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Borrowing to build: private money and public welfare.

The process of local government borrowing to finance the capital needs of social services has an impact on both central-local relations and the type of service which can be offered to the citizen-consumer. Based on an examination of these relationships in the United States, the United Kingdom, France, and Italy, it is postulated that different types of central-local relations are dependent on the nature of relations between central government and the investment community. Further, through use of material from a case study of public housing politics in Italy, it is shown how the investment criteria of the so-called "private" sector are transferred to the operations of the public sector through the mechanism of local borrowing. This transferal affects the manner in which social services are conceived and delivered.

Financial Management↗

The future of public health preparedness.

This redacted version of a speech by former United States Senator Sam Nunn, Chairman of the Nuclear Threat Initiative, points out that although there are concerns about global issues involving security and weapons of mass destruction and bioterrorism, it was not until September 11, 2001, that these issues (and new, unforeseen ones) were getting the funding and attention they deserved. In the event of a biological attack, millions of lives may depend on how quickly we diagnose the effects, report the findings, disseminate information to the healthcare communities and to state and local governments, and bring forth a fast and an effective response at the local, state, and federal levels. Public health must become an indispensable pillar of our national security framework. As we develop a national strategy to respond to these challenges, we must think in the broader context of causes as well as symptoms. To provide context for the next 25 years, Senator Nunn provided an overview of the "Seven Revolutions" for change identified by the Center for Strategic and International Studies (CSIS) with which he is also associated. Finally, he discusses major security challenges facing the United States.

Bioterrorism↗

Toward a healthy democracy.

Because it represents a revival of citizen responsibility, the Healthy Communities movement is not only a health and quality-of-life movement but a civic and democratic movement as well. Healthy Communities efforts need to seek meaningful partnerships with local governments and work their collaborative and citizen-based efforts into formal local political structures. As the foundation of the Healthy Communities movement, civic renewal should be elevated as a major theme and goal for its future.

Attitude to Health↗

Public policy, federalism, and AIDS.

The AIDS epidemic poses important challenges to the American political system. In the context of AIDS, relationships between the public and private sectors as well as those among federal, state, and local governments have had a significant impact in shaping the nations response to the epidemic. The character of health policy in the United States has in large part been determined by uncertainty regarding the appropriate role of the public sector and by persistent beliefs that the best solutions are private sector ones. Similarly, relationships across levels of government are clouded by concerns about the presumed excesses of centralized (federal) government and the widespread conviction that the most appropriate solutions are state and local ones. AIDS emerged as a public health issue at a point in the early 1980s when a new federal administration was calling for a reduction in public sector and federal responsibility for addressing health and social needs. Since that time, stronger public and federal leadership appears to be developing, and both are essential to forging the policy partnerships between the public and private sectors and across levels of government that are essential to the development of a comprehensive policy response to the AIDS epidemic.

Acquired Immunodeficiency Syndrome↗

Facing the cuts: a health authority's experience of rate-capping.

Health and social services in Britain are both publicly funded, but health care is provided centrally by the National Health Service while social services are provided by local government. Central government has sought to limit overall public spending by limiting the income of local authorities from rates (property taxes)--a policy known as rate-capping. In the face of this policy, one inner London local authority was forced to cut its social services budget in 1988/89 by 17%. We have compared the actual social service reductions with the perceptions, expressed in semi-structured interviews, of 69 health and social services staff. There was a perceived deterioration in social service provision, and indicators were suggested which would help health service staff to monitor these changes. There were also recent and more long-standing difficulties of communication between the two services, which limited joint working. The increasing emphasis on community care requires health authorities to cooperate more closely with social services at the local level.

Health Expenditures↗

Neural control of pulpal blood flow.

Blood flow of mammalian dental pulp is under both remote and local control. There is evidence for the existence of parasympathetic nerves in the pulp, but functionally the cholinergic influence is weak, and the physiological significance of this autonomic system seems to be low. The evidence for sympathetic vasoconstrictor nerves in the pulp is robust, and there is convincing support for the contention that these nerves play a physiological role, operating via release of noradrenaline and neuropeptide Y. However, there is no significant functional evidence in support of sympathetic beta-adrenoceptor-mediated vasodilation in the pulp. The local control of blood flow involves a subset of intradental sensory nerves. By virtue of their neuropeptide content, these afferent fibers cause vasodilation and inhibit sympathetic vasoconstriction in response to painful stimulation of the tooth. Such locally governed control may serve to meet immediate demands of the pulp tissue. A locally triggered reflex activation of sympathetic nerves in the pulp may modulate this control and limit its magnitude. Thus, there are competitive interactions between local and remote vascular controls which may be put out of balance in the injured and inflamed dental pulp.

