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PubMed2003

Pro-poor health policies in poverty reduction strategies.

Since 1999, the International Monetary Fund and World Bank have required low-income countries soliciting for debt relief and financial support to prepare a Poverty Reduction Strategy Paper (PRSP). The objective of this study is to arrive at a systematic assessment of the extent to which the first batch of interim PRSPs actually addresses the health of the poor and vulnerable. A literature study was used to design and test a semi-quantitative approach to assess the pro-poor focus of health policies in national documents. The approach was applied to the existing interim proposals for 23 Highly Indebted Poor Countries. Results show that a majority of proposals lack country-specific data on the distribution and composition of the burden of disease, a clear identification of health system constraints and an assessment of the impact of health services on the population. More importantly, they make little effort to analyze these issues in relation to the poor. Furthermore, only a small group explicitly includes the interests of the poor in health policy design. Attention to policies aiming at enhancing equity in public health spending is even more limited. Few papers that include expenditure proposals also show pro-poor focused health budgets. We conclude that our systematic assessment of a new international development policy instrument, PRSP, raises strong concerns about the attributed role of health in development and the limited emphasis on the poor, the supposed primary beneficiaries of this instrument. There is a need and an opportunity for the international development community to provide assistance and inputs as poor countries shift their policy thinking from an interim stage to fully developed national policies. This paper presents a menu of analytical and policy options that can be pursued.

Delivery of Health Care↗

PubMed2004

Providing pharmacy services to care homes in Northern Ireland: a survey of community pharmacists' views.

OBJECTIVE: This study sought to explore the views of community pharmacists as to their present and potential role in providing care to the residents of nursing and residential home in Northern Ireland. METHOD: A structured questionnaire was developed and mailed to all community pharmacists in Northern Ireland (n = 508) on 2 occasions. RESULTS: A response rate of 50% was achieved. Over 40% of responding pharmacists (42.1%) were currently providing medication-related services to care homes for the elderly and 57.9% were not. Of those who were providing services, 50 to 80% were already providing advice to care homes regarding record-keeping, compliance devices, storage and administration of medicines and the use of more appropriate formulations. More than 75% of pharmacists who were not providing services to care homes for the elderly supported all services detailed in a checklist provided on the questionnaire. For pharmacists who were providing services to care homes, 89% agreed that they required access to an up-to-date medical history of care home residents. Over 60% of pharmacists who worked with care homes had experienced difficulties when ordering prescriptions from general practice surgeries. Just over 75% of all respondents stated that they wanted to be more involved in providing pharmaceutical services to care homes to the elderly. CONCLUSION: Community pharmacists expressed enthusiasm for provision of services to care home residents. On-going developments in community pharmacy practice in the UK may facilitate the development of this role and may guide policy development for long-term care in other countries.

Aged↗

PubMed1994

The impact of social science research on health policy.

The relationship between research and health policy is discussed from a policy process perspective, describing communication problems in the course of policy formulation, implementation and evaluation. Policy process is often expected by researchers to be rational, having logical sequence of steps and the objective evaluation of alternatives based on scientific knowledge. In fact, policies are often formulated without clear problem identification or based on wrong assumption. The timing of research and policy-making differs. Policy-makers need to respond quickly. Evaluations may be regarded by politicians as embarrassing if they point to a need for significant change. It is not satisfactory to consider only research and policy-making: their relationship is influenced by the media, different interest groups and by the general public. Health policy formulation is embedded in the general policy environment of particular societies. Some countries have a long tradition of consensus-building, while in others health reforms have been formulated and introduced in a centralized way. Traditional bio-medical thinking influences health policy-makers. The importance of social and political acceptability tends to be overlooked. The paper emphasizes that we are experiencing an era of scarcity of resources and growing tension concerning allocation decisions. Existing institutions provide insufficient incentives for policy-makers and researchers to promote public dialogue about such issues. The paper concludes that there is a need for new approaches to policy development and implementation, new structures in policy-making, changes in research financing and co-operation between disciplines and new structures for public participation in policy-making. Research should facilitate more open and democratic dialogue about policy options and the consequences of alternative choices.

