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National and international organizations recommend creation of environments that support physical activity where people live, work, play, study, and travel. Policy changes can lead to activity-supportive environments and incentives. Research on environmental and policy influences on physical activity is well underway in many countries. An important use of the research is to inform policy debates, but the “translation” of research to policy is an emerging science. The papers in this supplement were presented at the 2008 Active Living Research Conference whose theme was “Connecting Active Living Research to Policy Solutions.” The papers include evaluations of policy initiatives and research that suggests promising new policies. Commentaries propose principles for improving the translation of research to policy. Improving the rigor of research, asking policy-relevant questions, presenting country-specific data, and effectively communicating findings to policy makers are likely to contribute to greater impact of research on policy processes.Journal of Public Health Policy (2009) 30, S1–S15. doi:10.1057/jphp.2008.59 [ABSTRACT FROM AUTHOR]

The current Bush Administration has made dramatic changes in US domestic and international reproductive health policies. This paper discusses the issues involved in some of these changes, and it considers likely developments in this area during the remainder of George W Bush's second term. The first section of the paper defines the term reproductive health and presents a framework for classifying reproductive health policies. The second section examines changes that the Administration has made in domestic family planning policies. The third section looks at analogous changes in American assistance for reproductive health internationally. The final section considers the implications of these trends for future policy and women's health. [ABSTRACT FROM AUTHOR]

The paper presents an analysis of policy directives needed to respond to threats of harm (e.g., violence against third parties) that may arise in the course of conducting descriptive epidemiological research with high-risk populations. It identifies two key areas where new policies must be developed to guide researchers conducting such investigations. The paper recommends that: (1) an NIH consensus panel be convened to set standards, analogous to Common Toxicity Criteria (CTC) criteria, to classify the severity of different types of indirect, non-research-related risk; and (2) case-based training modules be developed and incorporated into public health research ethics courses and training programs, to enhance researcher judgments in determining the likelihood of harm in different situations. In addition, researchers, Institutional Review Boards (IRBs) and community advisory groups must consider the issue of staff safety and the effectiveness of available responses to reduce the threat of harm. The author reviews and discusses implications for informed consent and IRB review.Journal of Public Health Policy (2006) 27, 293–308. doi:10.1057/palgrave.jphp.3200084 [ABSTRACT FROM AUTHOR]

This paper aims to provide insight on whether bicycling for everyday travel can help US adults meet the recommended levels of physical activity and what role public infrastructure may play in encouraging this activity. The study collected data on bicycling behavior from 166 regular cyclists in the Portland, Oregon metropolitan area using global positioning system (GPS) devices. Sixty percent of the cyclists rode for more than 150 minutes per week during the study and nearly all of the bicycling was for utilitarian purposes, not exercise. A disproportionate share of the bicycling occurred on streets with bicycle lanes, separate paths, or bicycle boulevards. The data support the need for well-connected neighborhood streets and a network of bicycle-specific infrastructure to encourage more bicycling among adults. This can be accomplished through comprehensive planning, regulation, and funding.

This paper outlines the increasing salience of drug "innovation" in the debate for reform of Australia's pharmaceutical policy, particularly change to Australia's price control mechanisms. The pharmaceutical industry has consistently criticised the central role of price control in Australia's pharmaceutical regulatory regime as an impediment to drug innovation and industry growth. Despite ambivalent or contrary evidence on the impact of price control on drug innovation, this criticism, and the appeals for reform it supports, appear to be increasingly influential in directing pharmaceutical policy. This is particularly evident in the implementation of the Australia/United States Free Trade Agreement, which has led to a weakening of the historical process of evidence-based reference pricing in Australia. Should drug innovation come to dominate Australian pharmaceutical policy, there is the potential to precipitate a devaluing of the current public orientation of regulation and diminish equitable access to affordable pharmaceuticals. The manner in which trade policy has effectively undermined a publicly funded pharmaceutical benefits scheme has clear implications for many countries that maintain such programmes.

The dramatic reduction of perinatally transmitted HIV in the United States has been a striking success story in the HIV epidemic. Routine HIV screening during pregnancy followed by appropriate therapy has been extremely effective. This paper puts forth three strategies needed to maintain these gains and reach the goal of eliminating perinatal HIV: standardize medical interventions and policy changes that support perinatal HIV reduction; institute HIV screening in routine preconception care to identify HIV infection in women before pregnancy; and critically focus attention and resources on primary prevention of HIV infection in women. Healthcare providers should incorporate HIV prevention education and routine screening into women's primary health care. Public health leaders should support and fund prevention strategies directed at young women. Successful approaches that have nearly eliminated perinatal HIV transmission in the United States offer valuable lessons that should be applied to primary HIV prevention for women in the United States and globally.

Labor unions can and should make strong allies in tobacco control efforts. Through much of the 1980s and 1990s, however, the organized labor and tobacco control communities rarely formed coalitions to achieve mutual gains. Recently, labor unions and tobacco control organizations have begun to work together on smoking cessation programs, smoke-free worksite policies, and increased insurance coverage for cessation treatments. This paper explores the historic and present-day intersections among organized labor and tobacco control advocates. We summarize research in this area and report on our recent programmatic efforts to promote collaboration between the labor and tobacco control communities. We discuss lessons learned with the aims of promoting deeper understanding among tobacco control and labor advocates of how each views tobacco control issues, and most importantly, stimulating further collaboration toward mutual gains in protecting workers' health.

