An exploratory study on how to improve the economy of American Samoa

Deep in the South Pacific region about 2,300 miles southwest of the Hawaiian islands1 lies a United States territory that many Americans have never heard of nor known anything about. However, some famous Americans such as Troy Polamalu of the Pittsburgh Steelers, semi retired professional wrestler Dwayne “The Rock” Johnson, and Hawaii Congresswoman Tulsi Gabbard have genealogical roots there. More importantly, many of the Territory’s sons and daughters have served and lost their lives for the United States flag and the cause of freedom around the world. This place is called American Samoa, a collection of seven islands that if glued together would have a total landmass of approximately 76 square miles, just a tad bigger than the capital city of the United States. According to the United States Census Bureau, there were 55,519 residents of American Samoa in 2010.1 The majority of them are ethnic Samoans, a Polynesian sect that traces its history back to early migrants from Southeast Asia who settled the islands around 1500 B.C.2 3 The climate is warm all year long and the forests along the mountains are ripe with vegetation. The main island is Tutuila with its beautiful and coveted landlocked harbor that was used as a coaling station by the United States naval ships during World War II. In fact, it was the Pago Pago Harbor that diminished the impact of the 2009 Tsunami that devastated the Samoan islands by channeling the waters of the Pacific Ocean towards the end of the harbor instead of flooding many other villages surrounding the Pago Pago Bay area. Lives and property were destroyed near the end of the Harbor but it could have been worse for the entire Bay area. Locally grown foods include coconut, taro, banana, guava, sugar cane, papaya, yam, pineapple, and breadfruit. It is completely surrounded by the Pacific Ocean from which the locals obtain a variety of seafood. There is a popular saying in Samoa that goes, “In Samoa, it is impossible to starve 1 American Samoa Department of Commerce, 2012 Statistical Yearbook, http://www.doc.as/wpcontent/uploads/2011/06/2012-Statistical-Yearbook-1.pdf 2 U.S. Census Bureau News, U.S. Census Bureau Releases 2010 Census Population Counts for American Samoa, http://www.census.gov/2010census/news/releases/operations/cb11-cn177.html (Aug. 24, 2011). 3 3 J. Robert Shaffer, American Samoa: 100 Years Under the United States Flag (Honolulu, Hawaii: Island Heritage Publishing, 2000), 34. 4 because people live off of the land’s and the ocean’s abundant resources.” To the west of American Samoa lies a larger group of four islands that make up the Sovereign State of Samoa, which became independent from New Zealand in 1962. Samoa and American Samoa share the same language, culture, and religion but are divided by government and political systems. The focus of this study will be on American Samoa, which became a United States territory in 1900 when the principal chiefs of Tutuila (the largest island in American Samoa) ceded the islands to the United States.

Courts as healthcare policy-makers: the problem, the responses to the problem and problems in the responses

This article starts by analysing healthcare litigation in Brazil by means of a literature review of articles that contribute with empirical findings on this phenomenon. Based on this review, I argue that health care litigation in Brazil makes the public health system less fair and rational. In the second part of this article, I discuss the three most overarching responses to control the level of litigation and its impact on the public health system: (i) the public hearing held by the Supreme Federal Court and the criteria the court established thereafter; (ii) the recommendations by the National Council of Justice aimed at building courts’ institutional capacity; and (iii) the enactment of the Federal Law 12.401/11, which created a new health technology assessment system. I argue that latter is the best response because it keeps the substantive decisions on the allocation of healthcare resources in the institution that is in the best position to make them. Moreover, this legislation will make the decisions about provision of health treatments more explicit, making easier for courts to control the procedure and the reasons for these decisions.

Impact of worksite health-promotion programs in hospital admission costs and medical leaves in a sample of brazilian companies

Programas de saúde e bem-estar têm sido adotados por empresas como forma de melhorar a saúde de empregados, e muitos estudos descrevem retornos econômicos positivos sobre os investimentos envolvidos. Entretanto, estudos mais recentes com metodologia melhor têm demonstrado retornos menores. O objetivo deste estudo foi investigar se características de programas de saúde e bem-estar agem como preditores de custos de internação hospitalar (em Reais correntes) e da proporção de funcionários que têm licença médica, entre Abril de 2014 e Maio de 2015, em uma amostra não-aleatória de empresas no Brasil, através de parceria com uma empresa gestora de ‘big data’ para saúde. Um questionário sobre características de programas de saúde no ambiente de trabalho foi respondida por seis grandes empresas brasileiras. Dados retirados destes seis questionários (presença e idade de programa de saúde, suas características – inclusão de atividades de screening, educação sobre saúde, ligação com outros programas da empresa, integração do programa à estrutura da empresa, e ambientes de trabalho voltado para a saúde – e a adoção de incentivos financeiros para aderência de funcionários ao programa), bem como dados individuais de idade, gênero e categoria de plano de saúde de cada empregado , foram usados para construir um banco de dados com mais de 76.000 indivíduos. Através de um modelo de regressão múltipla e seleção ‘stepwise’ de variáveis, a idade do empregado foi positivamente associada e a idade do programa de saúde e a categoria ‘premium’ de plano de saúde do funcionário foram negativamente associadas aos custos de internação hospitalar (como esperado). Inesperadamente, a inclusão de programas de screening e iniciativas de educação de saúde nos programas de saúde e bem-estar nas empresas foram identificados como preditores positivos significativos para custos de admissão hospitalar. Para evitar a inclusão errônea de licenças-maternidade, apenas os dados de licença médica de pacientes do sexo masculino foram analisados (dados disponíveis apenas para duas entre as companhias incluídas, com um total de 18.957 pacientes do sexo masculino). Analisando estes dados através de um teste Z para comparação de proporções, a empresa com programa de saúde que inclui atividades voltadas a cessação de hábitos ruins (como tabagismo e etilismo), controle de diabetes e hipertensão, e que adota incentivos financeiros para a aderência de funcionários ao programa tem menor proporção de empregados com licençca médica no período analisado, quando comparada com a outra empresa que não tem estas características (também conforme esperado). Entretanto, a companhia com menor proporção de funcionários com licença médica também foi aquela que adota programa de screening entre as atividades de seu programa de saúde. Potenciais fontes de ameaça à validade interna e externa destes resultados são discutidas, bem como possíveis explicações para a associação entre programas de screening e educação médica a piores indicadores de saúde nesta amostra de companhias são discutidas. Novos estudos com melhor desenho, com amostras maiores e randômicas são necessários para validar estes resultados e possivelmente melhorar a validade interna e externa destes resultados.

The Culture of entrepreneurship: a study of the entrepreneurial motivation and attitudes towards business creation in the UAE in comparison to the US and Brazil

This study demonstrates the cultural dimension and the surrounding environment of different entrepreneurs selected from three countries, the United States of America, the Federative Republic of Brazil, and the United Arab Emirates. The general objective is to understand the difference in the entrepreneurial motives and spirit towards venture creation from the three different countries. After conducting field research and collecting the required data, a deep analysis was conducted to draw a comparison between the three cultures from an individual’s point of view, to help shape a set of proposed recommendations, which could be used to improve the current culture of entrepreneurship in the UAE.