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PubMed2006

A conversation: challenging the relevance and wisdom of separate mental health legislation.

This paper explores the dilemmas encountered by mental health nurses when working with mental health legislation. The concerns and considerations of an expert mental health nurse, complemented by the opinion of an expert in health-care and legal issues are presented. It is argued that there is currently a distorted perception with regard to the function and sentiment of mental health legislation, and this paper aims to restore balance in interpreting and working with such law. Viewing mental health legislation primarily as a mechanism for involuntary hospitalization effectively removes any power or recourse given to mental health consumers by the law. Principles of mental health care and legislation are examined as well as the relationship the law has with dangerousness to self or others and mental ill health. A dialogue is established between the two authors to assist the exploration of these legal and clinical issues. The continued relevance of specific mental health legislation is brought into question. It is proposed that the existence of such legislation constitutes discrimination and contributes to stigma associated with mental illness. An alternative legislation for all circumstances where an individual is deemed incompetent is proposed as the most significant step towards mainstreaming of mental health care and an end to discrimination.

Attitude of Health Personnel↗
PubMed2004

UK legislation on analgesic packs: before and after study of long term effect on poisonings.

OBJECTIVE: To evaluate the long term effect of legislation limiting the size of packs of analgesics sold over the counter. DESIGN: Before and after study. SETTING: Suicides in England and Wales, data from six liver units in England and Scotland and five general hospitals in England, and UK data on sales of analgesics, between September 1993 and September 2002. DATA SOURCES: Office for National Statistics; six liver units in England and Scotland; monitoring systems in general hospitals in Oxford, Manchester, and Derby; and Intercontinental Medical Statistics Health UK. MAIN OUTCOME MEASURES: Deaths by suicidal overdose with paracetamol, salicylates, or ibuprofen; numbers of patients admitted to liver units, listed for liver transplant, and undergoing transplantations for paracetamol induced hepatotoxicity; non-fatal self poisonings with analgesics and numbers of tablets taken; and sales figures for analgesics. RESULTS: Suicidal deaths from paracetamol and salicylates were reduced by 22% (95% confidence interval 11% to 32%) in the year after the change in legislation on 16 September 1998, and this reduction persisted in the next two years. Liver unit admissions and liver transplants for paracetamol induced hepatotoxicity were reduced by around 30% in the four years after the legislation. Numbers of paracetamol and salicylate tablets in non-fatal overdoses were reduced in the three years after the legislation. Large overdoses were reduced by 20% (9% to 29%) for paracetamol and by 39% (14% to 57%) for salicylates in the second and third years after the legislation. Ibuprofen overdoses increased after the legislation, but with little or no effect on deaths. CONCLUSION: Legislation restricting pack sizes of analgesics in the United Kingdom has been beneficial. A further reduction in pack sizes could prevent more deaths.

Analgesics↗
PubMed2002

UNICEF's child injury league table. An analysis of legislation: more mixed messages.

This paper presents a summary table and discussion of legislation related to child injury prevention in member countries of the Organisation for Economic Cooperation and Development. The table is an expanded version of the one which appeared in the UNICEF Report Card "Child Deaths by Injury in Rich Countries" (2001). A commentary is provided on the variations in legislation between countries in terms of range and form of measures and an estimate of degree of enforcement. As legislation is generally considered a powerful tool in injury prevention, the paper examines whether those countries with the widest range of legislation and the strongest enforcement have made the most progress in reducing child injury deaths since the 1970s. It also considers whether a commitment to extensive legislation is reflected in a country's position in the UNICEF league table of injury death. The initial conclusion to these two basic issues is that no clear picture can be seen and we thus need to know far more about the relationship between legislation and societies and cultures as they vary from place to place. This paper hopes to stimulate more widespread debate about the role of legislation in different countries.

Accident Prevention↗
PubMed1997

Political realities of statewide smoking legislation: the passage of California's Assembly Bill 13.

