Leadership: the nurse's role in health policy development.
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Previous research has reported prevalence rates of mental health problems among homeless individuals that range from 20% to 90%. Attempting to validly verify prevalence rates is important because of the implications concerning both deinstitutionalization and developing an appropriate mental health policy over the next decade. In the present research, which used as its sample the largest homeless sample assessed to date, prevalence was found to fall at the lower range of previously cited data. Despite the fact that the prevalence of mental health problems among the homeless population was found to be relatively low, it was found that homeless people with mental health problems are, at best, only marginally served by the mental health system. Implications for community mental health policymakers and program designers are discussed.
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Increased public demand for health services, combined with fiscal and operating restraints, has led to the need for programs that will operate efficiently and effectively to achieve their objectives. Establishing such programs requires an understanding of the factors that contribute to their development and implementation. This in turn requires a greater understanding of the policy formulation and policy implementation processes. This paper uses a case study of Michigan's State/Local Cost Sharing Program to explore how policy formulation links to and influences implementation; it considers the interaction between the administrative and political processes and how they are affected by shifting power relations, constituencies, and the environment, and how in turn these affect program leadership and operating policies. The paper develops a model as a framework for monitoring the course of the program through the policy cycle and recommends that the policy process be considered as dynamic, interactive, and evolutionary. The case study approach allows for a greater understanding of the phases of the process, their interaction, and their impact on specific policy outcomes.
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This article analyses 3 areas of policy that could reduce the fragmentation and improve the competitiveness of the European pharmaceutical sector. It argues that a potential solution to the issue of fragmentation of pharmaceutical research, development and innovation may be the development of policies at the European level, in those areas that European institutions have a competence. These areas may not necessarily rely exclusively on solving the issue of pricing and reimbursing pharmaceuticals as European Union (EU) Member States invoke the subsidiarity principle to claim policy exclusivity in this area. By contrast, policy areas where European institutions have a competence may include: i) a more intensified collaboration in science and technology policy (supporting the science base, identifying education needs for the future, collaborating in the development of new technologies and fostering university-industry collaboration); ii) support of research and development (R&D) by means of directly channelling funds into basic pharmaceutical research, avoiding duplication of the research effort, developing a set of research priorities, tackling the issue of technology transfer, promoting university-industry and cross-border collaborations or providing incentives that would induce private R&D activities in areas with large socioeconomic impact; and iii) an improvement in the environment for the financing of innovation in the EU, by means of selective use of tax policy at the national level (and where applicable, at the EU level), institutional reform in order to widen the pool of available funds for private investment, and the introduction of schemes that would encourage individuals and institutions to hold equity in innovative companies. The article identifies specific research, regulatory, medical and financing needs that require policy intervention, evaluates the possible dynamic implications of such interventions and highlights the benefits that may accrue from their implementation.
Health promotion has become an official health policy of this country, and it is being pursued through efforts to change individuals' health-related behavior. This approach is based on the assumption that it is in fact an individual's behavior that most directly determines his or her health status. But how good is the evidence that supports this assumption? Specifically, is the evidence sufficient for this assumption to outweigh the long-standing finding that social and economic conditions have a strong relationship to health status? The major support for the behavior approach derives from the coronary heart disease risk-factor studies and the Alameda County Study. In a series of reports over time, the relationship between individuals' health practices and their health status generally, as well as that between heart disease and cancer specifically, have been established by these studies. These observations, however, have not been confirmed when deliberate efforts have been made to change those practices. The evidence in support of the importance of social and economic conditions to health status has been documented through a long series of studies in this country, which have found a direct relationship between individuals' socioeconomic status and their health status. This relationship, however, has not in this country been tested by intervention. Only a few studies have examined the interrelationship between these two approaches to health promotion, but the evidence to date has failed to suggest that either one is the mediator of the other. We must, therefore, conclude that pursuing a policy of health promotion based on either approach to the exclusion of the other would indeed be short-sighted health policy.
"Varied population issues have sprung up as the population-development question has received more attention with time.... This paper takes up [critical population] issues and refines them in the perspective of African realities for long-term development. It is argued that the assumptions on which the Coale-Hoover model is based are untenable in the African circumstances.... The issues [considered in this paper] and having a common denominator, namely, reduction of current high fertility, are as follows: (a) old age structure and prospects for economic development; (b) the danger for Africa of rapid decline in fertility; (c) maternal and child health advantages; and, (d) environmental protection."
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The article addresses the Dutch alcohol policy over the last decades and the present state of the art. In Dutch society an ambivalent attitude towards alcohol consumption prevails. Developments in legislation and regulations, in prevention and care are described. Several key problems are identified. Among others it is concluded that too little attention is paid to alcohol compared to other drugs. Both in prevention and care evidence-based work has to be stimulated. Legislation and regulations are insufficiently used and evaluated. The government needs to constantly evaluate its policy and develop its options within the area of legislation and regulations, which should also include a critical comparison with the situation in other countries.
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Quality of life measurements can lead to legislative programs for health, new policies for the health care system, and possibly new attitudes in the courts. Clinical decisions, public health evaluations, and advice for legislatures and courts require diverse measures. We illustrate potential use of such measures with reimbursement problems, programs like Head Start, mainstreaming the handicapped, day care and prenatal care, terminal care for the elderly, monitoring programs, and chronic disabilities. The many treatment policies discussed at the Portugal Conference show the need for quality of life measures in clinical trials. The courts, although considering quality of life, do not seem to consider quality of life measures. If scientists and medical experts wish to establish or change the positions of the courts, consensus conferences appear more effective than regulation or new legislation. To contribute more than they now do to policy, workers measuring quality of life need to develop a variety of measures and methods. They, then, must apply them to medical and health problems, build up a substantial literature, and set priorities for the research needs of the field.
In this article, local perceptions of family planning programs and federal population policy are examined, based on responses to a childbirth survey and on interviews with a range of individuals in one northern Nigerian town. The respondents' differing perceptions of the relationship between population and national development reflect distinctive ideas about political authority, population policy, and family planning programs, about development, and about domestic and international political affairs. Local suspicions about the Nigerian population policy and family planning programs suggest that they cannot be implemented in isolation from broader political and economic concerns. This distrust has ramifications for current family planning programs and reproductive health initiatives undertaken by Western-sponsored aid projects.