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PubMed1979

On knowledge, policy, practice, and fate.

Knowledge of the nation's health and nutritional status is dated, uncertain, incomplete, and complex, whereas politicans demand simplicity and administrators, practicability, and everyone wants more and better information. Rational policy, the unicorn intellectuals hunt, should combine clarity, realism, and conviction, which calls for a touch of passion. Attempts to reconcile these contradictory elements can lead to dangerous political pressures on research; the simplification, exaggeration, and over-generalization of findings; and excessive expectations for humdrum programs that often bear little resemblance to their glorified goals. Inadequate knowledge can justify both action and inaction, which are merely different lays of meeting our fate. The ultimate goal of health and nutrition policy, it may be said, is a long and healthy life and a quick and happy death. That may be desirable, but is it attainable.

Health↗

PubMed2026

The impact of drug decriminalization policy on mental health- and substance-related service utilization among people who use drugs with prior care in British Columbia.

BACKGROUND: In 2023, British Columbia implemented a pilot illicit drug decriminalization policy aimed at addressing the high burden of illicit drug toxicity deaths, creating a need to examine its health system impacts. Although research on decriminalization has largely focused only on substance-related outcomes, broader mental health service utilization, including substance-related mental health care, among people who use drugs remains an insufficiently studied domain that this study seeks to address. METHODS: In this single interrupted time series analysis of prevalent people who use drugs with prior care (PWUD-PC) in BC, we examined the proportion of people who accessed mental health and substance-related (MH-SR) services and their average monthly MH-SR visits one year before and after the decriminalization policy, stratified by physician visits, emergency department visits, and hospitalizations. RESULTS: The population prevalence of PWUD-PC remained stable at 1.8% before and after decriminalization, and no statistically significant changes were observed in the proportion of PWUD-PC accessing MH-SR physician services and hospitalizations. The early period following decriminalization did not produce large shifts in overall MH-SR service use among PWUD-PC. Some movements in trends were seen in emergency department use, while several other outcomes, particularly in hospitalizations and physician visits, continued pre-existing trends. CONCLUSION: Overall, we found stable patterns of MH-SR service engagement across the intervention period and small shifts in the post-intervention trends of average MH-SR service visits. These findings suggest that the early period following decriminalization did not lead to abrupt or large shifts in MH-SR service use among PWUD-PC.

Humans↗

PubMed2026

The future of precision oncology and artificial intelligence in Belgium: scenarios and policy responses.

PURPOSE: Precision medicine, also known as personalized medicine, enables the provision of tailored health services to patients. In the prevention, early detection, and treatment of cancers, precision medicine is highly promising, given the increasing use of genomic profiling for diagnosis and adapting therapies in several tumor types. Artificial Intelligence (AI) can support this process by analyzing vast amounts of relevant data. However, high-quality data and financial investments in the health system are essential for the implementation of precision medicine and AI solutions in routine cancer care. DESIGN/METHODOLOGY/APPROACH: Building on the quantitative outcomes of a foresight exercise published in another study, this article collects qualitative data to gain more detailed insights into the future of precision oncology in Belgium and discusses the role of AI in this field. It reports the results of a series of expert workshops, focusing on four hypothetical future scenarios that are centered around technological and economic issues that must be overcome for the widespread use of precision oncology in Belgium. FINDINGS: The study concludes that all four scenarios discussed in the workshops would require supportive policy measures in Belgium, which should go beyond mere technological and economic considerations, such as involving patient associations and the public in policy design or creating multi-disciplinary expert groups for precision medicine. ORIGINALITY/VALUE: To the best of our knowledge, this is the first study to employ foresight methodology to illustrate possible future scenarios, scrutinize feasible approaches for implementing precision oncology in Belgium, and discuss the use of AI in this context.

Belgium↗

PubMed1979

The development of early Chinese Communist health policy: health care in the Border Region, 1936-1949.

