Policy implications of public health workforce development for disaster preparedness in the United States

Public health efforts were initiated in the United States with legislative actions for enhancing food safety and ensuring pure drinking water. Some additional policy initiatives during the early 20th century helped organize and coordinate relief efforts for victims of natural disasters. By 1950's the federal government expanded its role for providing better health and safety to the communities, and its disaster relief activities became more structured. A rise in terrorism related incidents during the late 1990's prompted new proactive policy directions. The traditional policy and program efforts for rescue, recovery, and relief measures changed focus to include disaster preparedness and countermeasures against terrorism.^ The study took a holistic approach by analyzing all major disaster related policies and programs, in regard to their structure, process, and outcome. Study determined that United States has a strong disaster preparedness agenda and appropriate programs are in place with adequate policy support, and the country is prepared to meet all possible security challenges that may arise in the future. The man-made disaster of September 11th gave a major thrust to improve security and enhance preparedness of the country. These new efforts required large additional funding from the federal government. Most existing preparedness programs at the local and national levels are run with federal funds which is insufficient in some cases. This discrepancy arises from the fact that federal funding for disaster preparedness programs at present are not allocated by the level of risks to individual states or according to the risks that can be assigned to critical infrastructures across the country. However, the increased role of the federal government in public health affairs of the states is unusual, and opposed to the spirit of our constitution where sovereignty is equally divided between the federal government and the states. There is also shortage of manpower in public health to engage in disaster preparedness activities, despite some remarkable progress following the September 11th disaster.^ Study found that there was a significant improvement in knowledge and limited number of studies showed improvement of skills, increase in confidence and improvement in message-mapping. Among healthcare and allied healthcare professionals, short-term training on disaster preparedness increased knowledge and improved personal protective equipment use with some limited improvement in confidence and skills. However, due to the heterogeneity of these studies, the results and interpretation of this systematic review may be interpreted with caution.^

A review of economic analysis in the vaccination program; decision making and governance: Adivisory Committee on Immunization Practices (ACIP)

The Advisory Committee on Immunization Practices (ACIP) develops written recommendations for the routine administration of vaccines to children and adults in the U.S. civilian population. The ACIP is the only entity in the federal government that makes such recommendations. ACIP elaborates on selection of its members and rules out concerns regarding its integrity, but fails to provide information about the importance of economic analysis in vaccine selection. ACIP recommendations can have large health and economic consequences. Emphasis on economic evaluation in health is a likely response to severe pressures of the federal and state health budget. This study describes the economic aspects considered by the ACIP while sanctioning a vaccine, and reviews the economic evaluations (our economic data) provided for vaccine deliberations. A five year study period from 2004 to 2009 is adopted. Publicly available data from ACIP web database is used. Drummond et al. (2005) checklist serves as a guide to assess the quality of economic evaluations presented. Drummond et al.'s checklist is a comprehensive hence it is unrealistic to expect every ACIP deliberation to meet all of their criteria. For practical purposes we have selected seven criteria that we judge to be significant criteria provided by Drummond et al. Twenty-four data points were obtained in a five year period. Our results show that out of the total twenty-four data point‘s (economic evaluations) only five data points received a score of six; that is six items on the list of seven were met. None of the data points received a perfect score of seven. Seven of the twenty-four data points received a score of five. A minimum of a two score was received by only one of the economic analyses. The type of economic evaluation along with the model criteria and ICER/QALY criteria met at 0.875 (87.5%). These three criteria were met at the highest rate among the seven criteria studied. Our study findings demonstrate that the perspective criteria met at 0.583 (58.3%) followed by source and sensitivity analysis criteria both tied at 0.541 (54.1%). The discount factor was met at 0.250 (25.0%).^ Economic analysis is not a novel concept to the ACIP. It has been practiced and presented at these meetings on a regular basis for more than five years. ACIP‘s stated goal is to utilize good quality epidemiologic, clinical and economic analyses to help policy makers choose among alternatives presented and thus achieve a better informed decision. As seen in our study the economic analyses over the years are inconsistent. The large variability coupled with lack of a standardized format may compromise the utility of the economic information for decision-making. While making recommendations, the ACIP takes into account all available information about a vaccine. Thus it is vital that standardized high quality economic information is provided at the ACIP meetings. Our study may provide a call for the ACIP to further investigate deficiencies within the system and thereby to improve economic evaluation data presented. ^

