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PubMed1998

European food and nutrition policies in action. Finland's food and nutrition policy: progress, problems and recommendations.

Some progress has clearly been made in several aspects of Finland's food and nutrition policy: access to nutrition information and education, improvements in mass catering, increased availability of healthier food products, and pricing and quality requirements favourable to a healthy diet. Finnish eating patterns have improved in relation to some recommended foods and macronutrients. The structural changes in farm and food production are largely the result of new political and economic realities both in Finland and internationally, resulting in the Government focusing on fiscal efficiency, decentralization and a more competitive, consumer-oriented market. This new environment is creating pressures to reduce surplus animal fat production and to expand markets in new foods for Finns and other Europeans who, for reasons of demography, health or working or living arrangements, demand new and sometimes healthier foods. Within this context, some health leaders have been able to make and work for proposals that are consistent both with political and economic imperatives and with health needs. Although the populations health status is improving and in some respects is exemplary, diet-related death and illness rates and risk factors (such as serum cholesterol and obesity) are high and their decline, along with some healthy changes in eating patterns, has slowed since the mid-1980s (ironically, since the adoption of the nutrition policy). The more slowly improvements occur, the higher will be the social and economic costs. Major problems in policy implementation exist. Although much has been done in research and demonstration and in the development of national guidelines (in public catering and labeling, for example) there is an apparent lag in translating such soft technology into action and monitoring its implementation in order to develop corrective measures at the operational level. This problem may increase with decentralized budget control and a less regulated market, where listening to the consumer (whether an individual, retailer or caterer) may not necessarily result in healthier products are more accurate consumer information, especially as foreign products and media continue to attract Finnish young people. The lack of a leading strategic body that can authoritatively assess and anticipate problems in implementation, deal with them and coordinate and monitor the necessary action in fundamental to these issues. Rapid progress in economic and farm policy development and food enterprises can provide conditions supportive of health and nutrition goals if such interests are systematically taken into account and allowed to moderate potential negative changes. If it is to be effective, such accounting will require initiative, clarity of strategic purpose and organization by health and nutrition leaders.

Finland↗

PubMed2005

Can education policy be health policy? Implications of research on the social determinants of health.

Research on the social determinants of health has demonstrated robust correlations between several social factors, health status, and life expectancy. Some of these factors could be modified through policy intervention. National-level public policies explicitly based on population health research are in various stages of development in many Western countries, but in spite of evident need, seemingly not at all in the United States. Because research shows such a strong association between education and good health, we offer evidence to show that at least two pressing problems in American society, namely the uneven distribution of educational attainment and health disparities linked to socioeconomic position, may be ameliorated through policy initiatives that link quality early childhood care, child development programs, and parental training in a seamless continuum with strengthened K-12 education.

Educational Status↗

PubMedDate not supplied

CCCSAPR: a new approach to drug policy research in the twenty-first century. California Collaborative Center for Substance Abuse Policy Research.

The California Collaborative Center for Substance Abuse Policy Research (CCCSAPR) was established in 1997 to provide a nucleus for policy research in addiction and allied fields throughout the nine University of California campuses and allied research endeavors. The primary goal of CCCSAPR is that of providing data on statewide and national substance abuse issues toward the development and maintaining of a coherent substance abuse policy in the state of California. The authors present the history and scope of the Center as a new approach to drug policy research for a new century.

Academies and Institutes↗

PubMed1994

Granting authority to a new policy. A community benefit services policy becomes part of the general business strategy.

Bon Secours Health System's new strategic plan and community benefit services policy integrates the planning, budgeting, evaluating, and reporting of community benefit services into management processes at the same level of authority as other operational activities. The strategic plan of Bon Secours Health System, headquartered in Marriottsville, MD, documents the system's mission, operating principles, vision, and five goals, one of which is to improve the communities' health status. The community benefit services operating policy requires that the Bon Secours Health System chief executive officer (CEO) and each local system CEO and nursing home administrator form a multidisciplinary local work group to be responsible for community benefit services. Each local work group assesses the needs of its community within the framework of the annual planning process. Determining what services are needed and how to deliver them is relatively easy. The difficult task is determining which of the many needs to address. What a community lacks may be the result of poor or inadequate public policy. For example, its priority may not be healthcare. In these situations healthcare providers may be best able to serve the community by providing indirect support to social service providers or by advocating for change. The community benefit services operating policy provides a standard approach to match the community's priority needs with the institution's resources and produce a measurable improvement in health status.

