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New CDC condom fact sheet invites criticism. What role did politics play in changes?

Politics and science are clashing over the facts about condoms and what clinicians should tell their patients about their effectiveness. The CDC's updated condom fact sheet puts more emphasis on abstinence and condom failure. A group of Democratic lawmakers sent a letter to the secretary of Health and Human Services accusing the administration of 'playing politics'.

Centers for Disease Control and Prevention, U.S.↗

Politics of prevention: expanding prevention benefits in the Medicare program.

It is critical that public health advocates understand the structure of the Medicare program and the impact of the political process on Medicare's benefit set. This article provides an overview of the design of Medicare and its explicit exclusion of prevention benefits in the original legislation. We then provide a history of subsequent legislation authorizing coverage of specific prevention benefits over the last twenty years. We critique the current process in light of innovation in preventive services and the influence of politics in the decision-making. We conclude with a discussion of policy options to improve access to an appropriate range of evidence-based preventive services in Medicare within the context of new technology innovation and rising health care costs.

Aged↗

The effects of gender, race, religion, and political orientation on the sex role attitudes of college freshmen.

Freshmen (N = 556) at a large eastern private university were administered a questionnaire during the first week of classes. A social learning perspective was used to examine the effects of gender, race (Asian, black, and white), religion (Catholic, Jewish, and Protestant), and political orientation (liberal and conservative) on four areas of sex role ideology--traditional attitudes toward female sexuality, justification of male dominance, negative attitudes toward homosexuality, and attitudes toward feminism. Although all four independent variables produced a significant effect on at least one measure of sex role ideology, religion and political orientation produced significant differences on all four sex role measures. Liberals as compared to conservatives and Jews as compared to Protestants were less traditional in their attitudes toward female sexuality, less accepting of male dominance and negative attitudes toward homosexuality, and more accepting of feminist attitudes. The results support the view that entering freshmen have established sex role belief systems that tend to be organized around constellations of traditional/conservative versus egalitarian/liberal attitudes.

Adult↗

The politics of public health: a response to Epstein.

Conservatives are taking aim at the field of public health, targeting its efforts to understand and control environmental and social causes of disease. Richard Epstein and others contend that these efforts in fact undermine people's health and well-being by eroding people's incentives to create economic value. Public health, they argue, should stick to its traditional task--the struggle against infectious diseases. Because markets are not up to the task of controlling the transmission of infectious disease, Epstein says, coercive government action is required. But market incentives, not state action, he asserts, represent our best hope for controlling the chronic illnesses that are the main causes of death in industrialized nations. In this article, we assess Epstein's case. We consider his claims about the market's capabilities and limits, the roles of personal choice and social influences in spreading disease, andthe relationship between health and economic inequality. We argue that Epstein's critique of public health over-reaches, oversimplifies, and veils his political and moral preferences behind seemingly objective claims about the economics of disease control and the determinants of disease spread. Public health policy requires political and moral choices, but these choices should be transparent.

Coercion↗

Ethical issues in case management from a political and systems perspective.

This article has been excerpted from a talk which provided a description of the systemic context in which case management operates in relation to other services and provides an overview of the political context in which the system of services for older people operates. The ethical issues of case management, which are discussed elsewhere in this issue, are imposed in part by the role of case managers in the system as a whole, which in turn reflects our society's political consensus on how older persons will be served and at what cost.

Ethics, Medical↗

[Shifting of emphasis in the world health sector strategy; from political concerns to economic ones].

Primary Health Care, proclaimed by WHO in 1978, is a health strategy that aims to achieve the ultimate objective "Health For All", with underlying political concerns for ideals such as social justice, equity and human rights. Meanwhile, "globalization", urged by the U.S.A., other developed countries and multinational corporations, has since promoted liberalization of trade, capital and finance, which has in the past few decades been sweeping all over the world. With this "new economic liberalism", values that put much emphasis on economic efficiency are now at the forefront. The World Bank, which supports the tendency along with the International Monetary Fund and the World Trade Organization, has become an influential actor in helping developing countries to prosper economically. The World Bank, whose basic idea is that investment in health is basic for economic growth, has in the 1990s also exerted considerable influence on the international health sector with its overwhelming provision of financial assistance. Instead of political concerns like equity and human rights, 'economic concerns' such as fairer budget allocation, cost-effectiveness, cost reduction and efficiency have now become main points for discussion in the international health field. This shift in emphasis poses fundamental questions for the core goal of the World Health Organization; "Health For All".

