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PubMed2006

An analysis of public-interest group positions on radiation protection.

The history of radiation risk management is replete with contentious public debate between public interest groups and the technical community of radiation protection professionals. To promote a deeper understanding of this phenomenon, this paper describes the rationales and values underlying public-interest group positions in one radiation risk domain (low-level waste) and contrasts them with those of the technical community. Public interest group objections to recycling of radioactivity-contaminated materials and to discarding of other low-level wastes are made on fairness, risk assessment, and energy-policy grounds. Concerns about procedural fairness stem from the continuing use of top-down expert-driven, rather than deliberative, systems for low-level waste policy-making. Concerns about distributional fairness arise because the benefits and risks of alterative low-level waste policies accrue to different stakeholders. Risk assessment is faulted for failure to acknowledge hidden subjective assumptions (e.g., on screening vigilance in materials recycling, on integrity of disposal facilities in the far future). Skepticism of technological risk management arises from a history peppered with unexpected untoward events that lay outside the design bases of protection systems. Finally, public interest groups view low-level waste issues as part of a larger debate on wise and legitimate energy policy, and are reluctant to support measures that provide relief to a nuclear industry that, in their view, established itself outside the democratic process.

Consumer Advocacy↗

PubMed2003

Pre-assessment to assess the match between cost-effectiveness results and decision makers' information needs: an illustration using two cases in rehabilitation medicine in The Netherlands.

OBJECTIVE: To determine if a pre-assessment can be used to establish whether cost-effectiveness results would meet the actual information needs of Dutch healthcare decision makers. METHODS: Two recent studies in rehabilitation medicine served as study material. Based on Wholey, a limited pre-assessment was performed in which the potential impact of cost-effectiveness analysis (CEA) results on intended users' decision making was assessed. Desk research and semi-structured interviews with several intended users of CEA results were performed. These included general practitioners, representatives of health insurance companies, the Health Care Insurance Board (CvZ), and medical guidelines committees. RESULTS: In day-to-day decision making of the interviewed decision makers, a cost-effectiveness criterion seemed to be of limited importance. Instead, results from clinical effectiveness studies and budget impact studies appeared to be sufficient. CvZ, however, preferred relative cost-effectiveness to be a criterion for inclusion in future reimbursement guidelines. In both cases the limited pre-assessments changed the expectations of the investigators regarding decision-making impact of an economic evaluation. CONCLUSION: This study revealed that the use of CEA results for Dutch micro- and meso-level healthcare decision making is not self-evident. The main purpose of CEA results is to support health policy making and planning at a macroeconomic level. Pre-assessment can be a valuable tool in designing a CEA to support the actual information needs of the decision makers.

Access to Information↗

PubMed2002

Agent-based modeling as organizational and public policy simulators.

Agent-based models are an increasingly powerful tool for simulating social systems because they can represent important phenomenon difficult to capture in other mathematical formalisms. But, agent-based models have provided only limited support for policy-making because their distinctive abilities are often most useful in situations where the future is unpredictable. In such situations, the traditional analytic methods for applying simulation models to support decision-making are least effective. Fortunately, new analytic approaches for decision-making under conditions of deep uncertainty--emphasizing large ensembles of model-created scenarios and adaptive policies evaluated with the criteria of robustness, rather than with optimality or efficiency--can unleash the full potential of agent-based policy simulators.

Journal Article↗

PubMed1993

From large projects to case consultation--interaction of alcohol research and policy in Finland.

The interaction of Finnish social alcohol research and alcohol policy will be discussed in this paper. We will examine the history of alcohol research, focusing on the extent that problems related to alcohol policy have been covered in research. We also deliberate upon such questions as to what extent changes in alcohol policy can be linked to the findings of research. Researchers began their work in the 1950s, hoping to find a solution to the problems met in alcohol policy. In the 1960s the era of alcohol policy-centred projects was followed by an era which aimed to increase the factual knowledge of alcohol not necessarily tied to alcohol policy questions. After 1969 alcohol policy questions gained renewed interest. Alcohol research has not directly caused many new measures, but it has influenced the public and private discussion about alcohol policy. Producing results and research reports has been an important way to affect both public discussions and policy making. However, participating in the decision making processes in its different stages has been an even more crucial way to affect alcohol policy. Particularly in the 1970s, the ideas and views presented in studies had fairly immediate and direct repercussions on both alcohol policy and practical measures.