Catholicism↗

PubMed1998

The politics of EPSDT policy in the 1990s: policy entrepreneurs, political streams, and children's health benefits.

The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program, which was designed to ensure that Medicaid-eligible children receive comprehensive health services, is the only national attempt to provide a right to these services. The political factors that have shaped national EPSDT policy during the past decade are described, based on a conceptual framework developed by John W. Kingdon. The analysis focuses on the roles of two distinct sets of policy entrepreneurs: child health advocates and fiscally conservative governors. Their activities are described in relation to the larger political environment, or "political stream," from the period of the expansion of Medicaid eligibility for pregnant women and children in the late 1980s to the enactment of a new State Children's Health Insurance Program (SCHIP) in 1997. The relative saliency of eligibility and benefit issues in children's health policies had a major influence on the politics and outcomes.

Child↗

PubMed1996

US policy support for telehealth: organizational response to a new policy environment.

A sample of 40 from 176 public policy organizations in Washington, DC, was studied. The organizations were those whose leadership was deemed necessary to develop a new strategic vision of electronic technologies to support public health. The results showed that large, secure and well positioned organizations became active only to the extent of their mandates, while smaller and less influential groups, which were freer to think and act innovatively, had an incentive to work with other organizations to gain effective support for their policy positions. The conclusion is that the constituencies of leading policy organizations will have to ensure that well connected leaders and environmental scanning structures guide their organizations and that they have the institutional capacity to develop unconventional strategies to meet health challenges.

District of Columbia↗

PubMed1987

Tax policy as social policy: cafeteria plans, 1978-1985.

Since the passage of Section 125 of the Internal Revenue Code in 1978, cafeteria plans have offered employees a choice of tax-free fringe benefits. Although these plans have been popular with employers and employees, Treasury Department officials and many tax lawyers soon came to regard Section 125 as a mistake. The Treasury has tried to reclaim through regulation the revenue and the fundamental principles of tax law it had asked Congress to give away in 1978. This paper is a history of Section 125 that emphasizes its relationship to health policy. On the basis of interviews and printed primary sources, the paper argues that Treasury officials made a less than rigorous assessment of the impact of cafeteria plans because they were preoccupied with a larger agenda of making tax-free benefits more equitable. Moreover, they saw no reason to collaborate with the health policy community to plan this agenda; they saw themselves as implementing a social policy already in the Internal Revenue Code.

Civil Rights↗

PubMedDate not supplied

How government policy decisions affect seniors' quality of life: findings from a participatory policy study carried out in Toronto, Canada.

Toronto seniors explored how government policy decisions were influencing their health and well-being. In this participatory policy study, emphasis was upon the lay and critical knowledge of highly informed seniors. Focus groups and interviews revealed that all three levels of governments were seen as not listening to seniors' voices. In nine key policy areas identified as influencing seniors' quality of life--hearing seniors' voices, housing, acute illness care, long-term care, income supports, transportation and mobility, promoting healthy lifestyles, access to information, and hearing voices from cultural communities--many concerns were raised. The gap between government rhetoric and government action on seniors' issues merits public health attention.

Aged↗

PubMed1996

Influencing health care policy: nursing research and the ANA social policy statement.

This paper describes policy formation and its relationship to nursing research, examining ways in which nursing's disciplinary research can have greater influence on American health care policy. The American Nurses Association's Social Policy Statement (1995) is discussed in its role as a guide for nursing research efforts in a health care reform environment where favorable patient outcomes are key.

American Nurses' Association↗

PubMed1993

Policy regulation and demographic behaviour. Romanian population policy and its consequences.

The effect of population policy in Romania up to 1989 is discussed. The author finds that "Romania's population policy up to 1989, for which any contraceptive method was illegal and punished, and where as a consequence there was a severe control of information regarding family planning,...had a real and very important impact on attitudes and behaviour...[and] on health, especially on that of women and children." Data on deaths from illegal abortion, maternal mortality, and child abandonment are presented.