Animals↗

Burden of health care costs: businesses, households, and governments, 1987-2000.

In this article, we estimate expenditures by businesses, households, and governments in providing financing for health care for 1987-2000 and track measures of burden that these costs impose. Although burden measures for businesses and the Federal Government have stabilized or improved since 1993, measures of burden for State and local governments are deteriorating slightly--a situation that is likely to worsen in the near future. As health care spending accelerates and an economy wide recession seems imminent, businesses, households, and governments that finance health care will face renewed health cost pressures on their revenue and income.

Cost of Illness↗

[Creating the model county to promote the prevention of blindness in Zhejiang Province].

OBJECTIVE: To develop a system of enhancing work efficiency in prevention of blindness in Zhejiang province by creating the Model County in prevention of blindness. METHODS: Twenty counties were selected in the whole Zhejiang province to serve as the candidates of the Model County in prevention of blindness in 1996 - 1998. The activities for prevention of blindness were conducted in these counties according to the five standards of the Model County in prevention of blindness established by the National Committee for Prevention of Blindness. The Model County in prevention of blindness was awarded only after checking and accepting by the authorities in county, provincial and national levels. RESULTS: The effective way for creating the Model County in prevention was as follows: the local government put the prevention of blindness in the list of the priorities, the local committee for prevention of blindness was established, the three level network for prevention of blindness was established, the eye care workers were trained, the necessary equipment was provided. After the efforts for three years, seven counties were awarded as the Model County in prevention of blindness. In addition, Shaoxing Prefecture city became Model City in prevention of blindness. A strong effort was made to promote the activities for prevention of blindness during 1996 to 1998 in the other thirteen counties. The number of eye doctors increased from 602 into 1 850. There were two folds increase in the number of equipment availability, for example, slit lamp and ophthalmic microscope. The annual number of cataract surgeries was about 20 000. CONCLUSION: It appears to be a good approach to create the Model County to promote the prevention of blindness.

Blindness↗

Small-area population estimates: a review of methods used in Britain in the 1990s.

"Population estimates are usually produced by local government administrations in Britain, for each small area within their authority. Increasing interest has been shown by commerce and by central government. Five main methods are identified: apportionment, ratio change, additive change, cohort survival, and local censuses. Estimation strategies also vary according to available data, the detail in which a population is estimated, and the precise combination of elements chosen from one or more of the main methods. The use of methods at the beginning of the 1990s is surveyed in this paper, and examples given. The accuracy of each main method is quantified from empirical data collated by the Estimating with Confidence project. Likely developments towards the end of the 1990s are reviewed."

Developed Countries↗

Porcine trypanosomosis in Nigeria: infections in local and exotic pigs in the Nsukka area of Anambra State.

A twelve-month survey in three Local Government Areas (LGA) in Nsukka zone, Anambra State, Nigeria revealed that out of 150 local and exotic breeds of pig examined, 46 (30.7%) were infected with trypanosomes. Both single and mixed infections of Trypanosoma brucei and T. congolense were observed. However, T. brucei was the predominant trypanosome encountered. The husbandry system in practice was the most significant factor influencing the prevalence of trypanosomes in the pigs. In addition significantly higher prevalences were recorded during the rainy seasons. Clinical trypanosomosis was encountered in only eight of the 46 positive cases seen, with anaemia, loss of weight and anoestrus being the most important effects associated with these infections. The pathogenic and economic significance of these findings are discussed.

Animals↗

An analysis of purchasing services via competitive bid.

Ohio's community mental health system is structured much like other states', with local government boards that contract for community mental health services. Community mental health boards are the local planning, funding, and evaluating bodies that are prohibited, except under special circumstances, from directly operating mental health services. The services are delivered by human service agencies--mostly private, not-for-profit corporations. Obviously, the contract between the board and an agency is an important document that defines the relationship between the two organizations. As the demand for greater accountability and increased productivity appeared, boards altered contracting methods. Some boards employ a grant-type contract. Others use performance contracting. Still others use a purchase of service methodology, either with or without performance standards. As these techniques have been further refined, some boards have opted to purchase services via competitive bid.