Alcohol Drinking↗

PubMed2003

Policy and ethical issues in applying medical biotechnology in developing countries.

A brief review of some of the key issues in policy relating to the ethical issues raised by medical biotechnology in developing countries is presented, using India as an example. A series of some key issues is discussed, including information obtained from interviewing Indian government policy makers. Some of the issues discussed include: Economic and social incentives to encourage biotechnology; Health policy and ethics review; Patents on drugs; Medical genetics; Relationship to traditional medical practices; Positive public attitudes to biotechnology; Limited public participation; Infrastructural hurdles; Indian progress in stem cell research; and dilemmas of expensive technologies. The results show that although the needs of developing countries are different to those of rich countries, government policy utilizing guidelines and ethics committees has evolved as mechanisms to aid ethical health care delivery in India. In all countries there may be some of these concerns that are raised here, however, the integration of traditional medicine and advanced medical technology, and access to medical services by people in need, are particularly important challenges in developing countries. Better public involvement in policy making will require education and infrastructural organization as well as mutual willingness on the part of policy makers and citizens.

Attitude to Health↗

PubMedDate not supplied

Strengthening black and minority community coalitions for health policy action.

African Americans and other racial/ethnic minorities suffer greater disparities in health and quality of life than do nonminorities. Health professionals are challenged to improve the health of minority communities by mobilizing minority people to participate in the public policy process through coalition building. The purpose of this article is to examine the role of the nurse in community development and the policy making process. A case study analyzing one nurse's role in community activism for child care policy is presented. Recommendations are provided for strengthening the involvement of minority community coalitions in influencing policy initiatives.

Black or African American↗

PubMed2004

On food and nutrition policy activities in the USA, Australia, and Norway.

Formulation and implementation of a national food and nutrition policy is important for ensuring good health and quality of life. This study examined the formulation and implementation of food and nutrition policies in the USA, Australia, and Norway. Library searches, MEDLINE and POPLINE searches, and personal communications were used for collecting information and data on nutrition activities and policy formulation and implementation in each country. These countries were selected because policy activities have been ongoing since the 1930s with a clear improvement in the nutritional status of the people. Multisectoral participation, conflicts of interest, strategies to alter diet, and attempts to deal with new problems have been highlighted and compared. Findings of the study may be useful to policy-makers in less-developed countries during future policy-making processes.

Australia↗

PubMed2006

Managing partnerships and impact on decision-making: the example of health technology assessment in genetics.

For an emerging field such as Public Health Genetics, the partnerships that will be developed with stakeholders are of strategic importance, since they may affect long-term impact on policy-making. A concrete example in the field of health technology assessment in genetics was chosen to illustrate how the context in which scientific advisory bodies operate and the nature of partnerships developed over time influence the impact on decision-making at different levels, from the micro (professional) level through the meso (institutional) level to the macro (policy) level. As pointed out in the knowledge transfer literature, impact is not only reflected by instrumental use of knowledge, but also by problem-framing and strategic use of knowledge. Solid partnerships at the micro level, with researchers and health care professionals, are essential to build credibility and trust, and they lay the groundwork for contextualized and relevant advice and potential impact at the policy level. Even though maintaining the necessary critical distance with respect to all stakeholders is easier for institutions that are at arm's length from government, achieving the right balance between an institution's independence and service relationship is a real challenge.

Advisory Committees↗

PubMed2002

Integrating health law and health policy: a European perspective.

Health law is intended to create an environment in which the promotion of health goes hand in hand with the protection of individual rights and the general principles of equality and justice. Over the years, the importance of health law has grown, both at national and international level. As health and human rights are closely interlinked, it is important to integrate health law and health policy. It is to be expected that, especially in Europe, the impact of health law on health policy-making will increase as a result of several developments, e.g. the internationalization of health care and health policy, the issue of consumer protection and the legalization of society. This requires a strategy to stimulate the fruitful relationship between health policy and health law. The most important components of this strategy are discussed.

Consumer Advocacy↗

PubMed1998

The impact of health economics on health policy in England, and the impact of health policy on health economics, 1972-1997.

