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PubMed2001

A seat at the table: membership in federal advisory committees evaluating public policy in genetics.

OBJECTIVES: This study examined who participates in federal government advisory committees regarding public policy in human and medical genetics, what parties they represent, and to what extent the general public is meaningfully represented. METHODS: Analysis focused on 7 federal government documents published from January 1990 to February 1995. Advisors were categorized into 4 groups based on the professional affiliations that were listed in the publications. After a search of several references and data-bases, the study examined whether these individuals also had other affiliations not listed in the government publications. RESULTS: Individuals whose principal affiliations were with academia (n = 32; 44%) or industry (n = 19; 26%) represented nearly three fourths of the sample, followed by government employees (n = 13; 18%) and consumer advocates (n = 8; 11%). At least 16% of the advisors serving on the federal committees, mostly members of academia, had a dual affiliation. CONCLUSIONS: These data indicate that the public has modest representation on key federal advisory committees making policy recommendations regarding human genetics technology and clinical practice and that there is ample room for additional public participation.

Committee Membership↗
PubMed2003

The development of health technology assessment.

The field of health technology assessment (HTA) is still relatively new, but it has shown remarkable growth over the last decade, having spread first from the United States to Europe, and now to the entire world. HTA seeks to couple evidence with decision-making, and thus has similarities to evidence-based health care and evidence-based policy-making. The early history of HTA, beginning around 1975, reveals a first period of synthesising available evidence-principally that dealing with efficacy and cost-effectiveness of health care interventions-so as to put it in a format helpful to health policy-makers, especially those in national governments. From 1985 or so, the focus of the second period was on seeking more effective links with these policy-makers, particularly in Europe. The most recent period, beginning in the late 1990s, has been increasingly devoted to more effective dissemination and implementation in order to influence administrators and clinicians. While early assessments tended to focus on large, expensive, machine-based technologies, the scope has gradually widened to include smaller technologies, 'softer' technologies (such as counselling), and health care needs. Actual assessments have also taken on broader issues, such as organisational, social, and ethical implications. In the Member States of the European Union (EU), HTA activities are increasingly visible, and almost all now have a national focus for HTA associated with the Ministry of Health or its equivalent. Central and Eastern European countries are also developing HTA activities. Most recently, HTA has been highlighted by health policy documents from the European Commission. It seems likely that HTA will in the future be institutionalised in some form as part of EU activities.

Europe↗
PubMedDate not supplied

Housing, urban development and health in Latin America: contrasts, inequalities and challenges.

Since the outset of the 20th century, growing urbanization and its contingent waxing populations in Latin America, including Brazil, have come to have alarming effects on the conditions of life, especially in the areas of housing and healthcare for such populations. In this paper, we present data describing and qualifying the process of urbanization and its consequences for Latin American countries and certain Brazilian cities. Arguments are presented about the effects of the urbanization process and the development of low-income human settlements (slums known as favelas and squatting in tenement housing) on health conditions, diseases, and the death rate. The first part of the paper is based on secondary and quantitative data about urbanization, housing, and health in Brazilian and other Latin American cities. Governmental and nongovernmental data are used to structure the problematic landscape of the Latin American region. In the second part of the paper, we focus on a case study of a Brazilian coast city that has registered an intense population growth. This study demonstrates that urban policy (housing, environmental, sanitation, and urban transportation) requires an integration of health and environmental public policy and demonstrates the importance of the role of popular participation in urban public policy-making, and the potential importance of the Bertiioga Healthy City Project from the perspective of a better integration of actions, policies, and programs.

Brazil↗
PubMedDate not supplied

Improving the health of Californians: effective public-private strategies for challenging times.

This paper summarizes the discussion that occurred at a November 2003 roundtable on philanthropy and health policy making. The roundtable was intended to stimulate a conversation about the strategic interplay of health policy and philanthropy in a challenging economy; to gain a richer understanding of the needs and expectations of funders and policymakers so that resources can be leveraged far more effectively; and to identify practical, collaborative approaches for advancing policy development and implementation. The gathering included more than fifty key leaders from state and national foundations; state policymakers; representatives from the California governor's office and key state health agencies and commissions; private-sector leaders; and academics.

California↗
PubMed2001

Policy-oriented integrated analysis of land-use change: an analysis of data needs.