PREPAID MENTAL HEALTH SERVICES: A NATIONAL PERSPECTIVE

The purpose of this 1982 national survey of all operational prepaid health plans, or PHPs (including health maintenance organizations), was to provide information on the current coverage of PHP mental health and substance abuse services, benefits and service provision, general and mental health organization characteristics, mental health service costs, and physical and mental health service utilization.^ Two survey instruments were designed, pretested and distributed to all operational PHPs throughout the United States. A total of 237 PHPs were surveyed, of which 205 (86.50 percent) completed and returned both questionnaires.^ One result of the rapid growth in the PHP field over the past ten years has been the expansion in both the number of PHPs as well as the organizational characteristics of these PHPs. However, little attention in the research literature has been given to the application of empirical results to the PHP arrangements. This project has attempted to contribute to current knowledge regarding prepaid mental health services from a national perspective, and explore, on a preliminary descriptive basis, the variety of potential service delivery arrangements for physical and mental health services (total services) and for mental health services.^ The study emphasized that PHPs must continue to monitor the costs and utilization of mental health services, particularly in light of the apparent elimination of data collection and statistical summary responsibilities within the federal government regarding PHP activities as well as the proposed legislation to eliminate mandated mental health and substance abuse services from basic health plan benefits for federally qualified PHPs. ^

Minimum income for healthy living

Objectives: We sought to estimate the costs of implementing the current recommendations for healthy choices for a mother with two young children in Atlanta, Georgia. ^ Methods: Current recommendations for healthy choices promoted by the federal government or other credible source were compiled and operationalized into specific conditions or behaviors. The costs of implementing these choices in Atlanta were estimated by using internet searches of retailers/suppliers, phone interviews, and direct observation. The least expensive option was chosen when options were available. ^ Results: Recommendations for choosing a healthy neighborhood, home, school, child care, food, physical activity, and maintaining healthy relationships as well as access to health care were considered. Total costs for this family of three totaled $38,181. Housing, child care, and health insurance contributed to 78% of the total costs. ^ Conclusions: The minimum income needed to choose healthy choices falls short of current wages, and eligibility levels and benefits for income support. ^

Legal regulation of the food industry as a public health measure

Background. The Food and Drug Administration (FDA) is an agency of the federal government that is responsible for monitoring and maintaining public health through the regulation of many industries, including food safety. Through the Nutrition Labeling and Education Act of 1990, the FDA was granted authority over the implementation and regulation of nutrition labeling on packaged foods. Many nutrients are printed on nutrition labels as well as their percent Daily Values. Research has been undertaken to examine the evidentiary basis the FDA relied upon in making its determinations regarding which nutrients to include on nutrition labels as well as their Daily Values. ^ Methods. Relevant legal policies, scientific studies, and other published literature (either in print or electronic form) were used to collect data. ^ Results. Results demonstrated that the FDA did not employ one single method in its determination of which nutrients to select for inclusion on food labels. The agency relied upon current public heath studies of that time as well as recommendations from the U.S. Surgeon General.^