Abortion, Illegal↗

PubMed2002

Optimal temperature policy for immobilized enzyme packed bed reactor performing reversible Michaelis-Menten kinetics using the disjoint policy.

The optimal temperature policy that maximizes the time-averaged productivity of a continuous immobilized enzyme packed bed reactor is determined. This optimization study takes into consideration the enzyme thermal deactivation with substrate protection during the reactor operation. The general case of reversible Michaelis-Menten kinetics under constant reactor feed flow rate is assumed. The corresponding nonlinear optimization problem is solved using the calculus of variations by applying the disjoint policy. This policy reduces the optimization problem into a differential-algebraic system, DAE. This DAE system defines completely the optimal temperature-time profiles. These profiles depend on the kinetic parameters, feed substrate concentration, operating period, and the residence time and are characterized by increasing form with time. Also, general analytical expressions for the slopes of the temperature and residual enzyme activity profiles are derived. An efficient solution algorithm is developed to solve the DAE system, which results into a one-dimensional optimization problem with simple bounds on the initial feed temperature. The enzymatic isomerization of glucose into fructose is selected as a case study. The computed productivities are very close to that obtained by numerical nonlinear optimization with simpler problem to solve. Moreover, the computed conversion profiles are almost constant over 90% of the operating periods, thus producing a homogeneous product.

Algorithms↗

PubMed1999

Policy incongruence and public health professionals' dissonance: the case of immigrants and welfare policy.

The steady increase in immigrants to the United States has fueled a critical analysis of the process of allocation of health and social benefits to these newcomers. The myriad of interests and values surrounding this issue precipitated the formulation and adoption of the Personal Responsibility and Work Opportunity (Welfare Reform) Act of 1996. This dramatic welfare reform impacts federal, state, and local agencies that are required to determine the eligibility of benefits and manage the attendant consequences to the public as well as members of this vulnerable group. Especially challenging are the decisions confronting public health professionals who struggle to reconcile the resulting policy, programmatic mandates, and compliance imperatives with prevailing public health principles and practice norms. This paper proposes a framework for understanding the incongruence between the provisions of the law as it pertains to legal and illegal immigrants and public health values. The impact of policy incongruence and professionals' dissonance on public health practice norms is explored with an explicit focus on public health outcomes and legal implications. The examination of tuberculosis as a health example reveals the policy conflicts and public health dilemmas. Finally, the paper elicits a range of options available to public professionals for responding to these legal mandates.

Journal Article↗

PubMed1970

Science policy and science policy research.

This assessment of the value of science policy research in the making of policies is based on a lecture given at a meeting of the Sociology of Science Study Group of the British Sociological Association last March. The thoughts it contains are of course those of Dr Blume himself, and not of the Department of Education and Science or the Council for Scientific Policy.

Journal Article↗

PubMed2006

What drug policies cost: estimating government drug policy expenditures.

AIMS: Many nations now spend large sums of government money to reduce drug problems. The size and composition of public expenditures aimed at reducing drug use and related problems (a drug budget) is a useful partial description of a nation's drug policy. This paper examines whether it is possible to estimate these sums in a consistent manner across nations. METHODS: Past drug budget efforts in the United Kingdom and United States were reviewed. A new methodology was offered for estimation and used for estimates of expenditures in the Netherlands and Sweden. Using this methodology, expenditures were compared. FINDINGS: In both the Netherlands and Sweden, with very different official drug policy rhetoric, enforcement expenditures dominate the total; prevention expenditures are a tiny share. The baseline estimates indicate that the Netherlands, by a variety of metrics (e.g. Euros per capita, Euros per problematic user), spends more on drug control, even enforcement, than Sweden but the range of estimates is such that this cannot be inferred with confidence. CONCLUSION: Estimating total government expenditures on reducing drug use and related problems is feasible and can yield useful policy insights.

Budgets↗

PubMed2006

Building the evidence base for effective tobacco control policies: the International Tobacco Control Policy Evaluation Project (the ITC Project).