Communication↗

PubMed2006

How do treatment repeaters use the drug treatment system? An analysis of injection drug users in Massachusetts.

This study explored common drug treatment utilization patterns in the first four types of treatments entered by injection drug users (IDUs) with multiple admissions. A Massachusetts longitudinal database with all entries to all licensed drug treatment programs was used. Treatment repeaters' admission patterns varied considerably. For the years 1997-2001, there were 2,500-3,000 IDUs new to the system each year who became treatment repeaters and who had more than 250 utilization patterns. Only approximately half of these repeaters followed the 10 most common utilization patterns. The most common pattern (for 30% of the population each year) was only entering detoxification two to four times; the only other common pattern (involving 4-8% of the population) was having entered methadone maintenance twice or having entered detoxification then methadone maintenance. Studies are needed to identify the extent to which the absence of a systematic pattern is caused by client, payment, or treatment setting and systems issues. A key implication is the need to develop policies that provide support for states to develop continuum-of-care models for their drug treatment systems.

Adult↗

PubMed2004

Drug development strategies for asthma: in search of a new paradigm.

The spiraling costs of asthma treatment seem set to continue rising, given the equivocal performance of the latest generation of specific anti-inflammatory drugs in trials in adult asthmatics. We argue that the continuation of this trend is inevitable unless there is a substantial realignment of entrenched drug development policy in the pharmaceutical industry and a parallel shift in licensing policy by regulatory authorities to encourage the development of drugs capable of halting the progression from acute to chronic asthma when the disease first manifests in childhood. The theoretical framework for such an approach, including proof-of-principle data from studies in children with early-stage disease and a range of candidate drugs, already exists. What is needed is informed debate on the risks versus potential benefits of this approach.

Animals↗

PubMed2001

Application of population screening principles to genetic screening for adult-onset conditions.

Recent advances in molecular genetics have highlighted the potential use of genetic testing to screen for adult-onset chronic diseases. Several issues must be addressed, however, before such tests can be recommended for population-based prevention programs. These issues include the adequacy of the scientific evidence, the balance of risks and benefits, the need for counseling and informed consent, and the costs and resources required. Ongoing assessment of the screening program and quality assurance of laboratory testing are also needed. This paper considers the application of general principles for mass screening to genetic testing for susceptibility to adult-onset chronic diseases. Evaluation of proposals for genetic screening in context of these principles reveals that needed evidence is often absent, particularly with respect to the predictive value of tests, efficacy of interventions, and social consequences of testing. The principles of population screening are developed into a framework for public health policy on genetic screening that has three stages: assessment of the screening test and interventions for those who test positive, including assessment of risks and costs, policy development, and program evaluation. Essential elements are identified, including evaluation of evidence and processes for consensus development and program evaluation. The proposed framework for public health policymaking outlined in this commentary, when combined with future efforts that involve an authoritative consensus process, may be useful for the evaluation and planning of genetic screening programs aimed at reducing morbidity and mortality from adult-onset chronic diseases.

Adult↗

PubMed2003

Long-term care research and policy.

This article provides a framework for understanding how long-term care (LTC) research contributes to policy, develops a typology of research contributions to policy with examples of each type, and suggests ways to ensure that contributions continue in the future. The article draws on in-depth interviews with LTC experts working at the interface between research and policy, as well as a small, informal Internet survey and the relevant political science and health policy literature. LTC research makes important contributions to policy, but its contributions easily go unrecognized because they are subtle and often depend on research investments made many years before policy is affected. Thus, it is important to consider what investments in LTC research initiatives and infrastructure are needed to ensure the future contributions of research to policy and to identify barriers to funding such investments. A number of steps that researchers can take to enhance the future contribution of research to LTC policy are proposed.

Activities of Daily Living↗

PubMedDate not supplied

The nurse endoscopist: reality or fiction?