Policy analysis of shifting to the state-run Texas women's health program

During the 82nd Texas legislature, state leaders passed a provision stating that healthcare providers, who perform, promote, or affiliate with providers who perform or promote elective abortion services may not be eligible to participate in the Texas Medicaid Women's Health Program (WHP). The federal government reacted to this new provision by vowing to eliminate its 90% share of program support on the grounds that the provision violated a patient's freedom to choose a provider; a right protected by the Social Security Act. Texas leaders stated that the Women's Health Program would continue without federal support, financed exclusively with state funds.^ The following policy analysis compares the projected impact of the current Medicaid Women's Health Program to the proposed state-run program using the criteria-alternative matrix framework. The criteria used to evaluate the program alternatives include population affected, unintended pregnancy and abortion impact, impact on cervical cancer rate, and state-level government expenditures. Each criterion was defined by selected measures. The population affected was measured by the number of women served in the programs. Government expenditures were measured in terms of payments for program costs, Medicaid delivery costs, and cervical cancer diagnostic costs. Unintended pregnancy impact was measured by the number of projected unplanned pregnancies and abortions under each alternative. The impact on cervical cancer was projected in terms of the number of new cervical cancer cases under each alternative. Differences in the projections with respect to each criterion were compared to assess the impact of shifting to the state-only policy.^ After examining program alternatives, it is highly recommended that Texas retain the Medicaid WHP. If the state does decide to move forward with the state-run WHP, it is recommended that the program run at its previous capacity. Furthermore, for the purpose of addressing the relatively high cervical cancer incidence rate in Texas, incorporating HPV vaccination coverage for women ages 18-26 as part of the Women's Health Program is recommended.^

Cooperación y conflicto entre empresas, comunidades y gobierno : nuevos movimientos sociales en el caso de Cerro de San Pedro, México

El objetivo de este trabajo es analizar las relaciones de cooperación y conflicto entre una compañía minera y las comunidades, los Nuevos Movimientos Sociales y los tres niveles de gobierno involucrados. La compañía Minera inició operaciones para una mina a cielo abierto de oro y plata con el apoyo de los gobiernos locales, estatales y federal. Los habitantes de estas comunidades apoyados por grupos ambientalistas y Organizaciones No Gubernamentales argumentan que el proyecto contamina las Fuentes de agua fresca además de perturbar el medio ambiente y la ecología de la región. La metodología empleada consistió en un análisis histórico social para determinar, en un estudio exploratorio, las principales variables económicas, políticas, legales, sociales y culturales que inciden en el caso, sobre todo después de la firma del Tratado de Libre Comercio de América del Norte. Los hallazgos de esta investigación contribuyen a explicar las relaciones de cooperación y conflicto entre las empresas multinacionales que operan en las comunidades, a analizar el rol del gobierno en sus tres niveles y de los nuevos movimientos sociales en la conformación de las economías locales bajo procesos de integración económica regional. Los resultados también son de relevancia por sus contribuciones para el entendimiento de procesos de responsabilidad social corporativa de las empresas transnacionales y los procesos de contestación y acción colectiva de los nuevos movimientos sociales en el desarrollo económico y ambiental de las comunidades locales.

Instituciones territoriales, orden público y una ciudadanía en construcción : El Estado nacional y la formación de la Pampa Central (1884-1922)

La obra vincula las instituciones, el orden público y la construcción de una ciudadanía en la Pampa Central con la extensión de propiedades de construcción del Estado que el gobierno federal intentaba concretar en los territorios nacionales -fines del siglo XIX-. Se analizan las instituciones, su constitución, funcionamiento e inconvenientes. Se reconstruyen las relaciones de la incipiente sociedad civil que estaba adquiriendo rasgos de "ciudadanía", pese a la limitación del derecho a la soberanía y representación política, por cuya razón se abocó al reducido poder local, a la conversión del Territorio en provincia y a la presión sobre las instituciones del Estado. Ciertos sectores sociales -vecinos propietarios- participaron en el poder y pudieron incidir en la disposición de un determinado orden público. Se descubre este entramado a través de la cuestión política, la constitución de la esfera pública, el papel de la prensa, y el accionar de sectores gubernamentales y particulares, especialmente en los conflictos sociales. Estas cuestiones se analizan con mayor profundidad en el estudio particular de una institución: la justicia letrada nacional con marcado poder en el Territorio. Se demuestra que esta institución ejerció un papel importante en la extensión de las propiedades que caracterizaron la construcción y consolidación del Estado. El protagonismo judicial a nivel nacional tuvo su correlación en el poder de los jueces y de los juzgados letrados territoriales, basado en: el carácter nacional de estos tribunales, el perfil profesional de sus miembros, una red social y política de los magistrados a nivel nacional y, la debilidad de las demás instituciones del Territorio. Este poder era reconocido y consolidado por la prensa y los vecinos -propietarios, comerciantes y profesionales- interesados en jerarquizar el papel de la justicia.