OBJECTIVE: To prepare a history of the enactment of California Assembly Bill 13 (AB 13), a state law prohibiting smoking in most workplaces passed in 1994, and to discuss its initial impacts. METHODS: Data were gathered from open ended interviews with representatives of voluntary health organisations, local government organisations, and principal legislators involved in the process, as well as observers around the state who could provide insight into the legislative process. Information was also obtained from legislative hearings and debates, public documents, letters and personal communications, internal memoranda, and news reports. RESULTS: The success of local tobacco control legislation in California led to a situation in which some health groups were willing to accept state preemption in order to attract the support of the state restaurant association for a bill. The decision to accept this preemption compromise was made by the state level offices of the voluntary health agencies without consulting the broader tobacco control community within California. In contrast, local tobacco control advocates did not accept this compromise, in part because of their belief that local legislation was a better device to educate the public, generate media coverage, and build community support for enforcement and implementation of clean indoor air and other tobacco control laws. Enactment of AB 13 was associated with a slowing of all local tobacco control legislation, including youth oriented laws. CONCLUSIONS: Because its supporters initially doubted that AB 13 would pass, there was never an effort to reconcile the policy differences between state oriented and locally oriented tobacco control policies. This lack of consensus, combined with the political realities inherent in passing any state legislation, led to a bill with ambiguous preemption language which replaced the "patchwork of local laws" with a "patchwork of local enforcement."

California↗
PubMed1992

State unit on aging involvement with continuing care retirement community (CCRC) legislation.

State units on aging (SUAs) from 29 states with continuing care retirement community (CCRC) legislation were surveyed to (a) assess staff familiarity with CCRC legislation, (b) examine interdepartmental working relationships surrounding such legislation and ask what role(s) ombudspersons are playing in CCRC oversight, (c) determine what role(s) aging units have had in developing legislation, and (d) gain insights regarding legislative impact. Results indicate that SUAs have been active in legislative development but vary greatly in the intensity of their involvement with the implementation and enforcement of CCRC regulation and in their perception of legislative impact.

Aged↗
PubMed1982

Legislating hospital bed reduction: the Michigan experience.

A variety of programs aimed at health care cost containment have been initiated at the state level. This article presents a case study of one state's effort to deal with health care cost issues, focusing on the formulation of adoption of legislation to reduce the number of hospital beds. The Michigan bed-reduction legislation was the creature of a coalition of powerful, organized "professional consumers" of health services who placed hospital cost containment on the political agenda and framed a solution. The provisions of the legislation were reshaped during the legislative process to grant concessions to a variety of interest groups, particularly the Michigan Hospital Association. Many additional criteria for determining excess bed capacity, some subjective, were added. Cost containment as a goal was, if not subordinated, at least made competitive with other goals--access to care, equity among types of providers, and quality of services. While the initial proposal was attractive as a seemingly simple extension of the certificate-of-need process within the existing regulatory framework, the legislation became increasingly complex in response to new issues raised by political actors who contributed to the shaping of the final version of the legislation. The formulation and adoption of Michigan's overbedding legislation appears to underscore what many other observers have noted: there are no purely technical solutions to health policy problems.

Certificate of Need↗
PubMed1996

Recommendations for European health data protection legislation.

In year 1 of the SEISMED project, the Katholieke Universiteit Leuven coordinated the inventory and analysis of medical personal data protection legislation in Europe. A report on legal issues of medical data protection legislation in Europe was written by the Vrije Universiteit Amsterdam, the Centre National pour la Recherche Scientifique (Paris) and the University College Dublin. This report served as a basis for a second important legal deliverable, i.e. the Health Informatics Deontology Code. In this third and final report, we take into account the results of the other two legal reports and we formulate recommendations for the national and European legislator. This report analyses critically the upcoming privacy directive. We propose several recommendations which should be taken into account by the European and national legislator. We focused quite extensively on the use of medical data for research purposes. We had several reasons to do this. One of them is the fact that the use of medical data for research purposes is very popular, in particular now the health care sector is becoming more and more 'standardized' by using computers, networksystems and telematics. Legislation is therefore needed. Moreover, the use of medical data for research purposes involves the transfer of data from one Member State to another. Therefore, a harmonized legislation is really needed. We hope that the recommendations we propose, will be taken into consideration by the European legislator.