This paper examines the health care policy and program of the Chinese Communists in their earliest stages of development. An assessment of 1) political policy, 2) public health campaigns, 3) medical services, 4) public health education, and 5) medical education, indicates that the role of the health delivery scheme was primarily to mobilize mass support for the government, and to change popular health behavior, thereby improving the health of the people and lessening demand on scarce medical facilities. An analysis of the Border Region's health program from 1936 to 1949 gives us an insight into the strategy of a revolutionary government to win popular support and to effect social change.

China↗

PubMed1978

Policy, politics, and child health: four decades of federal initiative and state response.

This paper analyzes the continuity and change in the relationship between federal and state governments in the formation and implementation of child-health programs. After reviewing developments in federal child-health policy since the Sheppard-Towner Act of 1923, methods of implementation and changes in state laws and administrative organization in Vermont and Connecticut are compared with a focus on the major programs authorized by Title V of the Social Security Act. Four broad interactive areas of comparison--governmental relations, program delivery systems, expenditure patterns, and private interests--serve as vantage points for exploring, understanding and explaining the process of policy implementation. Specific conclusions are drawn regarding each area and the overall conclusion is that federal efforts under Title V have not lessened the general neglect of child health in state legislation; nor have they greatly expanded the volume of direct services for child care. They have been sufficiently ambiguous and diffuse to leave the providers dominant, treating diseases and existing conditions rather than focusing energy on preventive measures. Federal resources have been absorbed by expanding administrative overhead, state bureaucracies have been inflated rather than motivated.

Adolescent↗

PubMed1978

Quantitative decision techniques for the health/public sector policy-maker: an analysis and classification of resources.

Policy problems in the health and public sectors are quickly assuming a new level of complexity. Thus, the health/public sector analyst is being confronted with the task of identifying, formulating, evaluating, and making choices among larger and more complicated sets of decision alternatives. Given the context of such decisions, less-than-effective choices could adversely affect the health and social well-being of whole sections of a population. What seems to be needed, therefore, is an approach that would provide system and objectivity to the policy-making process. The use of quantitative techniques, so long applied to problems in the private and industrial sectors, would be the mainstay of such an approach. It is the goal of this article, therefore, to identify, classify, and briefly describe elements of the emerging set of materials (texts, edited readings, and monographs) which offer discussions of these techniques as they apply to problems in the health and public sectors. It is hoped that such a presentation will hasten the application of available analytic decision tools to the policy/decision problems of the public sector.

Bibliographies as Topic↗

PubMed1979

The design of failure: health policy and the structure of federalism.

This paper explores the impact of the federal structure of American government on health policy through the examination of three case studies of unsatisfactory policy: Medicaid cutbacks; provider licensure; and health planning under P.L. 93-641. Problems arise in three areas because of a disjunction between administrative or regulatory responsibilities and financial accountability. How the division of responsibilities among different levels of government might be managed better is examined briefly, in the context of possible state roles under a system of national health insurance.

Government Agencies↗

PubMed1979

The transfer of care: U.S. mental health policy since World War II.

Recent criticism of mental health policy has raised many questions about the so-called "mental health revolution." Following World War II, the federal government and the growing mental health lobby planned the first nationally oriented system of psychiatric treatment, rehabilitation, and prevention. The rapidly expanding National Institute of Mental Health coordinated that policy, particularly through its Community Mental Health Centers program. Custodial state hospitals were depopulated and their patients "dumped" in nursing and boarding homes, which now constitute the largest arena for and most expensive form of psychaitric care. While there has been some progress in decreasing the hospital population and in improving conditions, as well as in providing services to certain people who otherwise would never receive them, failures have been more dominant. Admission and readmission rates have climbed precipitously. Unplanned hospital discharge has led to hundreds of thousands of ex-patients living in dangerous, nontherapeutic nursing homes were the main concern is profit. They, and many others, are maintained on psychiatric drugs, another source of profit as well as a dangerous technology. Community mental health programs have maintained psychiatry's traditional class, race, and sex biases, and have incurred widespread intrusion into communities. This article shows that such problems are part of an interconnected system in which the driving forces are fiscal crisis, ideological justifications for dumping patients, attempts to pass responsibility from state governments to federal and local bodies, restrictions on government and insurance reimbursements, the free enterprise economics of the nursing home and drug industries, and the professionalist practices of the mental health field.