Novos formatos escolares para novas demandas sociais : O Ensino Médio Integrado

When it comes to reflecting on the Brazilian educational system , secondary education is what causes the most controversial debates . For a long time , enrollment rates in secondary school were embarrassing , what has changed in recent decades . It became mandatory and expanded significantly the enrollment , but keep the high level of failure and dropout . Historically, the definition of options for secondary education and particularly vocational education , has been in Brazil for conflict of interests and positions , which is expressed in the diversity of curricular proposals presented throughout the twentieth century and the beginning of this XXI century. Currently, the line adopted by the federal government is to encourage states and municipalities to implement the method of integrated secondary school , thus seeking to establish links between the academic and professional learning . The topic of this article is precisely this choice of integrated education . It is within the framework of the Brazilian educational scenario and its late development compared to other countries in the region under review debate and educational policies aimed to integrate the high school and the working world

A política fundiária do governo Olívio Dutra no Rio Grande do Sul - Brasil (1999-2002): diretrizes, dinâmica política e resultados atingidos

This paper has as objective to analyze the foundry work politics made by the Olívio Dutra's government in the state of Rio Grande do Sul-Brazil, being taken into account their guidelines, the dynamics of the political struggle promoted between the social leaders from the rural area and the achieved global results. This government's freshness is related to the fact of it was being sustained and supported by a coalition of left wing parties and by a group of social movements and also by syndical entities of the field, which was decisive in the presentation of an antagonistic program to the neoliberal politics on energy in a national extent. Hence this government became committed in adopting an own foundry work politics, being opposed to the program of market land reform extolled by Cardoso's government, in national wide. Therefore, the results presented along the article demonstrate that in spite of the assumed commitments and, in face of legal, institutional and economical limitations and also its existent politics, the space of the state governments' performance can only be thought about its complemental character on the federal government's actions.

A formulação das políticas públicas para a juventude rural no Brasil e os elementos constitutivos desse processo social

The construction of the research problem occurred in trying to investigate the configuration of public policies for the rural youth and how this political agenda was introduced in the State of the Brazil. The main issue in the research is how the process of configuration of public policies for rural youth in federal government has occurred. The methodology for this study used was qualitative research procedures were triggered participant observation, interviews and documentary analysis. During the research the actors, the formulated policies and rural youth category expressed during this process were highlighted

Educación en Educación Física en Brasil : Otros modos de pensar y intervenir en lo servicio público de salud

Lo que presentamos traduce un debate en lo campo de la salud pública/salud colectiva no Brasil sobre la formación en salud, especialmente en lo nivel de la atención primaria en salud, pero también resulta de una intervención en lo servicio público de salud que envolvió estudiantes y docente vinculados a o curso de graduación en Educación Física y Deporte de la Universidad de São Paulo, que se viran delante de lo desafío de responder a las necesidades de salud de la populación experimentando a actuación interprofesional. Lo Programa de Educación pelo Trabajo para la Salud (PET-Salud), una de las iniciativas de lo gobierno federal que busca aproximar universidad (estudiantes y docentes), servicios de salud (profesionales de la salud) y usuarios a fin de problematizar la enseñanza en salud, así como cualificar la atención y lo cuidado en salud, indusio esa formación diferenciada. De la participación de los estudiantes en lo PET-Salud, entre 2010 y 2012, resaltamos lo proceso de res significación de lo campo y do propio concepto salud y la posibilidad de intervenir en las necesidades de salud de la populación a partir do trabajo en equipo

La cancelación de la vía oligárquica de la gran irrigación en México: Sinaloa (1908-1936)

