-behavioural research on HIV infection and AIDS in Zimbabwe.

In July-August 1992, a directory was made of research projects on socio-behavioural aspects of HIV infection and AIDS in Zimbabwe. A total of 92 research projects were identified, most of which were already completed. Whilst there was a wide variety of topics, populations and geographical areas covered, there was a strong bias towards AIDS awareness and knowledge, attitudes and practices (KAP) studies. Many of these were not linked with any specific AIDS prevention programme or with policy making. Suggestions are given to make better use of existing scientific information. A call is made upon researchers to conduct action-oriented studies and to consult HIV/AIDS programme implementers when specifying 'researchable' problems, so as to increase the likelihood that the study results will indeed have an impact on policy making and programme implementation.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Health policy and case management.

The purpose of this article is to analyze the performance of and support for case management using a policy framework in order to increase case managers' awareness of policy making and facilitate successful planning for future policy initiatives. Feldstein's (1996) theory of opposing legislative outcomes indicates that legislation can be viewed on a continuum, ranging from legislation that meets the needs of the public to legislation considered to be in the self-interest of the participants and legislators. The current health care system requires that case managers working for publicly funded health care organizations balance the need for stewardship of U.S. tax dollars and the health care needs of consumers. It is apparent from the literature that case managers are successfully achieving this balance. However, certain conditions should exist that allow for case manager decision-making that promotes effective and efficient utilization of health care resources. Case managers must work within the context of the health care policy environment. Realizing that it is more likely that the conflicts between stewardship and the provision of health care services will continue, case managers' knowledge and influence regarding policy making becomes imperative in order to ensure that these conflicting goals do not become mutually exclusive.

Case Management↗
PubMed2006

Working up policy: the use of specific disease exemplars in formulating general principles governing childhood genetic testing.

Non-therapeutic genetic testing in childhood presents a "myriad of ethical questions"; questions which are discussed and resolved in professional policy and position statements. In this paper we consider an underdiscussed but strongly influential feature of policy-making, the role of selective case and exemplar in the production of general recommendations. Our analysis, in the tradition of rhetoric and argumentation, examines the predominate use of three particular disease exemplar (Huntington's disease, Tay-Sachs disease and sickle cell disease) to argue for or against particular genetic tests (predictive testing and testing for carrier status). We discuss the influence these choices have on the type and strength of subsequent recommendations. We argue that there are lessons to be drawn about how genetic diseases are conceptualised and we caution against the geneticisation of medical policy making.

Child↗
PubMed2001

Evidence-based health care: making health policy and management decisions.

The paradigm for health care delivery in the United States continues to evolve. Patients and physicians are beginning to reject guidelines for treatment that are solely based on cost reduction and are not evidence based. Future managed care guidelines will rely on the best external clinical evidence about the value of any given therapeutic intervention combined with individual physician experience and patient choice. Managed care organizations will need to play a greater role in the development, evaluation, and incorporation of clinical trials into their strategies.

Clinical Trials as Topic↗
PubMed1997

[Participatory action-research in the development of health policies for Izumo City, Japan].

The method of participatory action-research has been introduced in planning and implementing health and welfare projects for the elderly in Izumo City since 1993. Public health researchers have participated in the projects with other related administrative sectors, citizen and non-profit organizations. This study analyzes the establishment and implementation of health policies of Izumo from the following five aspects: policy-making, priority, education, intersectoral cooperation and community development. The participatory action-research method was useful for developing the ability of health-staff to work with citizens; for integrating community care and community development; for using community resources effectively for primary health care; and for developing community-based education of citizens, medical students and health staff. This method can be and should be adopted for strengthening the policy-making ability of public health researchers who learn through cooperation with citizens and non-profit organizations.

Community Participation↗
PubMed2000

Can economic evaluation guidelines improve efficiency in resource allocation? The cases of Portugal, The Netherlands, Finland, and the United Kingdom.

The use of economic evaluation in decision making appears to have increased over the past few years and economic evaluation is looked upon as another measure to help contain costs and improve efficiency in an evidence-based decision-making environment. Following the examples of Australia and the Canadian Province of Ontario, four European Union (EU) countries (Finland, the Netherlands, Portugal, and the United Kingdom) have recently introduced economic evaluation guidelines. In addition to the Australian and Canadian guidelines, which constitute a hurdle to reimbursement, the paradigm that seems to be evolving in the four EU countries follows a similar route. Finland and the Netherlands seem to be moving toward the notion of a fourth hurdle to reimbursement, whereas the National Institute for Clinical Excellence in England and Wales was in principle meant to influence practice, although in reality this essentially acts as a hurdle to reimbursement, requiring a different data set to that used by regulatory authorities. Whereas the Portuguese guidelines were developed to assist in preparing economic submissions to support reimbursement decisions, they are unclear about when such evidence will be required and also discuss the dissemination of economic evidence to broader audiences. The introduction of these guidelines poses a number of challenges to policy makers, the implications of which are analyzed in the paper: a) to ensure that economic evaluations are carried out scientifically without industrial or political bias; b) to define an acceptable methodology that would increase their credibility; and c) to address certain practical issues ranging from deciding how to use economic evaluations in policy making to setting up new institutions or improving the coordination and dissemination of evidence. The variation in the use of economic evaluation guidelines in the four EU countries highlights the differences in national pharmaceutical policies and is in line with policy makers' continuous attempts to contain costs. While the paper critically discusses the guidelines, it also points out that a series of methodologic issues need to be addressed if economic criteria are to be introduced in policy making with the aim to improve resource allocation. The paper concludes that economic evaluation as a discipline is beginning to impact on policy, whereas the consistent use of economic evaluation results is, in principle, being adopted by policy makers but needs to go a step further to reach practitioners.

