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PubMedDate not supplied

Development of healthy public policy: feminist analysis of conflict, collaboration and social change.

In the past two decades, the need for economic restructuring has served as a rationale for dismantling social programs in Canada. As it has been enacted, such social restructuring has disproportionately affected marginalized people, particularly women. In this article we explore the schism between the principles that underlie the development of healthy public policy and those that are driving current social policy development. Through this analysis we discuss the implications of policy development that is based upon principles of inequity, and we suggest that implementation of healthy public policy requires transformational change in the underlying principles of the social system. A policy shift based upon principles of equity and social justice has been espoused throughout the health promotion literature. We suggest that such a shift will be facilitated by strengthening collaborative relations among points of conflict within society and among policy makers and women's organizations.

Canada↗
PubMed1989

Public policy, local labor demand, and migration in Sweden, 1979-84.

"A model of private local labor demand and interjurisdictional migration is presented and estimated using data from Swedish counties and municipalities for 1979-84. Our goal is to compare the effects on local labor markets of distinctive public-sector programs with those of traditional market variables. We find that local income taxes and tax-equalization grants have important effects on local labor markets; regional development policy measures and geographical-mobility subsidies do not. Thus, recent efforts scaling back some of these programs may not materially alter the regional economy's performance. Wages and other traditional market variables are also often found to influence significantly local labor markets."

Demography↗
PubMed2005

After-hours coverage: national survey of policies and guidelines for primary care physicians.

OBJECTIVE: To determine the prevalence and content of existing or developing policies and guidelines of medical associations and colleges regarding after-hours care by family physicians and general practitioners, especially legal requirements. DESIGN: Telephone survey in fall 2002, updated in fall 2004. SETTING: Canada. PARTICIPANTS: All national and provincial medical associations, Colleges of Family Physicians, Colleges of Physicians and Surgeons, local government offices for the north, and the Canadian Medical Protective Association (CMPA). MAIN OUTCOME MEASURE: RESPONSE TO THE QUESTION: "Does your agency have a policy in place regarding after-hours health care coverage by FPs/GPs, or are there active discussions regarding such a policy?" RESULTS: The College of Physicians and Surgeons of British Columbia was the first to institute a policy, in 1995, requiring physicians to make "specific arrangements" for after-hours care of their patients. The College of Physicians and Surgeons of Alberta adopted a similar policy in 1996 along with a guideline to aid implementation. In 2002, the College of Physicians and Surgeons of Nova Scotia approved a guideline on the Availability of Physicians After Hours. The Saskatchewan Medical Association and the College of Physicians and Surgeons of Saskatchewan formulated a joint policy on medical practice coverage that was released in 2003. Many agencies actively discussed the topic. Provincial and national Colleges of Family Physicians did not have any policies in place. The CMPA does not generate guidelines but released in an information letter in May 2000 a section entitled "Reducing your risk when you're not available." CONCLUSION: There is increasing interest Canada-wide in setting policy for after-hours care. While provincial Colleges of Physicians and Surgeons have traditionally led the way, a trend toward more collaboration between associations was identified. The effect of policy implementation on physicians' coverage of patients is unclear.

After-Hours Care↗
PubMed2005

Science, policy, and stakeholders: developing a consensus science plan for Amchitka Island, Aleutians, Alaska.

With the ending of the Cold War, the US Department of Energy is responsible for the remediation of radioactive waste and disposal of land no longer needed for nuclear material production or related national security missions. The task of characterizing the hazards and risks from radionuclides is necessary for assuring the protection of health of humans and the environment. This is a particularly daunting task for those sites that had underground testing of nuclear weapons, where the radioactive contamination is currently inaccessible. Herein we report on the development of a Science Plan to characterize the physical and biological marine environment around Amchitka Island in the Aleutian chain of Alaska, where three underground nuclear tests were conducted (1965-1971). Information on the ecology, geology, and current radionuclide levels in biota, water, and sediment is necessary for evaluating possible current contamination and to serve as a baseline for developing a plan to ensure human and ecosystem health in perpetuity. Other information required includes identifying the location of the salt water/fresh water interface where migration to the ocean might occur in the future and determining groundwater recharge balances, as well as assessing other physical/geological features of Amchitka near the test sites. The Science Plan is needed to address the confusing and conflicting information available to the public about radionuclide risks from underground nuclear blasts in the late 1960s and early 1970s, as well as the potential for volcanic or seismic activity to disrupt shot cavities or accelerate migration of radionuclides into the sea. Developing a Science Plan involved agreement among regulators and other stakeholders, assignment of the task to the Consortium for Risk Evaluation with Stakeholder Participation, and development of a consensus Science Plan that dealt with contentious scientific issues. Involvement of the regulators (State of Alaska), resource trustees (U S Fish and Wildlife Service), representatives of the Aleut and Pribilof Island communities, and other stakeholders was essential for plan development and approval, although this created tensions because of the different objectives of each group. The complicated process of developing a Science Plan involved iterations and interactions with multiple agencies and organizations, scientists in several disciplines, regulators, and the participation of Aleut people in their home communities, as well as the general public. The importance of including all parties in all phases of the development of the Science Plan was critical to its acceptance by a broad range of regulators, agencies, resource trustees, Aleutian/Pribilof communities, and other stakeholders.