Integrated analysis of land-use change in support of informed policy-making for sustainable land use at various spatial levels makes heavy requirements for quality data. This paper aims to structure the principal methodological and practical issues of data needs for this task. The data needs for local level analyses of land-use change are given special attention. The paper adopts an integrated economic-environmental modeling framework and suggests the main types of data needed. Four main data dimensions are distinguished: system of spatial reference, system of temporal reference, definitions, and data collection procedures (sources, collection instruments and techniques, recording and retrieval systems, data format, frequency of data collection). To evaluate the suitability of current data sets as well as to guide the collection of new ones, a scheme based on substantive and practical criteria is employed. The former include compatibility, consistency, and reliability of data, while the latter include availability, ease and cost of data collection/retrieval, and transferability of data. The evaluation indicates the broad gaps in current data sets along the four main data dimensions. Based on this evaluation, the paper suggests framework guidelines to address the main data issues identified.

Conservation of Natural Resources↗
PubMed1999

Choices in Dutch health care: mixing strategies and responsibilities.

In the light of experience that choices in health care appear to be not so much hindered by a lack of insight into how choices should be made in theory, as uncertainty as to how choices could be made in practice, this paper sets out to deepen our insight into the dynamics of health care policy making within the concrete socio-economic and political context. The paper examines how Dutch policy-makers have dealt with the priority issue in health care over the past 10 years by means of a gradual incremental approach. In this approach, use is made of a mix of strategies and shared responsibilities, with an important role for the actors at the meso and the micro levels; while at the same time, the government has not abandoned the tried and trusted policy of national rationing (i.e. keeping the production capacity limited and setting a ceiling on production in order to resist the pressure on the public system of Dutch health care). Looking at the declining percentage of Gross National Product assigned to health care annually, the broad accessibility and the good overall quality of Dutch health care, it may be concluded that the issue of choice has not come off badly under this mixed approach. The degree to which the system can respond adequately to likely developments, such as a recession, worsening waiting lists, further liberalisation (i.e. the application of market forces in health care) and, by way of extension, the ongoing integration of 'Europe' is questioned.

Health Care Rationing↗
PubMed1986

Models of governance in multihospital systems. Implications for hospital and system-level decision-making.

This study utilizes data from a national survey of 159 multihospital systems in order to describe the types of governance structures currently being utilized, and to compare the policy making process for various types of decisions in systems with different approaches to governance. Survey results indicate that multihospital systems most often use one of three governance models. Forty-one percent of the systems (including 33% of system hospitals) use a parent holding company model in which there is a system-wide corporate governing board and separate governing boards for each member hospital. Twenty-two percent of systems in the sample (but 47% of all system hospitals) utilize what we have termed a modified parent holding company model in which there is one system-wide governing board, but advisory boards are substituted for governing boards at the local hospital level. Twenty-three percent of the sampled systems (including 11% of system hospitals) use a corporate model in which there is one system-wide governing board but no other governing or advisory boards at either the divisional, regional or local hospital levels. A comparison of systems using these three governance approaches found significant variation in terms of system size, ownership and the geographic proximity of member hospitals. In order to examine the relationship between alternative approaches to governance and patterns of decision-making, the three model types were compared with respect to the percentages of systems reporting that local boards, corporate management and/or system-wide corporate boards have responsibility for decision-making in a number of specific issue areas. Study results indicate that, regardless of model type, corporate boards are most likely to have responsibility for decisions regarding the transfer, pledging and sale of assets; the formation of new companies; purchase of assets greater than $100,000; changes in hospital bylaws; and the appointment of local board members. In contrast corporate management is relatively uninvolved in these issues, again regardless of governance model type. There is substantial variation in the locus of decision-making responsibility by governance model type for a variety of other issues, however, including: hospital-level service additions and deletions; operating and capital budgets; medical staff privileges, hospital-level long-range planning; hospital CEO performance evaluation and the appointment of hospital CEOs.(ABSTRACT TRUNCATED AT 400 WORDS)

Decision Making, Organizational↗
PubMed2001

The rocky road to health reform: some lessons from New Zealand.

Ongoing structural change has been a feature of the New Zealand health system throughout the 1990s. As we enter the new millennium a new government is now embarking upon yet another round of reform. I look back on the past few years and consider what lessons might be learned about the process of health policy-making in New Zealand. They include the need for a clear vision about the goals of health policy, the importance of consulting with key stakeholders at an early stage, the problems of implementing change too speedily, and the need to allow sufficient time for systems to mature before replacing them with new structures.

Health Care Reform↗
PubMed1993

The interaction between policy and research in the implementation of server training.

This paper describes the relationship between research and policy in the development of server training policy in Ontario. With the emergence of civil liability for the conduct of intoxicated patrons, there has been a growing movement toward the training of managers and servers in licensed establishment in the responsible service of alcohol. As part of a major government reform of alcohol regulations which has led to a new Liquor Licence Act, all persons who serve alcohol in licensed establishments in Ontario will be required to attend a server training course. The process leading to new alcohol regulations in Ontario is summarized with particular attention to the implementation of mandatory server training. The paper concludes with a discussion of the role of research in policy development. It is argued that the role of research in policy making is limited by an inherent conflict between the nature of scientific enquiry and the exigencies of policy development.

