Public Health Policy Is Political
Khusdeep Malhotra is with the Satcher Health Leadership Institute and with the Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA. Harry J. Heiman is with the Satcher Health Leadership Institute and with the Department of Family Medicine, Morehouse School of Medicine.American Journal of Public Health (Impact Factor: 4.55). 05/2012; 102(7):e1; author reply el-2. DOI: 10.2105/AJPH.2012.300801
In his article,(1) Goldberg provides a very cohesive critique of why concern over politicization of public health policy as a justification for preferring a narrow to a broad model of public health is a nebulous argument. To achieve its mission of assurance, public health is obligated to engage broadly with the spectrum of factors that impact health outcomes, most importantly the social and environmental determinants. Avoiding the political implications of these factors has never been possible. Even the "basic 6" services defined under the narrow model of public health(2) have never been free of politics. Several recent and ongoing controversies illustrate this point. Firstly, recent H5N1 research,(3,4) with clear implications for controlling communicable disease and epidemic preparedness, became controversial largely as a result of US national security concerns, a political matter. Secondly, the ongoing challenges regarding abortion rights in multiple state legislatures and the recent debate regarding coverage of contraception in the Affordable Care Act, both of which clearly fall within the purview of maternal health, remain a political quagmire. Lastly, sexual education, an important health education issue, has always been highly political. Thus, even issues within the "basic 6" have always been of a political nature. As a result, the "narrow model" not only fails to carry any less risk of politicization, it also fails to address some of the most critical public health issues. (Am J Public Health. Published online ahead of print May 17, 2012: e1. doi:10.2105/AJPH.2012.300801).
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ABSTRACT: Meaningful improvements in health require modifying the social determinants of health. As policies are often underlying causes of the living conditions that shape health, policy change becomes a health goal. This focus on policy has led to increasing interest in expanding the focus of community-based participatory research (CBPR) to change not only communities but also policies. To best realize this potential, the relationship between evidence and power in policy change must be more fully explored. Effective action to promote policies that improve population health requires a deeper understanding of the roles of scientific evidence and political power in bringing about policy change; the appropriate scales for policy change, from community to global; and the participatory processes that best acknowledge the interplay between power and evidence. (Am J Public Health. Published online ahead of print November 14, 2013: e1-e4. doi:10.2105/AJPH.2013.301471).American Journal of Public Health 11/2013; 104(1). DOI:10.2105/AJPH.2013.301471 · 4.55 Impact Factor
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ABSTRACT: Expansion of health insurance coverage, and hence clinical preventive services (CPS), provides an opportunity for improvements in the health of adults. The degree to which expansion of health insurance coverage affects the use of CPS is unknown. To assess whether Massachusetts health reform was associated with changes in healthcare access and use of CPS. We used a difference-in-differences framework to examine change in healthcare access and use of CPS among working-aged adults pre-reform (2002-2005) and post-reform (2007-2010) in Massachusetts compared with change in other New England states (ONES). Population-based, cross-sectional Behavioral Risk Factor Surveillance System surveys. A total of 208,831 survey participants aged 18 to 64 years. Massachusetts health reform enacted in 2006. Four healthcare access measures outcomes and five CPS. The proportions of adults who had health insurance coverage, a healthcare provider, no cost barrier to healthcare, an annual routine checkup, and a colorectal cancer screening increased significantly more in Massachusetts than those in the ONES. In Massachusetts, the prevalence of cervical cancer screening in pre-reform and post-reform periods was about the same; however, the ONES had a decrease of -1.6 percentage points (95 % confidence interval [CI] -2.5, -0.7; p <0.001). As a result, the prevalence of cervical cancer screening in Massachusetts was increased relative to the ONES (1.7, 95 % CI 0.2, 3.2; p = 0.02). Cholesterol screening, influenza immunization, and breast cancer screening did not improve more in Massachusetts than in the ONES. Data are self-reported. Health reform may increase healthcare access and improve use of CPS. However, the effects of health reform on CPS use may vary by type of service and by state.Journal of General Internal Medicine 05/2014; 29(9). DOI:10.1007/s11606-014-2865-2 · 3.42 Impact Factor
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ABSTRACT: While expectations of integrated public health policy (IPHP) promoting public health are high, assessment is hampered by the concept's ambiguity. This paper aims to contribute to conceptual clarification of IPHP as first step in further measurement development. In an online concept mapping procedure, we invited 237 Dutch experts, 62 of whom generated statements on characteristics of IPHP. Next, 100 experts were invited, 24 of whom sorted the statements into piles according to their perceived similarity and rated the statements on relevance and measurability. Data was analyzed using concept mapping software. The concept map consisted of 97 statements, grouped into 11 clusters and five themes. Core themes were 'integration', concerning 'policy coherence' and 'organizing connections', and 'health', concerning 'positioning health' and 'addressing determinants'. Peripheral themes were 'generic aspects', 'capacities', and 'goals and setting', which respectively addressed general notions of integrated policy making, conditions for IPHP, and the variety in manifestations of IPHP. Measurability ratings were low compared to relevance. The concept map gives an overview of interrelated themes, distinguishes core from peripheral dimensions, and provides pointers for theories of the policy process. While low measurability ratings indicate measurement difficulties, the core themes provide pointers for systematic insight into IPHP through measurement. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.Health Policy 01/2015; 119(6). DOI:10.1016/j.healthpol.2014.12.020 · 1.91 Impact Factor
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