Alaska↗
PubMedDate not supplied

Dealing with the unsafe student in clinical practice.

How do social justice issues affect the clinical evaluation of students? An emotionally charged issue, clinical evaluation can become a mine field when it becomes entangled with issues of social justice. The authors discuss the issues of justice and fairness in relation to situations that arise when a student repeatedly fails to meet minimum expectations for clinical performance. They discuss policies developed to deal with such situations and describe the application of these policies in a case study.

Aged↗
PubMed2003

The organisation of the Department of Veterinary Services in Malaysia.

The Department of Veterinary Services (DVS) in Malaysia was established in 1888 as an agency to control exotic and domestic animal diseases. Over the years, the structure and functions of the organisation have evolved to meet the growing demand for veterinary services. The responsibilities of the Veterinary Services are enshrined in the Constitution of Malaysia. The current organisation of the DVS is structured to achieve the following objectives:---to prevent, control and eradicate animal and zoonotic diseases--to facilitate the growth and development of a strong animal industry--to ensure that animal products for human consumption are wholesome, clean, safe and suitable to be consumed--to facilitate the growth and development of the animal feed industry--to ensure the welfare and well-being of all animals. To meet these objectives the DVS has nine different divisions, as follows: Planning and Evaluation, Epidemiology and Veterinary Medicine, Veterinary Public Health, Research and Development, Industry Development, Production and Development of Genetic Resources, Human Resource Development (HRD), Enforcement, and Administration. The development of the animal industry is managed through national development policies, including the Third National Agriculture Policy. The basis for current programmes for disease control and animal industry development is the Eighth Development Plan (2001-2005). Over the period of this Plan, Malaysia will address the need for sanitary and phytosanitary measures by developing specific programmes covering all fields of the animal industry. This is just one way in which Malaysia is meeting the challenges of the increased liberalisation of trade created by the World Trade Organization and the Association of Southeast Asian Nations Free Trade Area. The development of the industry is focused on the major commodities, namely, beef, mutton, poultry meat, eggs, pork and milk. Other commodities receive support if it is considered economically viable. All support services are being strengthened, particularly the HRD division. The organisation and functions of the DVS are constantly being reviewed in accordance with changes in the animal industry and the nature of the services in demand.

Animal Diseases↗
PubMed1998

The role of clinical practice guidelines in disease management.

UNLABELLED: This activity is designed for medical directors, pharmacy directors, quality assurance managers, and all members of disease management or quality improvement teams. GOAL: To review the guideline literature and help healthcare organizations plan guideline development and implementation strategies. OBJECTIVES: 1. Clarify the terminology used in practice policy development. 2. Explain how guideline implementation is related to disease management. 3. Discuss interventions utilized to enhance guideline adoption. 4. Provide a stepwise plan for healthcare organizations to follow.

Algorithms↗
PubMed1980

Federal drug policy and terminology: foes or allies?

A myriad of reasons exists for the persistence of drug use as a social phenomenon. To demonstrate one source of much of the controversy in drug issues and federal drug policy, an examination of the definitions applied to the terms "drug," "drug abuse," and "drug dependence" is conducted. Emphasis is placed on the implications of this terminology on US government drug policy development. Based on this examination, the author finds that many of the definitions applied to the above terms are vague and the basis for many misconceptions. In many cases, legal considerations take precedence over therapeutic evaluations. Furthermore, the informational systems which utilize these findings suggest that further development of drug terminology and data acquisition systems, upon which federal drug policy must depend, is sorely needed.

Drug Information Services↗
PubMed1996

Welfare reforms and services for children and families: setting a new practice, research, and policy agenda.