Computer Security↗
PubMed1979

Reduction in road fatalities and injuries after legislation for compulsory wearing of seat belts: experience in Victoria and the rest of Australia.

In 1970 the Government of the State of Victoria became the first in the 'western' world to introduce legislation for compulsory wearing of seat belts. Within 14 months the other Australian states followed. Seat belt wearing rates increased to attain 90 per cent in 1977. This paper presents an evaluation of changes during the period 1955--77 in the incidence of road crash fatalities and injuries for vehicle occupants in Victoria and the rest of Australia. The introduction of the legislation in Victoria and subsequently in the other Australian states coincided with significant and marked decreases in driver and passenger fatality and injury rates (numbers per 10 000 registered vehicles). The decreases were enough to reduce the total numbers of vehicle occupant fatalities and injuries for all post-legislation years in Victoria. The improvements have been maintained throughout the entire post-legislation period. The legislation did not apply to child passengers of less than 8 years of age and the frequency of seat belt or harness wearing among them remained low. These children did not share in the overall improvement for passengers. The Australian experience supports the view that legislation for compulsory wearing of seat belts is the single most effective method available for the protection of vehicle occupants in road crashes.

Accidents, Traffic↗
PubMed2002

New reproductive technologies, ethics and gender: the legislative process in Brazil.

In this article, I will analyse the conduct of the Brazilian legislative process regarding new reproductive technologies, mainly the moral assumptions of three categories that are essential to the debate: the status of the child generated by these techniques; the number of embryos transferred in each cycle (as well as foetal reduction); and the issue of women's eligibility for such techniques. The analysis will be a sociological study of the Brazilian legislative debate, using feminist perspectives in ethics as the theoretical reference. The focus will be the bills in progress in the Brazilian National Congress, the public and official declarations of legislators involved in the issue and the regulation of the medical class, which has influenced the legislative process. Aside from the analysis of the legislative process, I include a section on the justification of these bills, since that is where the legislator exposes what he/she believes is the moral support for the bill.

Adult↗
PubMed1981

Consequences of legislative restriction on the sale of compound analgesics in Newcastle (N.S.W., Australia).

In June 1979 legislation was enacted in New South Wales to restrict the sale of compound analgesics. The consequences of this legislation were assessed by a household survey in Newcastle, New South Wales, during November 1979. This survey followed an identical survey in the same community in November 1977. After legislation, a marked decrease was found in the proportion of homes having compound analgesics. A small decrease in total analgesic usage was also observed, though this was not necessarily related to the legislative restrictions. The legislative restrictions did not result in any substantial increase in use of the doctor to obtain prescriptions for compound analgesics, or any substantial increase in reported health problems. The results suggest that legislation is an effective method of inducing rapid change in health-related behavior.

Adolescent↗
PubMed1993

Out to pasture: a case for the retirement of Canadian mental health legislation.

The emergence of new adult guardianship and related legislation and systems in British Columbia, Ontario, and other jurisdictions has generated questions about the utility of separate mental health legislation. Mental health statutes are the descendents of legislation that once created and regulated separate institutions and systems for the insane (later known as the mentally diseased and, more recently, the mentally ill). Such legislation is no longer consistent with the dominant community care and treatment strategies in the mental health field and the growing trend to recognize and respect consumer involvement in care and treatment decision making. Emerging legislation in the guardianship field makes provision for a range of options and mechanisms that can replace separate mental health statutes (e.g., general consent to health care legislation, and provision for enduring powers of attorney of the person and Ulysses agreements) and produce a new and more effective legal framework for the provision of mental health care and treatment.

Canada↗
PubMed1976

Mobilization of membership for legislative action.

