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PubMed2005

Life cycle approaches to sustainable consumption: a critical review.

The 2002 World Summit for Sustainable Development in Johannesburg called for a comprehensive set of programs focusing on sustainable consumption and production. According to world leaders, these programs should rely on life cycle assessment (LCA) to promote sustainable patterns of production and consumption. Cleaner production is a well-established activity, and it uses LCA. UNEP, the European Union, and a number of national organizations have now begun to work on sustainable consumption. In developing sustainable consumption policies and activities, the use of LCA presents interesting opportunities that are not yet well understood by policy makers. This paper reviews how life cycle approaches, primarily based on input-output analysis, have been used in the area of sustainable consumption: to inform policy making, select areas of action, identify which lifestyles are more sustainable, advise consumers, and evaluate the effectiveness of sustainable consumption measures. Information on consumption patterns usually comes from consumer expenditure surveys. Different study designs and a better integration with consumer research can provide further interesting insights. Life-cycle approaches still need to be developed and tested. Current research is mostly descriptive; policy makers, however, require more strategic analysis addressing their decision options, including scenario analysis and backcasting.

Community Participation↗

PubMed1992

Ethics committees, organ transplantation and public policy.

CONCLUSION: It is clear that ethics committees face many dilemmas in developing sound public policy on organ transplantation through their roles in serving their institutions and their communities. With conscientiousnes and good faith, different committees may adopt different approaches to the same issue, and arrive at different solutions when subscribing to the same approach. It is valuable that committee members should be aware of other committees' approaches and disclose the reasons for their own in a frank, non-defensive way. It should also be remembered that a measure of legitimacy can attach to ethics committees' decisions because of the integrity with which their decisions are reached, even when they differ from other committees' decisions. Like courts of law, their decisions carry weight because of how they are reached, not simply because of how they comport with the judgments of others. This is not to say that every or any legally permissible policy is ethically sound, but only that ethics committees can contribute to public satisfaction that institutions are under reliable control through the demonstrable integrity and competence of their processes of policy making.

Adolescent↗

PubMedDate not supplied

The need for evidence-based health policy to address health care variations.

Medicare policy making now deals mostly with price-setting issues. However, as Warren Buffet has noted: "Price is what you pay. Value is what you get." Victor Fuchs's studies raise fundamental issues for a value-oriented Medicare program. Florida offers one of many regional patterns of Medicare mortality that are not yet adequately explained. Valued-oriented, evidence-based Medicare policies would target opportunities to improve population health and would foster greater use of evidence-based medicine.

Delivery of Health Care↗

PubMed2004

Petro-state constraints on health policy: guidelines for workable reform in Venezuela.

This article reviews the performance of the Venezuelan health care sector and suggests guidelines for workable health policy under difficult conditions. Two special circumstances constrain policy options. First, Venezuelans share a traditional value, solidarity, which includes a strong desire for equity. Reforms must comply with this norm to succeed. Second, foreign sales of state-controlled oil constitute the bulk of the government budget and the gross domestic product (GDP). Petroleum market fluctuations expose the country to extreme economic cycles. In response, policy making and stakeholders adopt a rentier attitude, focusing on preserving or enlarging entitlements to government oil monies. The side effects of this largesse include poor productivity, a weak private sector, a widespread sense of entitlement without accountability, and a crippled state which controls most of the available resources yet is unable to effectively tax, regulate, steer the economy, or pursue long-term policies. The health care sector shares these problems. As a result, Venezuela's health systems are fragmented, poorly coordinated, excessively centralized, inequitable, and ineffective. Policies to improve public health and public and private medical care must take into account these constraints.

Delivery of Health Care↗

PubMed1984

Australia's environment and its influences on health.

While the Australian geographic environment is essentially benign, we have had a history of imported infectious diseases which requires continual surveillance to avoid recurring in this age of high international mobility. Urbanisation and an ageing population provide what is now a common picture of health care problems found in most Western societies. There is renewed emphasis on environmental health policy making and the development of stronger strategies of health conservation in the workplace. Many of these efforts have to cope with the difficult legislative arrangements relating to Federal and State jurisdictions.

Australia↗

PubMed1996

National Nutrition Survey in Japan.

The National Nutrition Survey in Japan has played an important role for nutrition policy in this country, by monitoring nutrition and health status of the Japanese since 1946. During those 50 years, diet of the Japanese has remarkably changed, with the proportion of fat intake in total energy being more than 25% and salt intake gradually decreased. The aim of this survey also has shifted from the policy making for food supplies to monitoring the over intake for prevention of diet-related chronic diseases and health promotion.

Diet↗

PubMed2005

The ownership elephant: ownership and community-governance in primary care.