This article addresses barriers to family and community self-sufficiency. Many of these barriers have resulted from policymakers' biased definitions of self-sufficiency and related social program reforms. Social workers need to understand the worldviews and values that underlie political definitions of self-sufficiency to have a greater influence on social policy. This article describes a more appropriate definition of self-sufficiency and illustrates its usefulness with an example of community research conducted to identify social support needs. The author recommends changes in social work practice and education that can enable the profession to have a stronger influence on social policy. Finally, to achieve this social justice goal and integrate policy development into clinical and community practice, the author proposes new research and policy agendas for the profession.

Aid to Families with Dependent Children↗
PubMed1985

Teaching nursing homes: their impact on public policy, patient care, and medical education.

In summary, teaching nursing homes can be expected to have an impact on public policy development, patient care, and physician training. It is anticipated that research into the important public policy issues regarding relationships between costs and proprietary status and quality of care will be enhanced by developing teaching nursing homes. It will be important to coordinate efforts and evaluations between pilot projects with different funding bases in order to provide research projects with adequate controls. Many results regarding cost-quality comparisons may be of limited applicability to community institutions because of the higher costs inherent to teaching facilities. Nursing home patients living in teaching facilities can expect to be directly benefitted in terms of receiving increased medical attention. They will reside in model facilities providing what is hoped to be the optimal services in all aspects of nursing home care. Possible detrimental aspects for such patients include increased exposure to heroic interventions and possibly poorer care as a result of medical interference with established nursing home team approaches to patient care. As a result of living in a research environment, patients also may be pressured to participate in protocols to which they are not normally exposed. In addition, because many of the geriatric fellowships are based in Veterans Administration facilities (with their predominantly male patient population), it will be important to ensure that current research adequately studies the common problems of elderly women, who represent 70 per cent of those who are in nursing homes.(ABSTRACT TRUNCATED AT 250 WORDS)

Education, Medical↗
PubMed1999

Pakistan: contraceptive prevalence rate up.

Pakistan's low sociodemographic profile has changed dramatically since the 1994 International Conference on Population and Development, said the Minister for Population Welfare and Science and Technology, HE Begum Sayda Abida Hussain, during her statement at the Forum. Based on the population census of 1998, Pakistan has an annual population growth rate of 2.3%, she said. The decline may be attributed to changes in married patterns and a rapid reduction in marital fertility, she added. The contraceptive prevalence rate has gone up from only 2% in the early 1990s to about 27% in 1998. Meeting the demand for reproductive health services, reducing maternal, infant and child mortality, and promoting gender equality are high priorities for her government, she informed the participants in the Forum. In line with this priority, the Government of Pakistan has developed a new population and development policy and is working to improve the education and status of women, lower fertility, increase contraceptive prevalence, and reduce infant and maternal mortality, she told the meeting. Pakistan is expanding reproductive health services in the rural and urban areas through community-based organizations, she said. Some 50,000 women workers now provide counseling and other services to women at their doorstep. Before concluding her address, she called on donors' increased support for ICPD implementation. "The full implementation of the ICPD agenda requires resources that are beyond the capacity of a developing country like Pakistan," she said.

Asia↗
PubMed1982

A systems view of the smoking problem: perspective and limitations of the role of science in decision-making.

The complex issues and relationships surrounding the smoking problem indicate the desirability of a system dynamics computer simulation model for policy development and analysis. This paper describes an initial model-building effort, including reports of initial policy and sensitivity testing of the model. The lack of scientific research on most of the relationships and parameters required in such a model forced heavy reliance upon intuition in the model development. The sensitivity of simulated model outcomes to many of these assumptions demonstrates the need for a more concentrated multi-disciplinary research effort if forecasting and policy determination are to be carried out with confidence.

Adult↗
PubMed2005

Advanced nursing training in health policy: designing and implementing a new program.

Although the nursing profession has a growing role in the health policy arena, the rapidly changing health care environment means that clinicians need a sophisticated understanding of health policy. Nurses are assuming leadership roles in advocacy, research, analysis, and policy development, implementation, and evaluation, contributing to a growing need to educate nurses to specialize in health policy research and analysis. This article provides an overview of a new master's and doctoral educational program specializing in health policy for advanced practice nurses who are culturally diverse and sensitive to issues of diversity. The program, currently in its third year of operation at the University of California San Francisco, School of Nursing, is addressing the gap in nursing education and practice expertise in health policy. The program is supported through funding by the Department of Health and Human Services Health Resources and Services Administration, Advanced Nurse Training program.

Curriculum↗
PubMed2004

A life course approach to diet, nutrition and the prevention of chronic diseases.