El objetivo de este trabajo es mostrar las posibilidades que ofrece la documentación conservada en el Archivo Histórico del Agua para aproximarse a la cuestión de la creciente implicación del Estado mexicano en el proceso de modernización agraria, a través de la política de fomento a la irrigación, durante la primera parte del siglo XX. Para alcanzar esta meta partimos de la caracterización del modelo agroexportador implementado en México entre 1877 y 1930. Después sintetizamos la evolución del sector agropecuario en el estado de Sinaloa durante ese mismo periodo. Seguidamente, se enfatizan las expectativas iniciales que tuvo la oligarquía sobre la gran irrigación en Sinaloa a partir del estudio, fundamentalmente macroeconómico, de las tres empresas que suscribieron un contrato de subvención con el gobierno federal a fines del Porfiriato. Y, por último, a partir del seguimiento de estos mismos casos, se hacen claros los motivos que nos permiten entender la progresiva pérdida de legitimidad, tras el período revolucionario de 1910, de ese modelo modernizador del agro "desde arriba" con apoyo público hasta su quiebra final.

Estado, banca y crédito agrícola en Sinaloa y Sonora : El Banco de Sinaloa y el Banco Agrícola Sonorense, 1933-1976

En el Noroeste de México el incremento en la productividad agrícola entre los años de 1940 y 1970, fue debido a la expansión de las tierras de cultivo, el uso de fertilizantes y semillas mejoradas, la mecanización, la mayor disponibilidad de créditos, a los sistemas de irrigación y el mejoramiento de las carreteras. Así como la importante intervención del Estado mexicano al implementar políticas de inversión con el apoyo de agencias internacionales de desarrollo, y otorgar facilidades de crédito para el desarrollo de la agricultura a través de la creación de bancos agrícolas oficiales y las facilidades para la constitución de bancos privados comerciales.Después de la desarticulación de la banca en México debido a la revolución, se avanzó con pasos firmes en la reestructuración del sistema bancario con la creación de una nueva legislación bancaria, la fundación del Banco de México y la Comisión Nacional Bancaria en 1924; Banco Nacional de Crédito Agrícola (1926), el Banco Nacional de Crédito Ejidal (1935), el Banco Nacional de Comercio Exterior (1937) y el Banco Nacional Agropecuario (1965), que dieron apoyo financiero a los pequeños agricultores y ejidatarios. Los principales agricultores de Sinaloa y Sonora en colaboración con el gobierno federal a través de la Comisión Monetaria y el Banco de México fundaron el Banco de Sinaloa y el Banco Agrícola Sonorense en 1933. Explicar el impacto que tuvieron estas instituciones financieras en el crédito agrícola de Sinaloa y Sonora será el objetivo central de este trabajo.

Instituciones territoriales, orden público y una ciudadanía en construcción : El Estado nacional y la formación de la Pampa Central (1884-1922)

La obra vincula las instituciones, el orden público y la construcción de una ciudadanía en la Pampa Central con la extensión de propiedades de construcción del Estado que el gobierno federal intentaba concretar en los territorios nacionales -fines del siglo XIX-. Se analizan las instituciones, su constitución, funcionamiento e inconvenientes. Se reconstruyen las relaciones de la incipiente sociedad civil que estaba adquiriendo rasgos de "ciudadanía", pese a la limitación del derecho a la soberanía y representación política, por cuya razón se abocó al reducido poder local, a la conversión del Territorio en provincia y a la presión sobre las instituciones del Estado. Ciertos sectores sociales -vecinos propietarios- participaron en el poder y pudieron incidir en la disposición de un determinado orden público. Se descubre este entramado a través de la cuestión política, la constitución de la esfera pública, el papel de la prensa, y el accionar de sectores gubernamentales y particulares, especialmente en los conflictos sociales. Estas cuestiones se analizan con mayor profundidad en el estudio particular de una institución: la justicia letrada nacional con marcado poder en el Territorio. Se demuestra que esta institución ejerció un papel importante en la extensión de las propiedades que caracterizaron la construcción y consolidación del Estado. El protagonismo judicial a nivel nacional tuvo su correlación en el poder de los jueces y de los juzgados letrados territoriales, basado en: el carácter nacional de estos tribunales, el perfil profesional de sus miembros, una red social y política de los magistrados a nivel nacional y, la debilidad de las demás instituciones del Territorio. Este poder era reconocido y consolidado por la prensa y los vecinos -propietarios, comerciantes y profesionales- interesados en jerarquizar el papel de la justicia.