This paper contains a review of the impact of health economics on health policy in England during the past 25 years. Some health economists have expressed disappointment with the scale of the impact that health economics has had on policy but the record set out below suggests that there is modest cause for celebration. That is not to say that there is cause for complacency. There is still a long way to go before all important health policies are based on sound economics reasoning and evidence. The paper begins with some definitions and background; it covers nine areas of health policy, and health policy making, where past impacts of health economics have been postulated; it covers briefly the reciprocal impact of health policy on health economics; and it concludes with a discussion about the findings.

Economics, Medical↗

PubMed1999

Preventing morbidity and mortality from sickle cell disease. A public health perspective.

CONTEXT: Sickle cell disease is a group of conditions characterized by production of abnormal hemoglobin, with clinical manifestations that vary by genotype and age. OBJECTIVE: To discuss current public health issues associated with sickle cell disease, and approaches to preventing complications from these conditions in the United States. DESIGN: Literature review. RESULTS: Most clinical interventions for people with sickle cell disease discussed in the medical literature can be classified as tertiary prevention: for example, therapy to ameliorate anemia, reduce the frequency of pain crises, or prevent stroke recurrences. A form of secondary prevention, newborn screening, has emerged as an important public health approach to identifying affected children before they develop complications. Newborn screening is the starting point for simple public health strategies such as parental education, immunization, and penicillin prophylaxis. Identification of affected families by newborn or community screening programs has also been an entry point for genetic counseling, although utilization of prenatal testing has varied by factors such as geographic location. Public health agencies have had significant involvement with funding, policy making, and formulation of laboratory and clinical guidelines for sickle cell disease. Since the introduction of penicillin prophylaxis policies, newborn screening, new immunizations, and comprehensive medical care centers, the survival of young children with sickle cell disease has improved. CONCLUSIONS: Although the efforts of preventive medicine providers in public health programs are not solely responsible for the improved survival of children with sickle cell disease, such programs remain an important component in preventing sickle cell complications.

Anemia, Sickle Cell↗

PubMed2003

Post-war smoking policy in the UK and the redefinition of public health.

Current analyses of UK smoking policy within two frameworks--the 'heroes and villains' view of journalist accounts and a political science emphasis on rival 'producer' and 'issue' networks in policy making. It is often assumed that the US experience provides a universal historical model. This paper sees smoking policy in the UK as a case study in the relationship between 'scientific fact creation' and policy, which has also been emblematic of wider changes in public health ideology. The issue of smoking and lung cancer symbolized the post-war shift from infectious to chronic disease and the rise of a new 'lifestyle'-oriented public health. In the 1980s passive smoking brought a revival of environmentalism; in the 1990s the rediscovered concept of addiction symbolized developments in public health in which curative and preventive initiatives were entwined. Despite the rise of a militant 'healthism' within both anti-smoking and public health since the 1970s, British policy retained a dual focus, an emphasis on risk reduction as well as risk elimination in which policy networks were entwined rather than distinct. Some public health scientists worked in policy milieux, notably the expert committee, which crossed this apparent divide and which linked with industry. Connections between government and industry changed as public health 'treatment' brought the pharmaceutical industry into the picture.

Health Policy↗

PubMed2004

Risk and climate change: perceptions of key policy actors in Canada.

This article examines factors that predict perceptions of risk associated with global climate change. The research focuses on the perceptions of those associated with climate change policy making in the prairie region of Canada. The data are from an online survey (n=851) of those policy actors. The analysis integrates several dominant approaches to the study of risk perception: psychometric approaches that examine the effects of cognitive structure; demographic assessments that examine, for example, differences in perception based on gender or family status; and political approaches that suggest that one's position in the policy process may affect his or her perceived risk. Attitudes toward climate change are to a degree predicted by all of these factors, but only when indirect effects are observed. Sociodemographic characteristics have little direct effect on perceived risk, but do affect general beliefs that affect risk perceptions. Perceived risk is related more strongly to these general beliefs or world views than to more specific beliefs about the effects of climate change on weather patterns. Position within the policy process also contributes to our understanding of perceptions, with industry and governmental actors demonstrating similar attitudes, which contrast with environmental groups and university researchers.

Journal Article↗

PubMed1989

Community participation or community manipulation? A case study of the Illawarra Cancer Appeal-a-thon.