Economics↗

[Economic, social, and political impact of aging].

Aging is a social question, but it is also a political and economic issue of the utmost importance because it effects our economy and the collection of taxes in our societies and it questions our system of values, especially when we bear in mind that individualism, isolationism and people's loneliness predominate today. All of these factors demand forceful political measures separated from short term electoral slogans but having a vision for the future. This text is adapted from the report the author gave at the Menéndez Pelayo International University.

Aged↗

[The role of voluntary associations in healthcare politics].

In the recent years an increasing interest has been observed on volunteering; among social scientist, politicians, and economists. A different approach to the management of volunteering has been observed both in the political and social set. Furthermore a remarkable development of the phenomenon is present worldwide as within Italy. The contribute to social development, universally attributed to the volunteer action has been acknowledged by the General Assembly of United Nations that declared the 2001 The International Years of Volunteering. Different aims was attributed to this event: the promotion of volunteer action, as expression of cohesiveness and democratic participation of civic society progress; stimulate the improvement of the volunteering status and role; increasing facilities to the activities realization; facilitate the communication opportunities among volunteers, associations and governments. Nevertheless, the phenomenon relevance has to be viewed in social, cultural, political and economical changes taking place in the last years and still in action in the country that on the one hand have produced new needs and an increasing socio-assistance demand and the other hand the needs of changing the responding traditional style and way from Institutions. The major aims of this paper consist in the analysis of motivation and relevance of socio-sanitary role of volunteer in contemporary society.

Delivery of Health Care↗

Antenatal syphilis control: people, programmes, policies and politics.

Antenatal syphilis control is an integral component of reproductive health policies in most countries. In many of these countries, however, the existence of a health policy does not automatically translate into an effective health programme. We argue that neglecting to take into account the perspectives of all stakeholders when planning programmes may be the reason that functional and sustained interventions for antenatal syphilis are lacking. Stakeholders may include health policy decision-makers, programme managers, service delivery personnel (on whom implementation depends), as well as the pregnant women, families, and communities who will most benefit from the intervention. We describe how to undertake a multilevel assessment in order to identify stakeholders, identify interlinked perspectives, and analyse these perspectives within the socioeconomic, cultural and political environment within which an intervention is designed to be delivered. Using this multidisciplinary approach, we propose that the barriers to, and opportunities for, turning health policy into effective practice will be identified, and the result will be the formulation of a broad programme response to ensure implementation of the policy. Undertaking a multilevel assessment is but the first step in identifying barriers to successful programmes. Currently there is a lack of strong political support for this intervention at national and international levels. Devising strategies to address these potential barriers requires a broad range of skills and approaches some of which are outlined in this paper.

Female↗

American medicine and the politics of race.

Straw men play a major role in the debate over racial disparity in American medicine. Most have been deployed by the disparities-denying right, but progressives intent on "outing" racism have sent forth their share. This essay flushes out the straw men while attempting to understand the competing moral premises that drive the politics of health care disparity. At bottom, arguments about the scope of disparity and discrimination in medical care are disputes about the appropriate scope of personal responsibility for life circumstances. Further research into the factors that correlate with racial differences in health care can shed light on the circumstances that bring about these differences. Whether these circumstances, once understood, should be deemed acceptable is a moral and political matter, and sharp differences over the scope of personal and public responsibility for these circumstances are inevitable. Such disagreements, however, distract us from efforts to reach common ground solutions to agreed-upon inequities in health care.

Delivery of Health Care↗

[Clarification of a political assassination in 1839: statesman Johannes Hegetschweiler shot during civil unrest in Zurich].