Community Mental Health Services↗

Health spending trends in the 1980's: adjusting to financial incentives.

Health expenditure growth is projected to moderate considerably during 1983-90, reaching $660 billion in 1990 and consuming over 11 percent of the gross national product. During 1973-83, spending for health care more than tripled, increasing from $103 billion to $355 billion and moving from 7.8 percent to 10.8 percent of the gross national product. Government spending for health care is projected to reach $284 billion by 1990, with the Federal Government paying 73 percent. The Medicare Prospective Payment System, private sector initiatives, and State and local government actions are providing incentives to substantially increase competition and cost effectiveness in health care provision.

Data Collection↗

The burden of health care costs: business, households, and governments.

In this article, the authors recast health care costs into payer categories of business, households, and Federal and State-and-local governments which are more useful for policy analysis. The burden that these costs place upon the financial resources of each payer are examined for 1989 and for trends over time. For businesses, their share of health care costs continues to creep upward compared with other payers and relative to their own resources, despite many changes they are making in the provision of employer-sponsored health insurance to their employees.

Actuarial Analysis↗

Drought planning and water allocation: an assessment of local capacity in Minnesota.

Water allocation systems are challenged by hydrologic droughts, which reduce available water supplies and can adversely affect human and environmental systems. To address this problem, drought management mechanisms have been instituted in jurisdictions around the world. Historically, these mechanisms have involved a crisis management or reactive approach. An important trend during the past decade in places such as the United States has been a shift to a more proactive approach, emphasizing drought preparedness and local involvement. Unfortunately, local capacity for drought planning is highly variable, with some local governments and organizations proving to be more capable than others of taking on new responsibilities. This paper reports on a study of drought planning and water allocation in the State of Minnesota. Factors facilitating and constraining local capacity for drought planning were identified using in-depth key informant interviews with state officials and members of two small Minnesota cities, combined with an analysis of pertinent documentation. A key factor contributing to the effectiveness of Minnesota's system is a water allocation system with explicit priorities during shortages, and provisions for restrictions. At the same time, the requirement that water suppliers create Public Water Supply Emergency Conservation Plans (PWSECP) clarifies the roles and responsibilities of key local actors. Unfortunately, the research revealed that mandated PWSECP are not always implemented, and that awareness of drought and drought planning measures in general may be poor at the local level. From the perspective of the two cities evaluated, factors that contributed to local capacity included sound financial and human resources, and (in some cases) effective vertical and horizontal linkages. This analysis of experiences in Minnesota highlights problems that can occur when senior governments establish policy frameworks that increase responsibilities at the local level without also addressing local capacity.

Conservation of Natural Resources↗

Site-specific health risk assessment of dioxins and furans in an industrial region with numerous emission sources.

While the sources of releasing dioxins have received much attention, the health risks of incinerators are studied considerably more than those of other sources, such as metallurgical industry. Furthermore, risk assessments focus primarily on the effects of single sources; few have addressed the aggregate risks from multiple sources in a region. When many sources of dioxins exist in an area, such as the Industrial Park located in the densely populated district-Siaogang District in southern Taiwan where 17 primary known PCDD/F stationary emission sources are clustered, is the aggregate exposure to these sources imposing high risks even though individual sources comply with emission standards? The study combined the multimedia and multiple pathway exposure modeling and site-specific exposure scenario to assess dioxin risks contributed by the 17 emission sources in the District, including municipal waste incinerators, medical waste incinerators, sinter plants, electric arc furnace, secondary aluminum smelters, cement kilns, etc. The average cancer risk of a resident living in the District was found to be 3.43E-04 under the site-specific exposure scenario. The top emission source is the sinter plant, followed by the electric arc furnace. The information has driven the local government to conduct more complete assessment and at the same time to consider enforcing a stricter local standard of dioxin emissions in the Siaogang District.

Dioxins↗

Fundamental properties of local anesthetics: half-maximal blocking concentrations for tonic block of Na+ and K+ channels in peripheral nerve.

