Health Policy

The Future Of The Public’s Health: Vision, Values, And Strategies

The Future Of The Public’s Health: Vision, Values, And Strategies
Health Affairs, Vol. 23, Issue 4, 96-107.

Gostin, L.O., Boufford, J.I. & Martinez, R.
01/01/2004

The expansive vision of modern public health, "healthy people in healthy communities," is politically charged. This paper offers a justification for this broad vision and offers concrete proposals. By pointing to the poor condition of public health agencies; urging a transition to an intersectoral public health system; promoting the adoption of bold changes in U.S. physical, social, and economic conditions; and endorsing a values shift to a commitment to collective interest in healthier communities, we hope to take a dramatic step toward achieving these aspirations for "healthy people in healthy communities."

The Impact of Social Networks and Social /Political Group Participation on HIV Risk Behaviors Among African American Men Who Have Sex with Men

The Impact of Social Networks and Social /Political Group Participation on HIV Risk Behaviors Among African American Men Who Have Sex with Men

Wilson, P.A., Yoshikawa, H. & Peterson, J.L.
01/01/2004

As we enter the third decade of the AIDS epidemic, HIV/AIDS is the leading cause of death for Black U.S. citizens between the ages of 25-44. Black MSM have the highest incidence of AIDS in the U.S. Research is needed on the individual and contextual factors that place these men at risk. This study asks: 1) What are the profiles of social network and social/political group involvement for Black MSM? 2) Do levels of peer norms, AIDS knowledge, self-efficacy, and AIDS ethnocentrism differ for Black MSM according to their social networks and social activity? 3) Does HIV-risk differ for Black MSM according to their social involvement? METHODS: The sample consisted of 318 Black MSM. The average age was 31 years old, and 88% of the participants were single. 33% of the sample reported engaging in sexual behavior with both men and women. Measures included age, education level, make-up of social networks (race, sexual orientation), participation in social/political groups of Black gay, White gay and heterosexual types, levels of condom efficacy, peer norms, AIDS knowledge and AIDS ethnocentrism and number of instances of unprotected anal intercourse (UAI) in the past 6 months. Data were analyzed using cluster analysis, regression analysis and ANOVA. RESULTS: Men who were active in social/political groups were less likely to engage in UAI than men who were not active. This effect was mediated by higher condom efficacy and lower AIDS ethnocentrism. The study also showed that men with largely Black and gay networks reported higher UAI than men with White gay social networks. CONCLUSION: Results show that different social patterns among Black MSM can lead to different outcomes regarding HIV-risk. These findings will inform AIDS prevention efforts for Black MSM, and promote use of a framework that incorporates both individual and contextual factors in understanding HIV-risk.

The Organization of Schooling and Adolescent Development

The Organization of Schooling and Adolescent Development
In K. Maton, C. Schellenbach, B. Leadbeater, & A. Solarz (Eds.), Investing in children, youth, families, and communities: Strengths-based research and policy (pp. 233-250). Washington, DC: American Psychological Association,

Seidman, E., Aber, J.L. & French, S.E.
01/01/2004

Investing in Children, Youth, Families, and Communities takes a theoretically exciting and socially critical view of human development and the power of context to shape positive outcomes. Co-editors Kenneth I. Maton, Cynthia J. Schellenbach, Bonnie J. Leadbeater, and Andrea L. Solarz bring together leading social scientists and policy experts to discuss what helps or hinders healthy development.

A transformative theme, from deficits to strengths, emerges in this book, as it surveys the mounting evidence that programs that shore up resilience can and do work. Empirically rich chapters show how children, youth, families, and communities can be vital resources in countering the challenges posed by violence, abuse, neglect, and other obstacles to development. It provides concrete examples of programs that recognize, strengthen, and marshal the abilities of individuals and groups traditionally assumed to be deficient or in need of "fixing."

Uniquely, this book also extends the scientific findings to real-world program and policy implications. Each chapter is co-authored by scholars and policy experts with complementary strengths, bringing together expertise in the psychosocial aspects of an issue and expertise in social policy.

 

Wage inequality, health care, and infant mortality in 19 industrialized countries

Wage inequality, health care, and infant mortality in 19 industrialized countries
Social Science & Medicine Volume 58 Number 2, pages 279-292.