In this article, the author describes a study conducted to determine whether advanced practice registered nurses (APRNs) should perform endoscopic procedures, such as colonoscopy and esophagogastroduodenoscopy. Questionnaires were mailed to APRNs belonging to the Society of Gastroenterology Nurses and Associates. Questionnaire items pertained to demographics, current activities, interest in performing GI endoscopic procedures, and barriers to performing GI endoscopic procedures. Over 70% of respondents approved of nurses performing diagnostic endoscopic procedures, yet 80.6% did not think that nurses should perform therapeutic endoscopic procedures. Training opportunities were limited. The barriers to performing endoscopic procedures included liability, third-party reimbursement, lack of physician support, lack of policies, and lack of education. APRNs should develop policies and establish acceptable training guidelines and competency rates in performing GI endoscopic procedures.

Clinical Competence↗

PubMed2002

Proposing an evidence-based policy process.

Nurses' involvement with policy development may appear more feasible if the policy process is viewed as another example of an evidence-based decision-making process. Evidence-based practice is widely accepted in medicine and across health care as a sound principle or approach when attempting to establish "best" practice. The process of searching for and synthesizing the evidence is applied to the policy design process with the use of policy examples that are relevant to nurse administrators.

Benchmarking↗

PubMed1989

Health authority policies for the prevention of alcohol problems.

Although national policy has a major influence in preventing alcohol problems, much can be done at a local level. In addition national policy can either be made or at least influenced from the local level, and local communities are well placed to change attitudes and influence key processes, thus creating a climate for appropriate national debates and policy developments. This paper addresses why a local policy is needed for the prevention of alcohol problems, and then considers a number of the components of such a policy, how such a policy might be implemented, and how such a policy might be evaluated.

Alcoholism↗

PubMed2005

Passing a smoke-free law in a pro-tobacco culture: a multiple streams approach.

This article describes a case study of the policy development and political decision-making process involved in the enactment of Lexington, Kentucky's smoke-free law. The multiple streams framework is used to analyze the development of the law in a seemingly unlikely and challenging political environment. Proponents developed a dissemination research plan targeted at policy makers and the public to demonstrate the need for a comprehensive law. The existence of a strong coalition of health care providers and health care systems including the board of health, as well as long-standing tobacco control expertise and a strong legal team, were essential ingredients for success. A deliberate strategy to expose the tobacco industry was effective in preparing policy makers for the opponents' policy arguments. As expected, a hospitality industry association was formed to oppose the ordinance, resulting in a legal challenge that delayed enactment of the law.

Culture↗

PubMedDate not supplied

Angina and socio-economic status in Ontario: how do characteristics of the county you live in influence your chance of developing heart disease?

OBJECTIVE: To assist in the development of community heart health programming and policy development, the Central West Health Planning Information Network (CWHPIN) was asked by its partners to collaborate in obtaining information that might clarify the relationships between socio-economic status (SES) and heart disease among residents of Ontario, Canada. The purpose of this component of the project was to explore, at the county level, how much of the variation in angina pectoris (angina) could be explained by SES variables. STUDY DESIGN: Linear regression modeling was used to identify key predictors of angina hospitalization rates in counties Ontario-wide. RESULTS: Results of the linear regression modeling showed that SES variables (most notably education and occupation) were key predictors of angina, even when traditional risk factors (i.e., smoking, etc.) were included in the analysis. CONCLUSION: This study demonstrates that, at the county level, socio-economic variables such as education and occupation have a significant relationship with rates of heart disease at the population level, even when including the traditional risk factors in the analysis.

Adult↗

PubMedDate not supplied

Spatial pattern of migration of plantation labour and its dynamics.

"This study examines the issue of migration trends being witnessed by areas of plantation agriculture [in India]. The focus is on the linkages between structural changes in local economies, the overall development policy and people's responses to plantation agriculture both as an economic activity and as a way of life. Based on field data, it is a case study of Hassan district, Karnataka."

Agriculture↗

PubMed2005

Using poison data to develop treatment and policy: a Scottish perspective.

The development of clinical toxicology over the past 50 years has been extensive. This article illustrates ways in which the clinical toxicology unit in Edinburgh has used a combination of public health data, poisons information data, and clinical data to inform policy and aid clinical management of patients with poisoning. Integration of public health systems with poisons information and clinical treatment services is an important tool for the future development of clinical toxicology.

Drug Information Services↗

PubMed1997

Migrants, refugees and foreign policy: prevention and intervention strategies.