Accidents, Traffic↗
PubMed2005

Adaptation for river basins: connecting policy goals to the water resources system.

This paper focuses on a methodology called 'generic adaptation methodology for river basins' (AMR) that provides guidance to water managers seeking: (1) potential adaptation measures to climate change and climate variability, (2) measuring impacts, and (3) evaluating adaptations. The methodology uses basic elements addressed in existing adaptation research and is designed for a participatory setting involving various stakeholders. In AMR, the water resources system is seen as an economic asset that provides 'goods and services' for both humans and ecosystems. The innovative aspect of AMR is that it distinguishes impacts to water management objectives and impacts to the physical state of water resources in a river basin in a relatively simple iterative approach. Both impact types are quantified using indicators. The framework and results are demonstrated for a case study in the Walawe basin (Sri Lanka). It is explained that actually implementing adaptations in policy making can be difficult in trans-boundary river basins as each riparian country has its own policy objectives and hence ways of dealing with adaptation.

Conservation of Natural Resources↗
PubMed2002

Innovation in social policy: collaborative policy advocacy.

In a time of policy devolution, social workers have a unique opportunity to develop a significant voice in constructing state social welfare policy. This article examines a method of collaborative policy advocacy led by social work researchers, practitioners, advocates, and students. It is illustrated with a five-year project to reduce wealth inequality through community economic development. Researchers brought expertise in ideas and analysis to real-world applications. Social work practitioners brought essential "on the ground" expertise. Students brought much-needed assistance and a fresh perspective to the social policy process. Advocates, working in social welfare advocacy organizations, bridged these perspectives and provided experience in policy advocacy. Working with coalition partners, social workers successfully placed asset-based community economic development strategies on the state agenda and were instrumental in passage of innovative legislation. The article demonstrates that the policy-making process is open to influence by social workers, especially if they come prepared with innovative and promising ideas about long-standing social issues. Social workers can and should take the lead and become significant actors in state policy development.

Community Participation↗
PubMed2005

Public appraisal of government efforts and participation intent in medico-ethical policymaking in Japan: a large scale national survey concerning brain death and organ transplant.

BACKGROUND: Public satisfaction with policy process influences the legitimacy and acceptance of policies, and conditions the future political process, especially when contending ethical value judgments are involved. On the other hand, public involvement is required if effective policy is to be developed and accepted. METHODS: Using the data from a large-scale national opinion survey, this study evaluates public appraisal of past government efforts to legalize organ transplant from brain-dead bodies in Japan, and examines the public's intent to participate in future policy. RESULTS: A relatively large percentage of people became aware of the issue when government actions were initiated, and many increasingly formed their own opinions on the policy in question. However, a significant number (43.3%) remained unaware of any legislative efforts, and only 26.3% of those who were aware provided positive appraisals of the policymaking process. Furthermore, a majority of respondents (61.8%) indicated unwillingness to participate in future policy discussions of bioethical issues. Multivariate analysis revealed the following factors are associated with positive appraisals of policy development: greater age; earlier opinion formation; and familiarity with donor cards. Factors associated with likelihood of future participation in policy discussion include younger age, earlier attention to the issue, and knowledge of past government efforts. Those unwilling to participate cited as their reasons that experts are more knowledgeable and that the issues are too complex. CONCLUSIONS: Results of an opinion survey in Japan were presented, and a set of factors statistically associated with them were discussed. Further efforts to improve policy making process on bioethical issues are desirable.

Bioethical Issues↗
PubMed2003

'Fit for purpose' health impact assessment: a realistic way forward.

The UK government is committed to health impact assessment (HIA) as a means of ensuring that health will be a key consideration in policy formulation and other public decision making. However there has been some debate about whether current HIA practice can reliably inform decision making. In particular consultation with stakeholders and literature reviewing, key tools used in HIA, are said to suffer from a number of conceptual and methodological problems, which can undermine the validity of the assessment. In this paper, we argue that the philosophical nature of HIA, its purpose and its contribution to the promotion of public health is still being established. We outline our own HIA practice, which is based on a broad philosophy of 'fit for purpose' i.e. what is this HIA for and what is its spatial, temporal, social and political context. We suggest that it is important to guard against unrealistic expectations and illusions of total objectivity and precision in the HIA process. HIA 'screening' is capable of delivering benefits by making policies, programmes and projects, more health conscious. Once we move beyond this basic expectation and wish to be able to make judgements about the relative health benefits of alternative courses of action, the potential resource intensiveness of the process increases considerably. Even at a high level of resource usage any conclusions reached through the HIA process will always be, in part, subjective and therefore likely to be contested. We must decide what we want, what we are prepared to legislate for and what we are prepared to pay for in the HIA process.

