Health Policy

Reconsidering Risk: Biosocial Interactions and their Implications for Health Policy: The Case of Low Birth Weight.

Reconsidering Risk: Biosocial Interactions and their Implications for Health Policy: The Case of Low Birth Weight.
Journal of Health Politics, Policy and Law,

Strully, K. & Conley, D.
01/01/2004

According to recent research, interactions between infant health and environment can play crucial roles in clustering health and economic disadvantage among certain families. Researchers have provided a clear example of such intergenerational biosocial cycles when they document that interactions between parental low birth weight status and prenatal environment are associated with the risk of a low birth weight, and that interactions between a child's birth weight status and early childhood environment are associated with adult socioeconomic outcomes. In this article, we consider how existing policies may be revised to more effectively address such interactions between social and biological risk categories. We are particularly concerned in this discussion with revising risk categories so they can encompass biological risk, social risk, and developmental frameworks. A framework of biosocial risk is quite flexible and may be applied to a variety of issues and programs; however, in this article we focus on the single case of low birth weight to illustrate our argument. In considering specific applications, we further explore how attention to biosocial interactions may reshape Medicaid, special education, the Earned Income Tax Credit, and Temporary Assistance for Needy Families.

Reorganizing Primary Care at Mount Sinai Hospital

Reorganizing Primary Care at Mount Sinai Hospital
Health Services Management: Readings, Cases and Commentary, 8th ed.  Chicago, Health Administration Press,

Kovner, A.R. & Neuhauser, D.
01/01/2004

Managers of a healthcare organization have numerous demands on their time, their skills, their knowledge, and their budgets. They are responsible for adapting to change, managing their office, making effective decisions, among countless other tasks.

This text�newly revised to include readings, commentary, and cases�offers a bridge from management theory to the actual world of healthcare management.

Throughout its past editions, Health Services Management has featured the best literature on health services management to help readers understand the role of the manager, organizational design and control, the blending of organization and health professionals, change (adaptation), and responsiveness (accountability). This new edition continues that effort, and features new readings.

The cases take place in a variety of organizations, including a faculty practice, a neighborhood health center, a small rural hospital, an HMO, as well as a variety of other settings.

Should Capstone Activities Be Subject to the Human Subjects Review Process?

Should Capstone Activities Be Subject to the Human Subjects Review Process?
Journal of Policy Analysis and Management, Vol. 23, No. 4, pp. 921-927.

Blustein, J.
01/01/2004

Like many schools of public policy and management, New York University's Wagner School offers a capstone course in which teams of MPA students provide consultation to client organizations, This year, as the they began to assign students to teams, some members of the faculty sounded an alarm. Several of the projects might involve interviewing service recipients about sensitive issues. Other projects would give teams access to confidential information. Faculty members experience with their university human subjects review board knew that such projects, where they to be undertaken in a research context, would require lengthy and cumbersome review. Did the capstone projects need to go through the human subjects review process? If the answer was yes, the program would come to a grinding halt, given the open-endness of a capstone assignments and the bureaucratic nature of the committee application and approval process.

Teen Pregnancy and Urban Youth: Competing Truths, Complacency, and Perceptions of the Problem

Teen Pregnancy and Urban Youth: Competing Truths, Complacency, and Perceptions of the Problem
Journal of Adolescent Health , 34:5, pp.366-375.

Gallup-Black, A. & Weitzman, B.C.
01/01/2004

Purpose: To compare and contrast perceptions of community leaders, adults, and youth about the extent of the teen pregnancy problem in five American cities: Baltimore, Detroit, Oakland, Philadelphia, and Richmond.

Conclusions: Although few leaders see teen pregnancy as a pressing problem, adults remain deeply concerned, and youth indicate that the problem is prevalent and accepted.

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.

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