Ownership of primary care is an often neglected but important health systems design parameter. The New Zealand Primary Health Care Strategy has established Primary Health Organisations (PHOs) as non-profit umbrella organisations, however in most instances their constituent general practices are for-profit small businesses. This viewpoint paper aims to: (a) define ownership and community participation; (b) summarise some of the evidence from the NatMedCa study pertaining to ownership-related differences; and (c) discuss the policy implications of different ownership forms in primary care, and the implications of merging different ownership forms under the umbrella of PHOs. Ownership confers governance responsibility (ultimate control) for an organisation, and accountability for its actions. Community governance involves vesting overall control of resources in users and the community, rather than with health service managers or health professionals. Results from three studies using the NatMedCa survey indicate that community-governed non-profits in New Zealand differ in a number of respects from their for-profit counterparts. As non-profit and for-profit ownership forms have different social roles, and as meaningful community participation in governance is determined in large part by ownership structures, there is a need for ownership frameworks to be used more widely in health policy making. Because of the ownership boundary that exists between non-profit community-governed PHOs and their constituent for-profit general practices PHOs may have little real ability to effectively govern their practices.

Community-Institutional Relations↗

PubMedDate not supplied

Altering specialty balances.

In an on again, off again pattern, the numbers and distribution of physicians have been of policy concern since the passage of Medicare and Medicaid in the '60s. After a hiatus in the '80s, these issues are a significant part of the current health reform agenda, appearing in one form or another in many of the proposals already offered. If the solutions found this time are to have lasting effects, however, it is critical that the issues are carefully shaped and that those making policy are certain that agreement has been achieved on the basic terms that characterize the issues. This column is jointly edited by Keven M. Fickenscher, MD, Chair, and David A. Kindig, of the College's Forum on National Health Policy.

Health Care Reform↗

PubMed1996

Medicaid managed care and the health reform debate: lessons from New York and California.

Nearly every state now encourages (or requires) its Medicaid beneficiaries to enroll in managed care. There is, however, extraordinary variation in every aspect of state managed care policy. In this article, I examine the managed care initiatives of two states, New York and California, and focus on variation in state policy-making environments and on the influence of such variation on efforts to protect the medical safety net. I conclude that California's managed care initiative is less decentralized and pluralistic than New York's, and that California has used its discretion to adopt a strategy designed in part to protect safety-net hospitals. I end with a plea for greater federal control of managed care initiatives, a policy proposal that is at odds with the current trend to increase state authority.

California↗

PubMedDate not supplied

Evidence-based medicine and practice: what's new for the physicians?

This paper introduces the readers to the concepts of Evidence-Based Medicine (EBM) and Evidence-Based Health Care (EBHC). After taking the view that EBM and EBHC are essentially a new way of thinking about the theory and practice of medicine, the paper discusses their potential, limitation and ambiguities. Besides summarising the roles of EBM and EBHC in providing information relevant for patient care, medical education, health policy-making, information-seeking and eventually, guideline production, the paper closes discussing some of the potentials as well as dangers of this new scientific and cultural movement.

Conflict of Interest↗

PubMed1996

Integrating public health information and surveillance systems.

The Centers for Disease Control and Prevention (CDC) recognizes sound public health information is the essential ingredient of all of its work and the key to effective public health decision making. A CDC/ATSDR committee reached a consensus that CDC needed to streamline and consolidate its public health surveillance and information systems into an integrated system. With integrated systems, a wide range of diverse individual information systems will continue to exist but these systems must be coordinated, interconnected, comparable, and easy to use. The "glue" that holds these systems together consists of (1) uniform data standards, (2) communications networks, and (3) policy-level agreements regarding data access, sharing, and reduction of data collection burdens. By putting the appropriate policy-making apparatus and resources in place, CDC believes the end result will be a streamlined process that meets the information needs of CDC and its partners with less confusion and frustration.

Humans↗

PubMedDate not supplied

A Medicare reform primer.

The use of the federal budget process to change Medicare policy is of importance to physician executives because of its impact on the health care delivery system. In particular, changes in Medicare policy, driven by the need to shore up the solvency of a politically popular program, will create changes for other public and private purchasers of health care. Reforming Medicare through the budget process is not new. Physician fees have been frozen, reduced, and selectively increased as a result. In 1983, the hospital reimbursement methodology was changed to prospective payment through this process. The budget process will continue to be used to make policy changes because of the large amount that Medicare occupies of the federal budget. Given the profound impact changes in Medicare can have in other health care sectors, the lack of consensus for a long-term solution would mean those in the health care arena will have to be prepared for significant annual policy changes through the reconciliation process.

Aged↗

PubMed1997

Effect of a new antenatal care programme on the attitudes of pregnant women and midwives towards antenatal care in Harare.

OBJECTIVE: The aim was to study the effect of a new antenatal care (ANC) programme on the attitudes of pregnant women and midwives towards antenatal care. DESIGN: This was a controlled trial in which the attitudes of women and staff using the standard programme of ANC were compared to those using a new one. The new programme contained fewer but objective oriented visits, and was designed to improve consumer and provider satisfaction with ANC. SETTING: Antenatal sessions at primary care clinics in Harare. SUBJECTS: 200 pregnant women and 65 midwives. MAIN OUTCOME MEASURES: The satisfaction of pregnant women and staff with ANC, reasons for lack of satisfaction, and time spent waiting for consultations. RESULTS: The new programme did not make any impact on the time spent by women waiting to be seen at the clinics, nor on the time made available for the consultations. There was no significant impact on the degree of satisfaction with the care among the women. In the control clinics, significantly more staff wished the women to make fewer visits, and in the study clinics, significantly more staff thought the use of appointments was appropriate. The major problem limiting access to ANC was lack of money to pay for the booking fees. Other problems mentioned by the women were ignorance regarding the best time to book, lack of privacy and insufficient staff at the clinics. CONCLUSIONS: The solutions to some of the problems identified require infrastructural changes at policy making level, rather than changes within the antenatal care programmes.