Humans↗
PubMed1996

Clinical mycobacteriology. Activities and recommendations by the association of state and territorial public health laboratory directors.

By using the assessment, policy development, and assurance model to describe the functions of public health, the Association of State and Territorial Public Health Laboratory Directors (ASTPHLD) is shown to be responding to the laboratory aspects of tuberculosis detection, prevention, and control. The many activities described illustrate the value of public-private partnerships in addressing population-based, public health threats. The network of state and territorial public health laboratories, through voluntary involvement in ASTPHLD, provides an important resource to the scientific, educational, and policy-making community.

Bacteriology↗
PubMed1999

Risk, science and policy: definitional struggles, information management, the media and BSE.

This article examines the role of definitional struggles in the science policy interface using the example of the cattle disease bovine spongiform encephalopathy (BSE) or mad cow disease in the UK. A central contention is that an explicit focus on definition illuminates the processes by which scientific judgements are made, promoted, communicated, assessed and judged and gives an improved picture of policy making. Neglected areas such as the role of secrecy, public relations and the mass media in the science-policy interface are brought into sharper focus as an intrinsic part of the wider operation of definitional struggles. The focus on definitional struggles also sheds light on some current work on risk in social theory. It is argued that the neglect of questions of agency which are central to definitional struggles has led to some theorists presenting risks as inevitable concomitants of technological and cultural developments leaving them in the grip of political quietism.

Animals↗
PubMed1999

Clarifying the scope of Italian NHS coverage. Is it feasible? Is it desirable?

The reduction in National Health Service (NHS) expenditure as a share of total health care expenditure, the fragmentation of the NHS into 21 regional systems and the implementation of a 'quasi-market' on the provider side of the system has pressed the government to define and specify, in detail, the set of services that are to be guaranteed by the public sector. To understand whether rationing can be more rational and explicit in the Italian NHS, the following are analysed: (i) the new positive list of drugs, as a major example of limiting and making more rational NHS pharmaceutical coverage; (ii) the Di Bella case, as an example of the difficulties of rational policy-making on sensitive issues; (iii) what Italian people think about health care rationing and priority setting (using the 1998 Eurobarometer Survey);( iv) the criteria defining the set of 'essential services' to be guaranteed to all Italian citizens, which are contained in the recently released National Health Plan. The 'revolution' that has taken place in the pharmaceutical sector shows it is feasible to limit, in an explicit and rational way, the extent of NHS coverage. However, the re-classification of the positive list should be regarded as an exceptional event in the history of Italian social policy. The 'Di Bella' case, on the contrary, shows that limiting NHS coverage can be very unpopular, and that the Italian cultural and social context can be unfavourable for the implementation of hard choices. Public attitude toward rationing seems to confirm that Italians are not familiar with rationing issues. Thus, it is very difficult to predict whether the national government will really go ahead with the implementation of a 'list of essential services' and whether this attempt will be successful. Rationing and priority setting should be discussed in the context of a general debate concerning the future of the Italian NHS.

Health Care Rationing↗
PubMed2007

The impact of political context upon the health policy process in Pakistan.

BACKGROUND: Analysis of the political context is important for the understanding of a health policy and its success, because contextual factors may significantly influence the health policy process and health. This article describes how the political context in Pakistan influences the health policy process. METHODS: We used qualitative research methods based on document analysis and interviews of relevant actors in analysing the impact of the political context on the health policy process. Document analysis included policy documents and official reports of the health ministries, health-related departments and international agencies. Interviewees included relevant actors involved in the health policy process at local, provincial, national and international levels. RESULTS: Pakistan has experienced unbalanced power structures and frequent changes in government, which has disturbed health resources and has resulted in a centralized health system that hinders wider participation and disrupts health policy-making, planning and implementation. CONCLUSION: It is concluded that the political context has had a negative influence on the health policy process in Pakistan.

Government↗
PubMed2002

Implications of organizational ethics to healthcare.

Organizational ethics is an emerging field concerned with the study and practice of the ethical behaviour of organizations. For effective application to healthcare settings, we argue that organizational ethics requires attention to organizations' special characteristics combined with tools borrowed from the fields of business ethics and bioethics. We identify and discuss several implications of this burgeoning field to healthcare organizations, showing how organizational ethics can facilitate policy making, accountability, self-evaluation, and patient and business perspectives. In our conclusion, we suggest an action plan for healthcare organizations to help them respond appropriately to their ethical responsibilities.

Decision Making, Organizational↗