Macinko, J., Shi, L. & Starfield, B.
01/01/2004

This pooled, cross-sectional, time-series study assesses the impact of health system variables on the relationship between wage inequality and infant mortality in 19 OECD countries over the period 1970-1996. Data are derived from the OECD, World Value Surveys, Luxembourg Income Study, and political economy databases. Analyses include Pearson correlation and fixed-effects multivariate regression. In year-specific and time-series analyses, the Theil measure of wage inequality (based on industrial sector wages) is positively and statistically significantly associated with infant mortality rates--even while controlling for GDP per capita. Health system variables--in particular the method of healthcare financing and the supply of physicians--significantly attenuated the effect of wage inequality on infant mortality. In fixed effects multivariate regression models controlling for GDP per capita and wage inequality, variables generally associated with better health include income per capita, the method of healthcare financing, and physicians per 1000 population. Alcohol consumption, the proportion of the population in unions, and government expenditures on health were associated with poorer health outcomes. Ambiguous effects were seen for the consumer price index, unemployment rates, the openness of the economy, and voting rates. This study provides international evidence for the impact of wage inequalities on infant mortality. Results suggest that improving aspects of the healthcare system may be one way to partially compensate for the negative effects of social inequalities on population health.

What Matters to Low-Income Patients in Ambulatory Care Facilities?

What Matters to Low-Income Patients in Ambulatory Care Facilities?
Medical Care Research and Review. Sep 2004; 61: 352 - 375.

Delia, D., Hall, A. & Billings, J.
01/01/2004

Poor, uninsured, and minority patients depend disproportionately on hospital outpatient departments (OPDs) and freestanding health centers for ambulatory care. These providers confront significant challenges, including limited resources, greater demand for services, and the need to improve quality and patient satisfaction. The authors use a survey of patients in OPDs and health centers in New York City to determine which aspects of the ambulatory care visit have the greatest influence on patients’ overall site evaluation. The personal interaction between patients and physicians, provider continuity, and the general cleanliness/appearance of the facility stand out as high priorities. Access to services and interactions with other facility staff are of significant, although lesser, importance. These findings suggest ways to restructure the delivery of care so that it is more responsive to the concerns of low-income patients.

The Role of Social and Behavioral Science in Public Health Practice: A Study of the New York City Department of Health

The Role of Social and Behavioral Science in Public Health Practice: A Study of the New York City Department of Health
Journal of Urban Health 2003;80(4)625-634.

Van Devanter, N., Shinn, B., Tannert-Naing, K, Bleakley, A., Perl, S. & Cohen, N.
12/01/2003

Studies over the last decade have demonstrated the effectiveness of public health interventions based on social and behavioral science theory for many health problems. Little is known about the extent to which health departments are currently utilizing these theories. This study assesses the application of social and behavioral science to programs in the New York City Department of Health (NYCDOH). Structured open-ended interviews were conducted with executive and program management staff of the health department. Respondents were asked about the application of social and behavioral sciences within their programs, and about the benefits and barriers to increasing the use of such approaches. Themes related to the aims of the study were identified, a detailed coding manual developed, narrative data were coded independently by two investigators (kappa.85), and data analyzed. Interviews were conducted with 61 eligible individuals (response rate 88%). The most common applications of social and behavioral science were individual-level behavior change to prevent HIV transmission and community-level interventions utilizing community organizing models and/or media interventions for health promotion and disease prevention. There are generally positive attitudes about the benefits of utilizing these sciences; however, there are also reservations about expanded use because of resource constraints. While NYCDOH has successfully applied social and behavioral sciences in some areas of practice, many areas use them minimally or not at all. Increasing use will require additional resources. Partnerships with academic institutions can bring additional social and behavioral science resources to health departments and benefit researchers understanding of the health department environment.

Evidence Based Financial Management

Evidence Based Financial Management
Healthcare Financial Management, October

Finkler, S.A., Henley, R.J. & Ward, D.M.
10/01/2003

Focuses on the importance of evidence-based financial management of hospitals in the U.S. Concept behind evidenced-based financial management; Mechanics of an evidence-based financial management; Benefits provided by this type of financial management; Financial implications if this type of financial management is used.

The relationship between primary care, income inequality, and mortality in US States, 1980-1995.