Community Mental Health Services↗

PubMed1979

The policy culture of drugs: Ritalin, methadone, and the control of deviant behavior.

Various concepts are introduced which may be new to most readers of sociological journals. The concepts include policy culture and the medicalization of deviant behavior. Treatment drugs such as methadone and Ritalin are discussed within a framework which utilizes these concepts. It is concluded that the policy culture surrounding the introduction and use of these drugs is highly particularistic. This process in turn tends to produce certain unintended consequences.

Child↗

PubMed1979

Deciphering deinstitutionalization: complexities in policy and program analysis.

Deinstitutionalization as a public policy promised to be a major departure from previous psychiatric practice. Decrying traditional "medical paradigms" and the custodial "warehousing" of mental patients, policy makers advanced a "bold new approach" for care in the community. Progressive humanitarian reform could go hand in hand with fiscal conservatism. Community Mental Health Centers were to be the heart of a new national effort. But the rhetoric of reform failed to coalesce the activities among competing federal and state interests and systems. Intended beneficiaries may have become unfortunate victims.

Community Mental Health Services↗

PubMed1978

Balancing policy objectives in long-term care.

The public policy objectives in long-term care--quality, availability, and cost containment--are promoted by different groups with conflicting but legitimate interests. The problem faced by the policymaker is to balance the economic and political consequences for patients, providers, and public funding agencies, and he often does this by partial achievement or selective nonachievement of the policy goals. A multidimensional objective function is described that permits calculation of the optimum extent to which conflicting goals can be achieved. The model allows simulation of the effects, on several simultaneous measures, of an administered change in some or all of the measures. The example given illustrates the complexity of the policymaker's problem and suggests a rational approach to dealing with it.

Connecticut↗

PubMed2026

Risk governance of transgenic plants: bridging science, policy, and public trust.

Transgenic plants and genome editing technologies are revolutionizing agriculture through sustainable approaches to food security, pest management, and adaptation to climate change; but their widespread use is hampered by regulatory systems that are fragmented, ethics considerations, and an ongoing lack of trust from the general public. In contrast to other literature that evaluates regulation processes and public acceptance separately, our review paper introduces a new, holistic approach that includes both technical risk assessment from a scientific perspective, and Codex Alimentarius and OECD standards, and the socio-legal and judicial environment of how the national policy decisions are actually made. The paper provides a comparative, historical analysis of the key difference between product- and process-based risk governance in the USA, the EU, and India. Through the use of case studies with global significance like MON810 maize, Bt Brinjal, and the April 2024 Philippine Court of Appeals' order for cease-and-desist of Golden Rice, we discuss the increasing tension between administrative scientific approvals and precautionary judicial orders. We further explore the emerging exemptions to regulation of Site-Directed Nuclease (SDN-1 and SDN-2) genome edited crops which led to India's revolutionary 2025 commercialization of climate-resilient rice crops. Our review ends with a forward-looking approach to biotechnology regulation policy, making an appeal to shift from static historical dichotomies towards flexible risk-proportionate and internationally coordinated regulatory systems. Finally, we show that global success of agricultural biotechnology is not just about safety verification, but rather about establishment of transparent and communicable institutions that can transform scientific risk assessments into legitimate risk management decisions.

Plants, Genetically Modified↗

PubMedDate not supplied

A survey about blood bank policies and procedures.

A questionnaire about blood bank policies and procedures was prepared and sent out to 170 hospitals across the nation, 50 per cent responded. There is wide variation in both technical and nontechnical policies and procedures. Serum is separated from the original tube within 8 hours by 68 per cent of the hospitals and in 32 per cent serum is never separated from the original tube. Auto-control is included by 66 per cent of hospitals in at least one phase of the antibody testing, 34 per cent do not include auto-control in any phase. Du testing of the recipient is done in 85 per cent of the hospitals and in 15 per cent Rho type is determined by the immediate spin reactions alone. Slide type is the only method used to determine ABO group of cells of the recipients in 10 per cent of the hospitals, 18 per cent use serum-cell suspension, 10 per cent use the applicator stick method and only 62 per cent use washed saline-cell suspension routinely. Compatiblity testing between a recipient and a donor vary from a one-tube major crossmatch to a three-tube major crossmatch and minor crossmatch.

