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PubMed2001

Dutch alcohol policy developments: the last decades and present state of affairs.

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.

Adolescent↗
PubMed1987

Implications of measures of quality of life for policy development.

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.

Federal Government↗
PubMedDate not supplied

Sources of stem cells: ethical controversies and policy developments in the United States.

The bioethical controversy about public policy in the United States regarding human stem cell research, particularly with regard to several potential sources of stem cells, including aborted fetuses, unimplanted embryos following in vitro fertilization (IVF), and embryos created through IVF or cloning for research purposes is examined. On the one hand, the debate about the use of federal funds for this research was not resolved by President Bush's policy, announced in August 2001, because only a few cell lines are available under this restrictive policy. On the other hand, debate persists about whether the US should adopt a prohibitive, regulatory, or permissive policy toward the deliberate creation of embryos for biomedical research through somatic cell nuclear transfer. Although there is a wide consensus about the need to ban cloning-for-reproduction, there is deep division, reflected in the work of the President's Council on Bioethics, about a possible ban on cloning-for-biomedical research. The author concludes that ethical controversy will probably persist about both types of policy, and that the policy stalemate will probably also continue, because of fundamental disagreements about the moral status of the early embryo.

Cloning, Organism↗
PubMedDate not supplied

Perceptions of population policy, development, and family planning programs in northern Nigeria.

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.

Adolescent↗
PubMed2004

Knowledge-based changes to health systems: the Thai experience in policy development.

Over the past two decades the government in Thailand has adopted an incremental approach to extending health-care coverage to the population. It first offered coverage to government employees and their dependents, and then introduced a scheme under which low-income people were exempt from charges for health care. This scheme was later extended to include elderly people, children younger than 12 years of age and disabled people. A voluntary public insurance scheme was implemented to cover those who could afford to pay for their own care. Private sector employees were covered by the Social Health Insurance scheme, which was implemented in 1991. Despite these efforts, 30% of the population remained uninsured in 2001. In October of that year, the new government decided to embark on a programme to provide universal health-care coverage. This paper describes how research into health systems and health policy contributed to the move towards universal coverage. Data on health systems financing and functioning had been gathered before and after the founding of the Health Systems Research Institute in early 1990. In 1991, a contract capitation model had been used to launch the Social Health Insurance scheme. The advantages of using a capitation model are that it contains costs and provides an acceptable quality of service as opposed to the cost escalation and inefficiency that occur under fee-for-service reimbursement models, such as the one used to provide medical benefits to civil servants. An analysis of the implementation of universal coverage found that politics moved universal coverage onto the policy agenda during the general election campaign in January 2001. The capacity for research on health systems and policy to generate evidence guided the development of the policy and the design of the system at a later stage. Because the reformists who sought to bring about universal coverage (who were mostly civil servants in the Ministry of Public Health and members of nongovernmental organizations) were able to bridge the gap between researchers and politicians, an evidence-based political decision was made. Additionally, the media played a part in shaping the societal consensus on universal coverage.

Cost Control↗
PubMedDate not supplied

Using flowcharts in policy development: reporting abuse and neglect of patients.

Reports of abuse, both domestic and institutional, are increasingly common. A myriad of statutes and rules govern when and how incidents of abuse are reported. It is incumbent upon medical centers to establish policies that clearly outline the responsibility of all staff members to identify and report suspected abuse and neglect. This article presents a summary of a comprehensive hospital policy on identifying and responding to all types of suspected or witnessed abuse and neglect of patients. It also illustrates how multidisciplinary teams and flowcharts can be useful in developing and implementing policy in complicated areas that involve many players, rules, and regulations.

Data Collection↗
PubMed1997

Health policy development in wartime: establishing the Baito health system in Tigray, Ethiopia.

This paper documents health experiences and the public health activities of the Tigray People's Liberation Front (TPLF). The paper provides background data about Tigray and the emergence of its struggle for a democratic Ethiopia. The origins of the armed struggle are described, as well as the impact of the conflict on local health systems and health status. The health-related activities and public health strategies of the TPLF are described and critiqued in some detail, particular attention is focused on the development of the baito system, the emergent local government structures kindled by the TPLF as a means of promoting local democracy, accountability, and social and economic development. Important issues arise from this brief case-study, such as how emerging health systems operating in wartime can ensure that not only are basic curative services maintained, but preventive and public health services are developed. Documenting the experiences of Tigray helps identify constraints and possibilities for assisting health systems to adapt and cope with ongoing conflict, and raises possibilities that in their aftermath they leave something which can be built upon and further developed. It appears that promoting effective local government may be an important means of promoting primary health care.

Communicable Disease Control↗
PubMed1989

Nutrition policy development and implementation in Malta.

The paper highlights experiences in the development and implementation of the food and nutrition policy in Malta. As one could expect there has been tangible progress in certain areas but less so in others. Some background information on the food and health status of the Maltese population is given first as this was the reason for the establishment of the policy in Malta in the first place.

Female↗