Fashion parades, balls, raffles, and weekly deductions from thousands of workers' pay packets were integral to success of the Cancer Appeal-a-thon in the Illawarra region. In 1986-87 the Illawarra community was induced to contribute $1.5 million in order to purchase a linear accelerator for the Wollongong Hospital. The community agreed that a radiotherapy machine was the number one health service priority for the region. Or did it? Application of Alford's structural interests framework to this case-study reveals how failure to examine power relations between medical monopolizers, health care rationalizers and community participants results in an inability to recognise that alternative community needs--for cancer prevention, domiciliary care, or alternative therapies--might be unarticulated or unobservable, and in an inability to ask whether the community may be mistaken about, or unaware of, its own health needs. Specifically, the paper argues that, 'community needs' are easily manipulated or distorted by powerful interest groups and that the political context within which community needs are recognized, articulated and mobilized is the most important issue for community participation in the health policy-making process.

Community Participation↗

PubMed1980

China's health system: determinants.

This paper seeks to examine and explain the changes in China's health policy since 1949. It attempts to clarify the role of various determinants in the health policy-making process in various stages of China's development and discover what forces propelled the shifts in health policies and campaigns. Various social, economic and political forces are discussed as they bear on the evolution of China's health policies, and the fate of Maoist vs. pragmatic tendencies is assessed.

China↗

PubMedDate not supplied

End-of-life research as a priority for pediatric oncology.

Approximately 2,200 children and adolescents die a cancer-related death each year in the United States; of these, almost 90% will die while experiencing 2 to 8 troubling symptoms. With improved symptom control and end-of-life care, these patients might suffer less before they die and their survivors might experience fewer or less intense adverse physical and mental conditions secondary to their bereavement. The focus of this article is on five key areas related to end of life where research is critically needed; (a) the characteristics of cancer-related death and the profiles of survivorship in bereaved family members and health care providers, (b) the trajectory of dying in children and adolescents and a comparison of care delivery preferred by the family and that actually delivered, (c) end-of-life decision making, (d) the financial costs of a child or adolescent dying a cancer-related death and associated policy making, and (e) outcomes of symptom-directed or bereavement interventions. Knowing the characteristics of cancer-related deaths in children and adolescents will help researchers and clinicians develop and test effective interventions related to symptom management, decision making, and availability of care delivery models that match the dying child's needs and preferences. Such interventions could also contribute to the highest quality and cost-effective care being provided to the bereaved survivors.

Adaptation, Psychological↗

PubMed1997

Large-scale organizational and managerial change in health care: a review of the literature.

This paper takes an overview of the organizational and managerial literature on recent large-scale change efforts within health care organizations. Such literature refers to issues of enhanced policy significance, as a succession of such changes has swept through health care, at an international level. Interpretive and case study method have been widely employed in this field. While the literature is emergent, key empirical concerns can be identified: (1) Changing roles and relationships, with the rise of management and the challenge to clinical domination; some argue that radical deprofessionalization now is evident, while others take a more nuanced view. (2) The impact of marketization, with health care becoming more of a commodity; various models of a health care 'quasi market' have been formulated. (3) Understanding the process of change in health care organizations, such as the development of a management of change literature. New theoretical frameworks have been developed, notably 'the reform cycle' as a way of understanding progressive cycles of organizational reform, the impact on health care of the rise of the new public management, and examining the demedicalization thesis through the more generic literature on professions. The paper concludes with a discussion of what this research base could contribute to policy-making.

Economic Competition↗

PubMed2003

Cancer Battles and the Sleep of Reason policy and science need not be related.

Cancer Battles and the Sleep of Reason is an inquiry into the role of scientific experts in environmental health policy-making. The article first establishes two propositions: that there is no necessary relationship between science and environmental health policy; and that risk assessment is not the only science of environmental health. It then asks the question: why should policy-makers consult the scientific experts? If experts are to be consulted, there will have to be some way of grading experts as to the quality of their advice and their usefulness to policy-makers. A mode of grading experts is provided in Environmental Cancer--A Political Disease? by S. Robert Lichter and Stanley Rothman. But the arguments in this book are shown to be worthless; the book fails to address the underlying issue of why the experts should be consulted at all. The article concludes that experts are to be consulted whenever policy-makers consider their advice to be essential or useful. There is nothing in the scientific disciplines that entrenches them in the policymaking process; the opinions of scientific experts have no special place in environmental health policy.

Journal Article↗