Drug Therapy↗
PubMedDate not supplied

Health policy and the private sector. New vistas for nursing.

During the past two decades, the drive to rein in rising health care costs has shifted some of the power in health care policy making from professional groups, government agencies, and not-for-profit health care organizations to large for-profit corporations (1-4). This has been a world-wide phenomenon, as the provision and financing of health care services is shifted from governments to private health care organizations (5,6). In the United States, the shift in power is manifested in profound ways. Market competition and bottom-line economics have permeated the health care system, creating powerful new incentives for mergers, other corporate restructuring, and the shift to for-profit status by formerly not-for-profit insurance companies and providers. Private sector health care is now increasingly influenced by for-profit organizations (3). Moreover, the health insurance industry has been transformed as traditional indemnity insurance is replaced by versions of managed care. The role of government, or the public sector, in setting parameters for health care financing and standards for the delivery of health care services is increasingly outpaced in cost cutting by organizations that directly face the bottom line. In addition, private foundations, many of which are under the auspices of managed care organizations, now fund a large proportion of health care research and demonstration projects, a task once largely within the realm of the government. Through education and experience, nurses have developed political sophistication and understanding of policy making in the public sector (7). The challenge now is to educate nurses to adapt their political and policy strategies to the new health care milieu. This challenge is particularly crucial for advanced practice nurses, who must survive in a managed care environment.

Education, Nursing↗
PubMed2001

Climate change. Uncertainty and climate change assessments.

Clear and quantitative discussion of uncertainties is critical for public policy making on climate change. The recently completed report of the Intergovernmental Panel on Climate Change assessed the uncertainty in its findings and forecasts. The uncertainty assessment process of the IPCC should be improved in the future by using a consistent approach to quantifying uncertainty, focusing the quantification on the few key results most important for policy making. The uncertainty quantification procedure should be fully documented, and if expert judgment is used, a specific list of the experts consulted should be included.

Journal Article↗
PubMed2005

Welfare state and women's work: the professional projects of nurses and occupational therapists in Sweden.

In this article we explore how Swedish welfare politics within health-care and rehabilitation has opened up a space for nurses' and occupational therapists' professional projects. Using historical data, an analysis of the policy-making process behind welfare programs central to the professionalization of nursing and occupational therapy is presented. The time period covered is, in the case of nurses, the larger part of the twentieth century, while the modern history of occupational therapists first began in the 1940s. Special emphasis is placed on the corporative nature of the Swedish welfare state and the professional strategies utilized by nurses and occupational therapists in their struggle for jurisdiction. In the article, politicization is identified as a core strategy by which female-dominated welfare state occupations in Sweden have tried to gain influence over the welfare policy-making process and their occupations' jurisdiction.

History of Nursing↗
PubMed1999

Refutation and conjecture around consensus breast cancer screening guidelines.

Public health policy making sometimes goes beyond dispassionate scientific review of data and program analysis to reflect the attitudes and promote the interests of various health care constituencies, professional organizations, consumer groups, and governmental bodies. This article recounts events that precipitated the issuance of guidance about the advisability of periodic screening mammography for women 40 to 49 years of age. It illustrates how a pragmatic choice was born from equal parts of data, the community's underlying value system, and political exigencies. Examining the policy making process will provide public health practitioners greater capacity to find workable solutions in their advocacy of better health for all.

Adult↗
PubMed1997

Membership theory, rationalism, and the claim to adequacy in health services.

The immediate, practical purpose of this paper is to discuss and elaborate upon the concept of adequacy, especially when applicable to an understanding of the social work role in health policy making. The relevant topics under the general category of adequacy are (1) the perception and definition of the citizen/client; (2) the concept of rationality in health planning broken down into conditionality and prioritization, and (3) the concept of adequacy itself. Each will be addressed from the standpoint of recent experience and what may be done in the future to clarify and rationalize each. Clarity about clients, about rational approaches to policy making and planning, leading to a clear idea about adequacy in health care are presented as the indispensable elements in social work. Conditionality and prioritization are significant because no society will bring within equal reach of all members the benefits of health care, which usually means that health care is not rendered arbitrarily but as a result, among other things, of rational planning.

Forecasting↗