ABO Blood-Group System↗

PubMed1979

Can China's health care be transplanted without China's economic policies?

China's economic policies of the past 25 years have shaped its present health-care system. China's leadership has decided to have neither a national health-insurance system nor a national health service. Instead, it decided that its health system would mirror the workings of its industrial and agricultural system. Decisions to minimize imports, ban private economic activity, assign university graduates on a compulsory basis, control wages, maintain a large domestic standing army and prevent professions or universities from acquiring independent status led directly to the present system of medical care. Consequently, transplantation of China's striking achievements in health-care delivery to the United States or other countries is unlikely to occur in the absence of transfer of the underlying economic policies.

Agriculture↗

PubMed1978

Who should make moral policy decisions in health care?

Physical therapists are not always involved in the formulation of moral policy that significantly affects their professional practice as clinicians, researchers, and educators. This paper analyzes five major positions being taken regarding what the physical therapist's role ought to be, and suggests possibilities for increased involvement in the policy-making process.

Decision Making↗

PubMed1975

Bluetongue certification -- Australian policy.

Australian quarantine policies with respect to BT are based on regarding this disease as one of high risk and major potential economic importance to our ruminant population. There are deficiencies in our knowledge of world distribution, epidemiology and pathogenesis. There may be unknown vectors and unsuspected animal reservoir hosts. The international distribution of BT could be extending through the movements of insects or cattle. If introduced into Australia, the cattle and sheep populations would probably be at continuous risk as eradication would be difficult or impossible. Costs to the sheep industry at least could be high and productivity gravely affected. To reduce the probability of introduction, imports of ruminants and semen have, for the last 16 years, been restricted to a very small number of countries presumed free from BT. Future policies will almost certainly be based on these same considerations taking into account scientific advances in diagnosis and virus detection. The establishment of an off-shore high security quarantine station will facilitate imports of ruminants even from known BT-infected countries.

Animals↗

PubMed1978

Cognitive development and social policy.

The city of Warsaw was razed at the end of World War II and rebuilt under a socialist government whose policy was to allocate dwellings, schools, and health facilities without regard to social class. Of the 14,238 children born in 1963 and living in Warsaw, 96 percent were given the Raven's Progressive Matrices Test and an arithmetic and a vocabulary test in March to June of 1974. Information was collected on the families of the children, and on characteristics of schools and city districts. Parental occupation and education were used to form a family factor, and the district data were collapsed into two factors, one relating to social marginality, and the other to distance from city center. Analysis showed that the initial assumption of even distribution of family, school, and district attributes was reasonable. Mental performance was unrelated either to school or district factors; it was related to parental occupation and education in a strong and regular gradient. It is concluded that an egalitarian social policy executed over a generation failed to override the association of social and family factors with cognitive development that is characteristic of more traditional industrial societies.

Child↗

PubMed1979

Hospital antibiotic policy in a health district.

A hospital antibiotic policy is described in which only a few antibiotics were used over a two-year period. Six antibiotics--namely, ampicillin, cloxacillin, cephradine, penicillin, erythromycin, and oxytetracycline--accounted for 98% of the antibiotics consumed. Gentamicin was not used topically. Apart from high levels of resistance to ampicillin in Staphylococcus aureus (80%), the Enterobacteriaceae (37%), and Bacteroides (83%), antibiotic resistance was not a problem and no major epidemics of cross-infection occurred. With this policy antibiotic consumption declined and the total true cost of the antibiotics fell from 16 361 pounds in 1976 to 10 448 pounds in 1978.

Anti-Bacterial Agents↗