Background and structure of the New York State Occupational Therapy Association and the committees assigned to implement legislative procedures are explored, followed by a description of the methods used to mobilize the membership to secure legislation to license occupational therapists. Workshops were given to educate the membership in the legislative process and a communication system was set up among the members, state legislators, other health agencies, and special interest groups. Support of legislators for the licensure bill was solicited, as well as support from others contacted through the communication system. The members continued to solicit support and to monitor the progress of the bill during a two-year period. The bill was passed in August 1975. Based on their recent experiences with the legislative process. NYSOTA concludes that to secure licensure logical and judicious organization, education, constant feedback of information among participants, and hard work, determination, perseverance, and dedication of the group involved are necessary.

Legislation as Topic↗
PubMed2005

Research on human embryos and cloning: difficulties of legislating in a changing environment and model approaches to regulation.

It is difficult to regulate rapidly changing fields of science. New technologies are not anticipated and legislation becomes inadequate. Legislative definitions are also problematic. This article begins with consideration of such difficulties in the context of research on human embryos and cloning. It considers problems with past legislative definitions in Australia, the new regulatory regime, and whether that regime now sets clear boundaries. It is found that problems still exist--some terms are not adequately defined and boundaries for research prove unclear. Three regulatory approaches are therefore discussed. Legislation based on strict definitions is compared to a legislative model that leaves terms undefined. The third model--which combines framework legislation with the oversight of a regulatory authority--is seen as most suitable. However, problems with this model are recognised and suggestions made regarding how to ensure the "framework" remains workable and effective.

Australia↗
PubMed1980

Nutrition legislation: strategy for success.

The decision to sponsor legislation should be carefully considered. Participation in the legislative process requires a major commitment of your organization's time and resources. You will need first to define short- and long-term legislative goals and then to draft these concepts into a bill and estimate its cost. You will need to select a sponsor, considering the commitment, staff interest, committee assignment, political party, and connections of the legislator. Next, a coalition of groups must be formed to support your bill and maintain media coverage to ensure public interest in it. Testimony and appearances during committee hearings must be made. Grassroots lobbying and letter-writing campaigns will further consume your organization's energies. A strategy for nutrition legislation can yield satisfying results. In a relatively short time, you can literally turn the tide of nutrition programs and funding within your state. But the price is high. Participation in the legislative process is not for the weak-hearted, the meek, the indecisive, or the uncommitted. You will get out of it what you put into it. Plant a turnip, get a turnip!

Dietetics↗
PubMed1995

Impact of legislative measures on the sales of analgesics and the subsequent prevalence of analgesic nephropathy: a comparative study in France, Sweden and Belgium.

In a number of European countries (e.g. Belgium), analgesic nephropathy continues to be a highly prevalent renal disease, whereas in other countries (e.g. Sweden) the problem has been resolved after legislative measures were taken. In still other countries, e.g. France, the official prevalence of analgesic nephropathy has always been low. The aim of the present study is to detect whether specific legislation in particular countries has played a role in the prevalence of analgesic nephropathy. Hence, we compared analgesic legislation in Belgium, France and Sweden, and then compared it with the respective sales data of non-narcotic analgesics and with the prevalence data of analgesic nephropathy in the dialysis population. Each investigated country represents a different evolution pattern in the prevalence of analgesic nephropathy. This study indicates that legislation restricting the over-the-counter availability of the majority of analgesic components and resulting in the absence of analgesic mixtures--containing two analgesic substances and one potentially addictive substance--on the market, has effectively resulted in a substantially lower prevalence of analgesic nephropathy. Moreover, it shows that permissive legislation could be associated with very different sales data, depending on the marketing strategy of the pharmaceutical industry and the subsequent purchasing behaviour of the population. These findings indicate that, in order to eradicate analgesic nephropathy, there is a need to elaborate legislation that prohibits the availability of analgesic mixtures containing two analgesic components and at least one potentially addictive substance.

Analgesics↗
PubMed2004

Has the implementation of the TRIPS Agreement in Latin America and the Caribbean produced intellectual property legislation that favours public health?

