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Issues of social policy and ethics in gene technology.

Technical developments in the last ten years have made possible mapping and sequencing of the entire human genome, along with the possibility of treating genetic disorders by manipulating DNA. A variety of issues regarding potential uses and abuses of these technologies have become apparent. They relate to both genetic screening and gene therapy. Problems facing individuals and their families mostly revolve around rights of self-determination and of confidentiality. Health care professionals will need to design optimal systems to provide genetic counseling and to protect confidentiality of DNA data bases. Society and social institutions will need to develop policies and laws that protect the privacy of individuals whose DNA is stored in data banks. Patenting of the results of gene research remains controversial internationally. Moreover, there is concern in many quarters about society's potential abuse of gene technology for eugenic purposes. Gene therapy is now a reality. There is little disagreement on the use of gene therapy to treat genetic diseases in individuals by somatic cell therapy. There is much controversy, however, over the use of germ-line cell therapy. Gene technology has contributed to the growth among a small group of influential people of the Post-Modern Movement, which is strongly antiscience and antitechnology. This movement may pose a long-term threat to future technological advances and should not be ignored. There is much outside of the laboratory that scientists, particularly molecular biologists, can do to assure a secure place for science and technology in our culture.

Ethics, Medical↗

A non-linear goal programming approach to modeling intraregional economic development.

"This paper provides a one-period normative model that may be used as a guide or benchmark by which the economic planner may develop policies and plans for regional economic development. The model can accomodate a region that could be as large as a small country or as small as a city, provided sufficient relevant data are available." The authors outline "a procedure for modeling and solving economic planning and analysis problems with 'intergoal trade-offs' while retaining the deviational variable as a measure of satisfaction....[They present] a generalized regional polynomial goal programming model with some suggested objectives and constraints [and illustrate] the approach with a hypothetical example."

Economics↗

Occupational and environmental health in eastern Europe: challenges and opportunities.

As the nations of Eastern Europe undergo political and economic transitions, they face considerable occupational and environmental health challenges. Although occupational health services are relatively well developed, environmental health services and policies are not. There are major needs in the areas of education and training, supplies and equipment, and policy development. In addition, privatization poses a variety of new challenges and dangers to occupational and environmental health. This commentary discusses the challenges that face Eastern European nations, and describes opportunities for collaboration among scientists, policymakers, labor, management, and community groups in the United States and Eastern Europe.

Environmental Health↗

Behavioral determinants of healthy aging.

With global trends in population aging, many nations are developing and implementing healthy aging policies to promote quality as well as years of healthy life. To broaden the evidence base for such policy development, a review of the literature was conducted to summarize the existing evidence regarding the behavioral determinants of healthy aging. Such research is needed so that the efficacy of modes of intervention can be better understood. The outcome of "healthy" or "successful" aging was selected for this review since this nomenclature dominates the literature describing a global measure of multidimensional functioning at the positive end of the health continuum in older age. Studies published between 1985 and 2003 that reported statistical associations between baseline determinants and healthy aging outcome were identified from a systematic search of medical, psychological, sociological, and gerontological databases. Eight studies satisfied the search criteria. Modifiable risk factors among the behavioral determinants included smoking status, physical activity level, body mass index, diet, alcohol use, and health practices. On the basis of these findings, effective healthy aging policies need to enhance opportunities across the life span for modification of lifestyle risk factors. Efforts to standardize concepts and terminology will facilitate further research activity in this important area.

Aged↗

The International Classification of Functioning, Disability and Health: a new tool for understanding disability and health.

Reliable and timely information about the health of populations is part of the World Health Organization's mandate in the development of international public health policy. To capture data concerning functioning and disability, or non-fatal health outcomes, WHO has recently published the revised International Classification of Functioning, Disability and Health (ICF). In this article, the authors briefly outline the revision process and discuss the rationale for the ICF and the needs that it serves in rehabilitation. The ICF is shown to be an essential tool for identifying and measuring efficacy and effectiveness of rehabilitation services, both through functional profiling and intervention targeting. Existing applications of the ICF in rehabilitation are then surveyed. The ICF, in short, offers an international, scientific tool for understanding human functioning and disability for clinical, research, policy development and a range of other public health uses.

Activities of Daily Living↗

Migrants, refugees and insecurity. Current threats to peace?

Since the early 1980s, international migration has moved beyond humanitarian, economic development, labor market and societal integration concerns, raising complex interactive security implications for governments of migrant sending, receiving and transit countries, as well as for multilateral bodies. This article examines the effects of international migration on varied understandings and perceptions of international security. It discusses why international migration has come to be perceived as a security issue, both in industrialized and developing countries. Questions are raised on the migration-security nexus and the way in which the concepts "security" and "migration" are used. The real and perceived impacts of international migration upon national and regional security, both in industrialized and developing countries, are analyzed. The policies developed by governments and multilateral agencies since the mid-1980s to mitigate the destabilizing effects of certain kinds of international population movement and human displacement are examined. The conclusions stress the need for the establishment of a comprehensive framework of international cooperation among origin and receiving countries and international organizations to address the destabilizing implications of international migration.