The death by violence of the scientist and statesman Johannes Hegetschweiler (1789-1839), M.D., constituted a double tragedy: just previously, at the instigation of his friends, he had withdrawn an already submitted petition to be relieved of all his public functions. And from the outset he declared himself an opponent to the appointment of the theologian Friedrich David Strauss to the Zurich Professorship for Dogmatics, an appointment leading to political unrest ('Züriputsch'). On September 6, 1839, Hegetschweiler dashed, as a member of the Cantonal Government, between the militia of the Government and the advancing insurrectionists with instructions to effect a cease-fire. While doing so, he was wounded in the head by a deliberately aimed discharge of a shot, succumbing after three days of suffering. The general turbulence occasioned by the Züriputsch, the unprecedented animosity among the political misdemeanors and felonies rendered any legal prosecution impossible. It is here proven that one of the insurrectionists from the Zurich Oberland is the only person who can be considered as the murderer of Hegetschweiler.

History, 19th Century↗

Policy reform as creative destruction: political and administrative challenges in preserving the public-private mix.

As political pressure for affordable universal coverage intensifies, various proposals have been crafted to improve the system without sacrificing the role of the private sector. Some analysts view the preservation of a mixed public-private system as an exercise in incrementalism, avoiding disquieting departures from familiar arrangements. A review of the political and administrative challenges of several main options--market innovation, tax credits, play or pay, and Medicaid expansion--suggests that the path to true reform is a slippery slope. Over time, changes in particular sectors, such as insurance, employers, government, and providers, will very likely implicate the others too. Although redefining the public-private mix may be more incremental than (say) adoption of a Canadian model, it will also entail considerable "creative destruction" of existing patterns and cannot fail to disturb the institutional status quo substantially.

Financing, Government↗

The "incompleat" physicians: community physicians' lack of knowledge of medical socioeconomics and politics.

The suspicion that physicians in this community know little about current events in American medical socioeconomics and politics led to a survey of the local medical society membership. The results showed a discouraging lack of knowledge about information that is readily available to physicians. We concluded that current methods for educating physicians in these subjects are largely ineffective. Live, as opposed to printed, presentations at local, state, and specialty medical society meetings may be more effective in educating, and thereby involving, physicians in the critical political and economic issues presently facing them.

Data Collection↗

The nursing shortage and provider attitudes: a political perspective.

The nursing shortage has been labeled a significant crisis in the health sector. This shortfall could severely threaten both the nursing profession and the entire American health care system. Numerous studies have focused on nurses' satisfaction with their work and the factors leading to positive and negative evaluations. A major deficiency of these endeavors, however, is that none have examined the attitudes of the nurses toward the shortage nor the activities which might be undertaken to rectify it. Moreover, political competence and the nurses' perceptions of the political arena have not been addressed and related to the shortage. The purpose of this paper is to help fill these gaps in the literature.

Attitude of Health Personnel↗

Politics and policy in the history of the disability rights movement.

Although the disability rights movement consists of a small portion of all Americans with disabilities, activists have pressed claims on behalf of that entire population. The nascent movement in the early and mid-1970s drew upon policy goals of other civil rights movements, particularly at the federal level, to gain political and legal objectives. Disability rights activists achieved mixed results over the past decade despite joining broader coalitions to fight social budget cuts and a conservative civil rights agenda. If the disability rights movement is not yet fully autonomous and faces an uncertain future, it has established itself as a presence in American social welfare politics.

Activities of Daily Living↗

[Politics and psychoanalysis in Vienna before 1938].

On the basis of personal reminiscences the author describes the political climate of Vienna between the end of the Monarchy and Anschluss of Austria. At the same time she clarifies the extent to which politics impinged on psychoanalysis.

Austria↗

The politics of choice: roles of the medical profession under Nazi rule.

In 1933, when Adolf Hitler took power, the German medical community was faced with intense crisis and change. Because social processes become more clearly defined in times of crisis, the days of Nazi rule offer an excellent opportunity to examine health care and moral issues. This article describes historical events that illustrate physicians' and medical students' role in the political process. In addition, we detail four types of responses made by physicians and students: flight, conformism, individual resistance, and group resistance. We conclude that if the role of physicians is to aid and protect patients against disease or experimentation on humans, then he or she must maintain heightened political awareness in order to deal with social crises before they overwhelm any response.

Dissent and Disputes↗