UNLABELLED: Local anesthetics suppress excitability by interfering with ion channel function. Ensheathment of peripheral nerve fibers, however, impedes diffusion of drugs to the ion channels and may influence the evaluation of local anesthetic potencies. Investigating ion channels in excised membrane patches avoids these diffusion barriers. We investigated the effect of local anesthetics with voltage-dependent Na+ and K+ channels in enzymatically dissociated sciatic nerve fibers of Xenopus laevis using the patch clamp method. The outside-out configuration was chosen to apply drugs to the external face of the membrane. Local anesthetics reversibly blocked the transient Na+ inward current, as well as the steady-state K+ outward current. Half-maximal tonic inhibiting concentrations (IC50), as obtained from concentration-effect curves for Na+ current block were: tetracaine 0.7 microM, etidocaine 18 microM, bupivacaine 27 microM, procaine 60 microM, mepivacaine 149 microM, and lidocaine 204 microM. The values for voltage-dependent K+ current block were: bupivacaine 92 microM, etidocaine 176 microM, tetracaine 946 microM, lidocaine 1118 microM, mepivacaine 2305 microM, and procaine 6302 microM. Correlation of potencies with octanol:buffer partition coefficients (logP0) revealed that ester-bound local anesthetics were more potent in blocking Na+ channels than amide drugs. Within these groups, lipophilicity governed local anesthetic potency. We conclude that local anesthetic action on peripheral nerve ion channels is mediated via lipophilic drug-channel interactions. IMPLICATIONS: Half-maximal blocking concentrations of commonly used local anesthetics for Na+ and K+ channel block were determined on small membrane patches of peripheral nerve fibers. Because drugs can directly diffuse to the ion channel in this model, these data result from direct interactions of the drugs with ion channels.

Anesthetics, Local↗

Health politics and policy: survey of U.S. health administration courses.

In summary, the vast majority of graduate health administration programs in this country offer a course in health politics and policy. Most of these courses are conducted as a seminar involving class discussions, guest speakers, and student projects. Aside from these generalizations, there is little consensus regarding such matters as course content, objectives, textbooks, and readings. The findings of this survey indicate a crying need in health administration education for a basic textbook or collection of readings on health policy and politics. Such a text should cover the following: 1. Basic information on United States politics and government: our constitutional framework; the presidency; the legislative process; the role of the judiciary; state and local governments; etc. 2. Late 20th century United States political culture: why Americans hate politics and distrust politicians; government as "part of the problem"; the role of the media; the role of lobbyists; campaign financing; increased us of initiatives and referenda; etc. 3. Comparisons of the United States health care system to systems in other countries: Canada, Great Britain, Sweden, Germany, etc. 4. Case studies on traditional health policy issues: Hill-Burton, planning, cost versus access, risk segmentation, rationing, health ethics, etc. 5. Bibliography of suggested readings. A textbook or anthology of this type would provide a solid foundation for a health policy course. Instructors could then add discussion of current events, guest speakers' presentations, and selected readings on emerging issues such as health care reform. In this way the course could be grounded in sound political science theory while also meeting the students' needs for practical insights into health policy issues of the day and their own role as health care executives in influencing the outcome of those policy debates.

Curriculum↗

An assessment of national needs for community physician manpower in Nigeria: staff training needs and programmes.

This second part of a national survey was designed to identify the training needs and programmes considered most appropriate by the most senior health management staff of the state governments for the field practice of community medicine in Nigeria. The operation of the current primary health care programme and the field practice of community medicine although constitutionally a local government responsibility, effectively rests on the state governments at present because of economic and political constraints at the LG level. The main needs identified in the study are for a certifiable and appropriate generalist community physician training programme as well as the relative levels of emphasis needed in the different sub-specialty areas. While holders of the current fellowship diploma in public health of the National Postgraduate Medical College of Nigeria are welcome to practice in the field if they are available, many state governments and officials consider the programme ill-suited to the needs of field practice community physicians. Thirteen (68.4% of the) respondents, consider it suitable only for jobs at state employment levels and higher up. Twelve of the 17 physician respondents considered clinical practice essential for all community physicians. Eighteen of the 21 state governments would be ready to sponsor their physician candidates to local training programmes in public health as identified in this study, if different from the current postgraduate fellowship. Maternal and child health was the area of sub-specialty training considered most needed in the states. This was followed by epidemiology, environmental health, health education, health and biostatistics, health management, and occupational health in that order.(ABSTRACT TRUNCATED AT 250 WORDS)

Community Medicine↗