Demography↗

The politics of public health policy.

Politics, for better or worse, plays a critical role in health affairs. The purpose of this article is to articulate a role for political analysis of public health issues, ranging from injury and disease prevention to health care reform. It begins by examining how health problems make it onto the policy agenda. Perceptions regarding the severity of the problem, responsibility for the problem, and affected populations all influence governmental responses. Next, it considers how bounded rationality, fragmented political institutions, resistance from concentrated interests, and fiscal constraints usually lead political leaders to adopt incremental policy changes rather than comprehensive reforms even when faced with serious public health problems. It then identifies conditions under which larger-scale transformation of health policy can occur, focusing on critical junctures in policy development and the role of policy entrepreneurs in seizing opportunities for innovation. Finally, it reviews the challenges confronting officials and agencies who are responsible for implementing and administering health policies. Public health professionals who understand the political dimensions of health policy can conduct more realistic research and evaluation, better anticipate opportunities as well as constraints on governmental action, and design more effective policies and programs.

Government Agencies↗

A spoonful of competence helps the medicine go down.

The Organisation Development Consultancy based in the training department of the North Western RHA has been involved recently in a variety of projects researching into management competencies. This article outlines the findings from a project undertaken at Tameside and Glossop HA. The aim of the research was to provide an information base on which to build an appropriate recruitment and selection strategy and training and development policy for the continued future development of the district.

Administrative Personnel↗

Increasing dentists' capacity for secondary prevention of eating disorders: identification of training, network, and professional contingencies.

The incidence of eating disorders has increased substantially over the last forty years. Primary care physicians and dentists share a parallel challenge for secondary prevention of anorexia nervosa and bulimia nervosa. The dentist, in particular, has a uniquely important and valuable role with respect to assessment of oral and physical manifestations, patient communication, referral, case management, and restorative care. Despite this crucial role, few dentists are engaged in eating disorder-specific secondary prevention. The purpose of this study was to explore beliefs, attitudes, and experiences of general dentists regarding eating disorder-specific secondary prevention behaviors using focus group methodology. Three ninety-minute focus groups were conducted with twenty-one general dentists (seventeen male, four female) recruited from the 2004 Academy of General Dentistry Leadership Conference. Data from the focus groups were analyzed to identify two over-arching themes and associated subthemes with regard to supports and barriers to eating disorder-specific secondary prevention practices. Analysis of data revealed that training, network, and dental professional contingencies emerged as places of influence for increasing capacity among dentists with regard to secondary prevention of eating disorders. This exploratory assessment identifies leverage points where strategic interventions including curriculum development, policies, and practices can be developed to support and sustain secondary preventive clinical behaviors among dentists.

Attitude of Health Personnel↗

Alerting patients to the risk of radon.

The potential lung cancer risk from exposure to radon gas and the development of appropriate public health policy have been the subject of much discussion for several years. The American Lung Association has taken a leading role in educating the public on radon and other environmental hazards. This article presents background on radon, including the issues of risk assessment and policy development; reviews the current understanding of the hazards of exposure and the scope of the problem; describes how to test for radon; and discusses how to decrease radon levels.

Adult↗

Informing policy and service development at the interfaces between acute and aged care.

This paper argues that policies to address the interfaces between acute care and aged care should view older people as members of the wider Australian population entitled to a range of health services under Medicare rather than focusing only on supposed "bed blockers". In seeking to explain the current level of policy interest in this area, three areas are canvassed: pressures on acute hospital care, particularly those attributed to population ageing; shrinking provision of residential aged care; and the proliferation of post acute services. If policy development is to maintain a wider rather than narrower perspective, attention needs to be given to improving collection and analysis of critical data that are currently unavailable, to developing system-wide funding arrangements for post acute care, and to reassessing what constitutes appropriate hospital activity for younger and older age groups alike.

Acute Disease↗

Nutrition advocacy and national development: the PROFILES programme and its application.

Investment in nutritional programmes can contribute to economic growth and is cost-effective in improving child survival and development. In order to communicate this to decision-makers, the PROFILES nutrition advocacy and policy development programme was applied in certain developing countries. Effective advocacy is necessary to generate financial and political support for scaling up from small pilot projects and maintaining successful national programmes. The programme uses scientific knowledge to estimate development indicators such as mortality, morbidity, fertility, school performance and labour productivity from the size and nutritional condition of populations. Changes in nutritional condition are estimated from the costs, coverage and effectiveness of proposed programmes. In Bangladesh this approach helped to gain approval and funding for a major nutrition programme. PROFILES helped to promote the nutrition component of an early childhood development programme in the Philippines, and to make nutrition a top priority in Ghana's new national child survival strategy. The application of PROFILES in these and other countries has been supported by the United States Agency for International Development, the United Nations Children's Fund, the World Bank, the Asian Development Bank, the Micronutrient Initiative and other bodies.

Africa, Western↗

Research evaluation and policy in dental public health.