OBJECTIVE: To briefly review the current understanding of the aetiology and prevention of chronic diseases using a life course approach, demonstrating the life-long influences on the development of disease. DESIGN: A computer search of the relevant literature was done using Medline-'life cycle' and 'nutrition' and reviewing the articles for relevance in addressing the above objective. Articles from references dated before 1990 were followed up separately. A subsequent search using Clio updated the search and extended it by using 'life cycle', 'nutrition' and 'noncommunicable disease' (NCD), and 'life course'. Several published and unpublished WHO reports were key in developing the background and arguments. SETTING: International and national public health and nutrition policy development in light of the global epidemic in chronic diseases, and the continuing nutrition, demographic and epidemiological transitions happening in an increasingly globalized world. RESULTS OF REVIEW: There is a global epidemic of increasing obesity, diabetes and other chronic NCDs, especially in developing and transitional economies, and in the less affluent within these, and in the developed countries. At the same time, there has been an increase in communities and households that have coincident under- and over-nutrition. CONCLUSIONS: The epidemic will continue to increase and is due to a lifetime of exposures and influences. Genetic predisposition plays an unspecified role, and with programming during fetal life for adult disease contributing to an unknown degree. A global rise in obesity levels is contributing to a particular epidemic of type 2 diabetes as well as other NCDs. Prevention will be the most cost-effective and feasible approach for many countries and should involve three mutually reinforcing strategies throughout life, starting in the antenatal period.

Aging↗
PubMed2000

The role of outbreaks in developing food safety policy: population based surveillance of salmonella outbreaks in Wales 1986-98.

In developing public policy on food safety, systematic identification and thorough investigation of all general outbreaks is necessary in order to avoid bias towards highly publicised outbreaks. In Wales, from 1986 to 1998, 87 general foodborne outbreaks of salmonellosis were identified. Most outbreaks occurred at functions or were associated with small catering outlets such as bakeries and sandwich bars. In 50 outbreaks, a vehicle of infection was confirmed microbiologically and/or epidemiologically. The most common food vehicles were those containing shell eggs. Salmonella enteritidis outbreaks were significantly more likely than outbreaks of other serotypes to be associated with vehicles containing shell eggs, suggesting that eggs were also the source of infection in many outbreaks. The routine use of analytical epidemiological studies to identify vehicles in outbreaks is recommended.

Disease Outbreaks↗
PubMedDate not supplied

State health agencies and the legislative policy process.

A new era of health care reform places increasing pressure on public health leaders and agencies to participate in the public policy arena. Public health professionals have long been comfortable in providing the scientific knowledge base required in policy development. What has been more recent in its evolution, however, is recognition that they must also play an active role in leading and shaping the debate over policy. A profile of effective State legislative policy "entrepreneurs" and their strategies has been developed to assist health agencies in developing such a leadership position. Based on the experiences of State legislative liaison officers, specific strategies for dealing with State legislatures have been identified and are organized into five key areas--agency organization, staff skills, communications, negotiation, and active ongoing involvement. A public health agency must be organized effectively to participate in the legislative policy process. Typically, effective agencies centralize responsibility for policy activities and promote broad and coordinated participation throughout the organization. Playing a key role in the agency's political interventions, the legislative liaison office should be staffed with persons possessing excellent interpersonal skills and a high degree of technical competence. Of central importance to effective legislative policy entrepreneurship is the ability to communicate the agency's position clearly. This includes setting forward a focused policy agenda, documenting policy issues in a meaningful manner, and reaching legislators with the proper information. Once a matter is on the legislative agenda, the agency must be prepared to negotiate and build broad support for the measure. Finally, public health agencies must be active policy players. To take advantage of new opportunities for action, the public health (policy) leader must monitor the political environment continually.By working to anticipate and formulate legislation,health officials can form meaningful relationships with legislators and the community, which are the cornerstones of political strength.

Health Policy↗
PubMed1999

Implementing smoking policies within trusts: nurses' perceptions and views of effectiveness and implications.

AIM: This study set out to explore nurses' views and perceptions of their hospital Trust's smoking policy, and the effects that it has had on both staff and patients. BACKGROUND: Although soliciting and considering the views and perceptions of staff during smoking policy development increases the likelihood of effective implementation, such activity does not appear to be routinely undertaken within the NHS. METHODS: Semistructured interviews were conducted with seven surgical nurses working within one district general hospital in the UK. RESULTS: While all of the subjects acknowledged the value of there being a smoking policy, they felt that their Trust's policy placed nurses in a powerless and vulnerable position, with little support available to help effectively address the problems that smoking raised for them and their patients. CONCLUSIONS: NHS Trusts that wish to develop and implement effective smoking policies should engage their staff throughout the process, and not underestimate the positive contribution that they all can make.

Adult↗