The relationship between primary care, income inequality, and mortality in US States, 1980-1995.
Journal of the American Board of Family Practice Volume 16, Number 5 Sep-Oct 2003; pages 412-22.

Shi, L., Macinko, J., Starfield, B., Wulu, J., Regan, J. & Politzer, R.
09/01/2003

OBJECTIVES: This study tests the robustness of the relationships between primary care, income inequality, and population health by (1) assessing the relationship during 4 time periods-1980, 1985, 1990 and 1995; (2) examining the independent effect of components of the primary care physician supply; (3) using 2 different measures of income inequality (Robin Hood index and Gini coefficient); and (4) testing the robustness of the association by using 5-year time-lagged independent variables. DATA SOURCES/STUDY SETTING: Data are derived from the Compressed Mortality Files, the US Department of Commerce and the Census Bureau, the National Center for Health Statistics, the Centers for Disease Control and Prevention, and the American Medical Association Physician Master File. The unit of analysis was the 50 US states over a 15-year period. STUDY DESIGN: Ecological, cross-sectional design for 4 selected years (1980, 1985, 1990, 1995), and incorporating 5-year time-lagged independent variables. The main outcome measure is age-standardized, all-cause mortality per 100,000 population in all 50 US states in all 4 time periods. DATA COLLECTION/EXTRACTION METHODS: The study used secondary data from publicly available data sets. The CDC WONDER/PC software was used to obtain mortality data and directly standardize them for age to the 1980 US population. Data used to calculate the income inequality measure came from the US census population and housing summary tapes for the years 1980 to 1995. Counts of the number of households that fell into each income interval along with the total aggregate income and the median household income were obtained for each state. The Gini coefficient for each state was calculated using software developed for this purpose. RESULTS: In weighted multivariate regressions, both contemporaneous and time-lagged income inequality measures (Gini coefficient, Robin Hood Index) were significantly associated with all-cause mortality (P <.05 for both measures for all time periods). Contemporaneous and time-lagged primary care physician-to-population ratios were significantly associated with lower all-cause mortality (P <.05 for all 4 time periods), whereas specialty care measures were associated with higher mortality (P <.05 for all time periods, except 1990, where P <.1). Among primary care subspecialties, only family medicine was consistently associated with lower mortality (P <.01 for all time periods). CONCLUSIONS: Enhancing primary care, particularly family medicine, even in states with high levels of income inequality, could lead to lower all-cause mortality in those states.

Functional Outcomes of Pediatric Liver Transportation

Functional Outcomes of Pediatric Liver Transportation
Journal of Pediatric Gastroenterology & Nutrition, 37(2), 155-60.

Alonso, E.M. Neighbors, K., Mattson, C., Sweet, E., Ruch-Ross, H., Berry, C. & Sinacore, J.
08/01/2003

The functional status and health-related quality of life (HRQOL) of children who survive liver transplantation (LT) have not been well documented. The purpose of this study was to determine the functional status and HRQOL in this population using a validated measure for children, the Child Health Questionnaire-Parent Form 50 (CHQ-PF50).

Methods: The CHQ-PF50 instrument was completed by the parents of 55 children who agreed to participate in a mailing survey. Subscale scores for the sample were compared with those of a published normal population (n = 391).

Results: Study sample characteristics were: 87% Caucasian, 54.5% female, mean age at survey was 9.6 years (range, 5-17 years). Responding caregivers were 95% biologic parents and 93% female. Compared with the normal population, LT recipients had lower subscale scores for general health perceptions (P < 0.0005), emotional impact on parents (<0.0005) and disruption of family activities (0.0005). The mean physical summary score of the LT recipients was lower than that of the normal population 48.1 /- 12.1 (P = 0.005), but the mean psychosocial summary score was similar 48.8 /- 11.9 (P = 0.156). Within the LT population, the original diagnosis (biliary atresia vs. other), type of LT (living donor vs. cadaveric), age at LT, z score for height, and hospital days did not significantly influence any of the subscale scores.

Conclusions: Children who have survived LT have functional outcomes in the physical domain that are lower than those of normal children. Self-esteem and mental health in this group appeared normal. The parents in this sample experienced more emotional stress and disruption of family activities than did parents in a normal population.

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