Adult↗

PubMed2005

Public understanding of food risks in four European countries: a qualitative study.

BACKGROUND: In the wake of the 'bovine spongiform encephalopathy (BSE) crisis' there was renewed interest in how those responsible for public health could take account of public views, both to 'democratize' policy making and to increase the likelihood of information about health risks resonating with public concerns. This study explored how members of the public in four European countries (Finland, Germany, Italy and the UK) understood food risks in general, and risks arising from BSE in particular. The aims were to identify the sources of knowledge used and trusted by the public and to explore how public views could be accessed for public health information policy. METHODS: Thirty-six focus group interviews were held using a common protocol across the four countries, including people from four life-cycle stages. RESULTS: The study demonstrated the utility of using focus groups as a relatively efficient method for accessing public views, and the feasibility of cross-national qualitative research on public views. We found that public views of food risks are neither irrational nor naïve, but that they do need to be interpreted in the context of everyday food purchasing decisions, in which particular food risks are unlikely to have the same salience as they do for experts. CONCLUSIONS: Focus groups are a feasible method for accessing public knowledge on public health risks to inform information strategies.

Adolescent↗

PubMed2003

Urban premature mortality in the U.S. between 1980 and 1990: changing roles of income inequality and social spending.

Measuring the effects of policy and social inequality is complicated because inequalities and policies may have delayed or accumulative effects on health. The objective of this study is to build on the body of work on population mortality and income inequality by investigating the association between income inequality and mortality at the city level at two points in time (1980 and 1990) as well as to determine whether indicators of 1980 social policies of cities are associated with 1990 mortality rates due to delayed or accumulative effects. We found that 1980 income inequality and police spending is associated with increased premature mortality for 1990. In conclusion, there appear to be long-term consequences of city levels of income inequality on population health, although this relationship is incompletely understood. While a lack of information on how inequality operates on health should not preclude us from making policy decisions aimed at creating greater social equality, for example, through improvements in education, we would benefit from longitudinal research on specific macroeconomic and environmental factors, inequality, and health. Establishing such causal relationships is critical in creating social policies that optimally promote health and well-being.

Health Status Indicators↗

PubMedDate not supplied

[Collective participation and the elicitation of preferences for health care programs: a health system perspective].

The need to increase collective participation in health care decision-making is one of the main health reform issues in publicly financed health systems. The present article examines the arguments for collective participation, the means for improving it and the methods available to elicit collective preferences concerning health programs to be financed by the health system. We review the various collective participation tools, as well as the preference elicitation methods assist priority setting in collectively funded health care systems. Finally, the paper suggests some policy implications for policy making design in Spain.

Community Participation↗

PubMed2006

Health services research as a source of legislative analysis and input: the role of the California Health Benefits Review Program.

This article examines the role of the California Health Benefits Review Program (CHBRP) as a source of information in state health policy making. It explains why the California benefits review process relies heavily on university-based researchers and employs a broad set of criteria for review, which set it apart from similar programs in other states. It then analyzes the politics of health insurance mandates and how independent research and analysis might alter the perceived benefits and costs of health insurance mandates and thus political outcomes. It considers how research and analysis is typically used by policy makers, and illustrates how participants inside and outside of state government have used the reports prepared by CHBRP as both guidance in policy design and as political ammunition. Although there is consensus that the review process has reduced the number of mandate bills that are passed out of the legislature, both supporters and opponents favor the new process and generally believe the reports strengthen their case in legislative debates over health insurance mandates. The role of the CHBRP is narrowly defined by statute at the present time, but the program may well face pressure to evolve from its current academic orientation into a more interactive, advisory role for legislators in the future.

California↗

PubMed1995

The implementation of health promotion: a new structural perspective.

Although health promotion has become a critical concept in public health, both research and practical projects in this area are almost devoid of theory. The present article uses a theory of complexity and structure to organize the different elements of health promotion in a new perspective. This perspective involves (1) new ways for looking at patterns of behavioral risk factors and health-related lifestyles. It (2) relates health promotion to policy making. In particular, it (3) focuses on a comprehensive model of the implementation process, revealing the true interrelationship of relevant elements to the concept of health promotion. In this context, it (4) becomes obvious that the reflexivity and recursiveness of scientific analyses are an integral part of the structure of health promotion. Thus, the professional role of the social scientist with regards to the implementation and utilization of scientific knowledge in the field of public health policy will be discussed. Finally, the role of appropriate theory is emphasized as a strategy for improving the practice of health promotion and to further the development of a new public health.

Forecasting↗