Decision and policy makers in dental public health are confronted increasingly with the problem of which programs make the best use of limited resources and are the most worthwhile investments. One way that the research and public health community can assist the decision process and thereby facilitate policy development is through rigorous, objective, quantitative, policy-oriented research evaluations that synthesize findings from relevant epidemiologic studies of particular oral conditions and clinical trials of preventive and treatment technologies. Issues covered in the most recent research evaluations of oral health topics include the assessment of cost-effectiveness analyses for various procedures and techniques used in caries prevention and oral cancer screening. Several papers in the dental public health literature also have critically discussed basic methodologic issues involved in performing cost-effectiveness analyses and implications of research evaluations for the development and assessment of oral health policy.

Cost-Benefit Analysis↗

Time, complex systems, and public policy: a theoretical foundation for adaptive policy making.

Can public policy development and implementation be improved by closely tracking and coordinating its timing with that of the regulated sector? Built-in asynchronies between political process and regulated sectors or activities can produce unintended disruptions in rates of economic change and development undermining the original intent of the policy or regulatory action. Such events sometimes lead to unexpected future disruptions as well. A policy approach is needed that adaptively ties the right mix of resources and regulatory activity to the timing of particular stages of economic development or growth associated with a particular industry. These public policy timing problems are explored using a new theory based on the concepts of "time-ecology," "heterochrony," and "temporal signature." The full range of linear and nonlinear time-space web linkages (electronic, selling and buying, technology transfer are examples) in an government-industry cluster between political, economic, and other elements creates an interconnected ecology-a time-ecology-of unique, more or less intense, and often complex rhythmic pulses occuring in parallel or in a punctuated way, and entrained with or influencing each other across multiple time scales flowing into the future. Each organizational structure is situated in its own past, present, and future in a unique way (time signature). Outside linkages mutually influence structuration by varying rates of development and growth (heterochrony). Nonlinear dynamics may be involved in these interactions. This whole process occurs on linked government/industry adaptive landscapes. The approach detailed in this paper may be applicable to organizational and time related issues in other disciplines. The paper ends with suggestions for testing the theory.

Adaptation, Psychological↗

Role of knowledge in public health and health promotion policy change.

A framework of policy development is presented that identifies the role various forms of knowledge can play in the policy formation process. The framework is based upon the premise that public health and health promotion issues should be addressed within an analysis of policy change that considers concepts of interactive and critical knowledge in addition to scientific knowledge. Progress in developing meaningful health policy will require accepting the validity of these various forms of knowledge and developing frameworks that see experts and citizens working together to develop and achieve public health and health promotion goals.

Health Policy↗

Using knowledge brokering to promote evidence-based policy-making: The need for support structures.

Knowledge brokering is a promising strategy to close the "know-do gap" and foster greater use of research findings and evidence in policy-making. It focuses on organizing the interactive process between the producers and users of knowledge so that they can co-produce feasible and research-informed policy options. We describe a recent successful experience with this novel approach in the Netherlands and discuss the requirements for effective institutionalization of knowledge brokering. We also discuss the potential of this approach to assist health policy development in low-income countries based on the experience of developing the Regional East-African Health (REACH)-Policy Initiative. We believe that intermediary organizations, such as regional networks, dedicated institutional mechanisms and funding agencies, can play key roles in supporting knowledge brokering. We recommend the need to support and learn from the brokerage approach to strengthen the relationship between the research and policy communities and hence move towards a stronger culture of evidence-based policy and policy-relevant research.

Africa, Eastern↗

Development of a policy for patients receiving neuromuscular blocking agents.

PURPOSE: To develop a policy to standardize the care of patients paralyzed with neuromuscular blocking agents (NMBAs). METHODS: Criteria were developed to assess adherence to the policy. Categorical and continuous data were collected and analyzed. RESULTS: Deficiencies were identified in frequency of train-of-four monitoring and in carrying out daily discontinuation of NMBAs to allow effects of paralysis to dissipate. CONCLUSIONS: The policy was useful as an educational tool. A NMBA order form should be developed to improve adherence to the policy.

Adult↗

Positive and negative effects of widespread badger culling on tuberculosis in cattle.

Human and livestock diseases can be difficult to control where infection persists in wildlife populations. For three decades, European badgers (Meles meles) have been culled by the British government in a series of attempts to limit the spread of Mycobacterium bovis, the causative agent of bovine tuberculosis (TB), to cattle. Despite these efforts, the incidence of TB in cattle has risen consistently, re-emerging as a primary concern for Britain's cattle industry. Recently, badger culling has attracted controversy because experimental studies have reached contrasting conclusions (albeit using different protocols), with culled areas showing either markedly reduced or increased incidence of TB in cattle. This has confused attempts to develop a science-based management policy. Here we use data from a large-scale, randomized field experiment to help resolve these apparent differences. We show that, as carried out in this experiment, culling reduces cattle TB incidence in the areas that are culled, but increases incidence in adjoining areas. These findings are biologically consistent with previous studies but will present challenges for policy development.

Animals↗