The Framework Convention on Tobacco Control (FCTC) is a seminal event in tobacco control and in global health. Scientific evidence guided the creation of the FCTC, and as the treaty moves into its implementation phase, scientific evidence can be used to guide the formulation of evidence-based tobacco control policies. The International Tobacco Control Policy Evaluation Project (ITC Project) is a transdisciplinary international collaboration of tobacco control researchers who have created research studies to evaluate and understand the psychosocial and behavioural impact of FCTC policies as they are implemented in participating ITC countries, which together are inhabited by over 45% of the world's smokers. This introduction to the ITC Project supplement of Tobacco Control presents a brief outline of the ITC Project, including a summary of key findings to date. The overall conceptual model and methodology of the ITC Project--involving representative national cohort surveys created from a common conceptual model, with common methods and measures across countries--may hold promise as a useful paradigm in efforts to evaluate and understand the impact of population-based interventions in other important domains of health, such as obesity.

Evidence-Based Medicine↗

PubMed1998

Management of otitis media using Agency for Health Care Policy and Research guidelines. The Agency for Health Care Policy and Research.

Increased costs of managing otitis media and its complications may result from delays in diagnosis and treatment. The Agency for Health Care Policy and Research developed guidelines to assist in the management of chronic otitis media with effusion. We examined the medical care adherence to Agency for Health Care Policy and Research guidelines in 59 consecutive patients referred because of chronic otitis media with effusion and recurrent acute otitis media. Patient history and examination data were collected prospectively. In the group with chronic otitis media with effusion, the rate of adherence to Agency for Health Care Policy and Research guidelines was 0%; in those with recurrent acute otitis media, adherence was 5%. Delayed referral occurred in 34% of patients; 25% of patients were referred early. The average duration of effusion in patients with chronic otitis media with effusion was 5.2 months; the duration of recurrent acute otitis media immediately before referral was 9.3 months. Eighteen patients (47%) in the chronic otitis media with effusion group had a history of recurrent chronic otitis media with effusion spanning an average of 22.7 months. On referral, hearing loss was discovered in 92% of all patients, and in 69% the tympanogram was flat. The complication and sequelae rate was 49.1%, and speech delay was the most frequent at 16.9%. We conclude that in our study patients there is a significant referral delay, long history of chronic otitis media with effusion in patients before referral, high rate of hearing loss, and high complication rate. Continued efforts should be directed toward improving education of all clinicians so that diagnostic tools and timely otolaryngologic referral are better used.

Acoustic Impedance Tests↗

PubMed1996

Policy and ideology: the politics of post-reform health policy in the United Kingdom.

While it is commonly accepted that the broader political and economic climate directly influences the nature of any major changes in the provision of health care (witness the 1991 National Health Service reforms in the United Kingdom), there is less consideration of the effect of paradigm changes in health care and health care management themselves on wider political and ideological strategies. This article examines the recent health policy initiatives presented by Britain's Labour Party. The author argues that while the Conservatives' market-oriented reforms reflected the perceived political and economic realities of the 1980s, the rapidly increasing credibility of strategies of prevention within the health care sector (including an emphasis on the social determinants of ill-health, the need to plan a shift from acute to community care, and the desire for greater lay participation in policy-making) allows Labour to highlight the limitations of a strongly market-oriented system in the health care sector more so than in any other policy area.

Decision Making, Organizational↗

PubMed1997

Medicare program; revisions to payment policies under the physician fee for schedule, other Part B payment policies, and establishment of the clinical psychologist fee schedule for calendar year 1998--HCFA. Proposed rule.

This proposed rule discusses several policy changes affecting Medicare Part B payment. The changes related to physician services, including resource-based practice expense relative value units and geographic practice cost index changes, clinical psychologist services, supervision of diagnostic tests, the methodology used to develop reasonable compensation equivalent limits, payment to participating and nonparticipating suppliers, global surgical services, caloric vestibular testing, clinical consultations, and payments based on actual charges. Under the law, we are required to develop a resource-based system for determining practice expense relative value units effective January 1, 1998. In addition, since we established the physician fee schedule on January 1, 1992, our experience indicates that some of our Part B payment policies need to be reconsidered. This proposed rule is intended to correct inequities in physician payment and solicits public comments on specific proposed policy changes.

Centers for Medicare and Medicaid Services, U.S.↗