OBJECTIVE: The World Trade Organization's Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement establishes minimum standards for intellectual property rights, including patent protection for pharmaceuticals; therefore, it may make it difficult for developing countries to gain access to medicines, especially those countries that are the least developed. This study aims to determine whether implementation of the TRIPS Agreement in Latin American and Caribbean countries has generated patent legislation that is sensitive to public health needs. METHODS: Legislation in 11 Latin American and Caribbean countries was analysed. The variables considered in the analysis were: the term of patents issued, patentable subject matter, transition periods (that is, time until legislation was enacted), reversal of the burden of proof of patent infringement, exhaustion of rights, compulsory licensing and the early working exception (which allows a country to complete all procedures necessary to register a generic product before the original patent expires). FINDINGS: By 2000, all of the countries studied had reformed their legislation to conform to the agreement. Brazil and Argentina used the transition period until 2005 to grant patents in the pharmaceutical industry. All countries, except Panama, made use of the safeguards and flexibilities available through the agreement by including mechanisms for compulsory licensing in their legislation. Argentina; Bolivia, Colombia, Ecuador, Peru and Venezuela (countries that represented the Andean community); the Dominican Republic; and Panama included mechanisms to allow parallel importation. Mexico did not. Brazil only permits parallel importation after a compulsory licence has been issued. The early working exception is included in legislation in Brazil and the Dominican Republic. CONCLUSION: The countries in this study did not incorporate all of the mechanisms allowed for by the Agreement and are not adequately using the provisions that enable World Trade Organization (WTO) members to obtain better health for the public, particularly in regard to gaining access to medicines. This situation may deteriorate in future if other agreements establish more restrictive rules for intellectual property rights.

Caribbean Region↗
PubMedDate not supplied

Factors affecting the implementation of health legislation and its impact on the rural poor in China: a case study of implementation of the maternal and infant health care law in two poor counties.

This paper presents and discusses a case study of health legislation in China. In the transition to a market economy, legislation has been developed to offset the weakening in the central planning mechanism and political control that have historically influenced the behaviour of institutions and individuals in the Ministry of Health. There has been relatively little empirical examination of the implementation and impact of legislation as a tool for influencing health service provision in low-income countries. The study aimed to contribute towards filling this gap by exploring the factors affecting the implementation and impact of the Maternal and Infant Health Care Law, through a case study of two poor, rural counties in Chongqing municipality, China. The study found that key local actors perceive health legislation to be an important tool for safeguarding access to essential health care. However, the implementation of health legislation is inevitably a political process. The study illustrates the difficulties involved in efforts to influence provider behaviour through a national level legislative framework in a situation of decentralization of control over those providers, due to extreme regional variation in economic situations and limited resource inputs from the centre. Lessons are drawn for Chinese and international policy makers.

Child Health Services↗
PubMedDate not supplied

Predictors of state legislators' intentions to vote for cigarette tax increases.

BACKGROUND: This study analyzed influences on state legislators' decisions about cigarette tax increase votes using a research strategy based on political science and social-psychological models. METHODS: Legislators from three states representing a spectrum of tobacco interests participated in personal interviews concerned with tobacco control legislation (n = 444). Measures of potential predictors of voting intention were based on the consensus model of legislative decision-making and the theory of planned behavior. Multiple logistic regression methods were used to identify social-psychological and other predictors of intention to vote for cigarette tax increases. RESULTS: General attitudes and norms concerning cigarette tax increases predicted legislators' intention to vote for cigarette tax increases. More specific predictors included perceptions of public health impact and retail sales impact of cigarette tax increases. Constituent pressure was the strongest perceived social influence. Political party and state also were strong predictors of intention. Results were consistent with related research based on political science models. CONCLUSIONS: Legislators' votes on cigarette tax increases may be influenced by their perceptions of positive and negative outcomes of a cigarette tax increase and by perceived constituent pressures. This research model provides useful insights for theory and practice and should be refined in future tobacco control research.

Female↗