The authors discuss policy development options to deal with migrants and refugees to developed countries. "Our principal argument--perhaps to state the obvious--is that international migration and refugee movements are foreign policy, not simply domestic, issues. Nevertheless, citizens and policy makers are all too often unaware that if they want to secure their borders against unwanted population flows, this cannot be done simply by unilateral decisions to regulate entry." The focus is on Germany and the United States.

Americas↗

PubMed2000

New for old--recent developments in public policies towards older workers in the United Kingdom.

This article reviews recent developments in public policies towards older workers in the United Kingdom. In the last decade, against a background of population ageing, tightening labour markets and a recognition that older workers face barriers in the labour market, successive UK governments have begun to implement policies aimed at increasing labour force participation rates among this group. These have included education campaigns encouraging the recruitment and retention of older workers by firms and assistance and guidance aimed at helping older workers to obtain training and to make decisions about returning to work. The impact of these policies is discussed and proposals for developments in policies are set out.

Aged↗

PubMed2006

Uneven dietary development: linking the policies and processes of globalization with the nutrition transition, obesity and diet-related chronic diseases.

In a "nutrition transition", the consumption of foods high in fats and sweeteners is increasing throughout the developing world. The transition, implicated in the rapid rise of obesity and diet-related chronic diseases worldwide, is rooted in the processes of globalization. Globalization affects the nature of agri-food systems, thereby altering the quantity, type, cost and desirability of foods available for consumption. Understanding the links between globalization and the nutrition transition is therefore necessary to help policy makers develop policies, including food policies, for addressing the global burden of chronic disease. While the subject has been much discussed, tracing the specific pathways between globalization and dietary change remains a challenge. To help address this challenge, this paper explores how one of the central mechanisms of globalization, the integration of the global marketplace, is affecting the specific diet patterns. Focusing on middle-income countries, it highlights the importance of three major processes of market integration: (I) production and trade of agricultural goods; (II) foreign direct investment in food processing and retailing; and (III) global food advertising and promotion. The paper reveals how specific policies implemented to advance the globalization agenda account in part for some recent trends in the global diet. Agricultural production and trade policies have enabled more vegetable oil consumption; policies on foreign direct investment have facilitated higher consumption of highly-processed foods, as has global food marketing. These dietary outcomes also reflect the socioeconomic and cultural context in which these policies are operating. An important finding is that the dynamic, competitive forces unleashed as a result of global market integration facilitates not only convergence in consumption habits (as is commonly assumed in the "Coca-Colonization" hypothesis), but adaptation to products targeted at different niche markets. This convergence-divergence duality raises the policy concern that globalization will exacerbate uneven dietary development between rich and poor. As high-income groups in developing countries accrue the benefits of a more dynamic marketplace, lower-income groups may well experience convergence towards poor quality obseogenic diets, as observed in western countries. Global economic policies concerning agriculture, trade, investment and marketing affect what the world eats. They are therefore also global food and health policies. Health policy makers should pay greater attention to these policies in order to address some of the structural causes of obesity and diet-related chronic diseases worldwide, especially among the groups of low socioeconomic status.

Journal Article↗

PubMed1994

Reducing violent injuries: priorities for pediatrician advocacy.

A basic framework for developing an advocacy plan must systematically break down the large task of policy development implementation into manageable components. The basic framework described in detail in this paper includes three steps: Setting policy objectives by narrowing the scope of policy, by reviewing policy options, and by examining options against selected criteria. Developing strategies for educating the public and for approaching legislative/regulatory bodies. Evaluating the effectiveness of the advocacy action plan as a process and as an agent for change. To illustrate the variety of ways in which pediatricians can be involved in the policy process to reduce violent injuries among children and adolescents, we apply this systematic approach to three priority areas. Prohibiting the use of corporal punishment in schools is intended to curb the institutionalized legitimacy of violence that has been associated with future use of violence. Efforts to remove handguns from the environments of children and adolescents are aimed at reducing the numbers of firearm injuries inflicted upon and by minors. Comprehensive treatment of adolescent victims of assault is intended to decrease the reoccurrence of violent injuries.

Adolescent↗