Prevention in Norway and in Europe more generally, is a multidisciplinary collaboration between many professions, organized largely in municipalities, villages, and counties. This paper addresses three questions: What relevant legislation on prevention currently exists? What are the perspectives of ongoing activities and their intentions? What are the strategic issues? Since 1984, Norway's primary health care system has been based on the Local Authority Health Care Act. In 1995, the Communicable Disease Control Act replaced the chapter on communicable diseases in the old Public Health Act of 1860. The new act emphasizes communicable disease control as more of a right rather than a duty for both the individual and the population. In Europe, future public health policy, practice, and research will need to focus not only causes of disease and injuries, but also on factors promoting health.

Russia, despite recent legal reforms, still has one of the highest rates of imprisonment in the world. There are many reports of the adverse conditions in Russian prisons, often highlighting the consequences for health, in particular, risks of HIV, tuberculosis, and other infectious diseases. However, there are no reviews of the broader health issues in the Russian penal system. This paper reviews the available information on the health of the imprisoned population in Russia and the factors underlying it. It was undertaken by means of a search of Russian and international literature, including unpublished sources, supplemented by in-depth interviews with 27 key informants from the Ministry of Justice, prison administration, and non-governmental organizations. Published and unpublished data from the ministries of health and justice were used to describe the demographic characteristics of the imprisoned population and compare it with the general population. Although convicts are drawn disproportionately from disadvantaged groups in society and are detained in adverse physical conditions, the standardized mortality ratio from all causes is slightly over one-third of that in the overall Russian male population. This is mainly explained by an eight-fold lower mortality from external causes and a more than two-fold lower mortality from cardiovascular disease. These far outweigh the increased mortality from infectious diseases. The chances of survival of young men in Russia may actually be improved by being in prison, highlighting the need for policies that reduce the overall level of violence and other external risks, such as dangerous driving habits, in Russian society. Yet while conditions are improving in Russian prisons, with death rates falling, there are still many avoidable deaths and high levels of mental illness and infectious disease. There is also much that is not known about the health of Russian convicts, with what is available reflecting what is measured rather than what is important.

A common assumption is that international health policies are imposed on developing countries, owing to their high level of dependence on international aid. In reality, the process is likely to be complex. Drawing on analytical frameworks developed to study policy transfer between jurisdictions, this paper explores how far two globally promoted infectious disease policies (DOTS for tuberculosis and syndromic management for sexually transmitted infections) were voluntarily or coercively transferred in one particular setting, Mozambique. The paper suggests that guidelines emanating from these policies were not imposed, but evolved in the 1980s through technical networks of national and international experts. Further, that it was experience at the country level that fed into the globally promoted policies of the 1990s. By the time the policies were transferred by WHO and other international organisations to developing countries in the 1990s, Mozambique had already adopted their guidelines for good practice.

Between 1998 and 2001, the Peruvian Ministry of Health made sweeping changes in its malaria treatment policies in response to a resurgence of disease and the spread and intensification of antimalarial drug resistance. On the Pacific Coast, the first-line treatment for uncomplicated Plasmodium falciparum malaria was changed to combination therapy with sulfadoxine-pyrimethamine plus artesunate; in the Amazon region, mefloquine-artesunate combination therapy was introduced. With these changes in treatment policy, Peru became the first country in the Americas to use combination therapy with an artemisinin drug as its first-line treatment for falciparum malaria and the first country in the world to use two different drug combination therapy regimens based on an artemisinin drug in different regions of the country. This paper describes the process involved in assessing the geographic distribution and intensity of antimalarial drug resistance throughout the country and the use of that information to guide decisions related to national malaria treatment policy.

This paper reviews the major elements of the WHO Framework Convention on Tobacco Control and considers those that can be applied to diet and nutrition. Tobacco and food policy have important differences: the two commodities have distinctly different health impacts, and food companies may be more responsive to public concerns than the tobacco industry. Nevertheless, both food and tobacco policy address public health issues surrounding legal products. Both require comprehensive and multi-sector approaches at global and national levels. The degree of flexibility possible in interacting and partnering with the private sector and food and related industries and the related implications for regulations and laws are reasons for a more nuanced approach to diet and physical activity policy.

This paper summarises and compares the impacts of cannabis decriminalisation measures in two countries. In Australia, an expiation model of decriminalisation succeeded in avoiding the imposition of criminal convictions for many offenders, but substantial numbers of offenders received criminal convictions because of a general "net-widening" in cannabis offence detections, and the failure of many offenders to pay expiation fees and thus avoid criminal prosecution. Despite these problems, the expiation approach has been cost-effective, reducing enforcement costs without leading to increased cannabis use. In the United States, cannabis decriminalisation similarly reduced enforcement costs, with enforcement resources generally redirected toward trafficking and other illicit drugs. There were no increases in cannabis use or substantial problems that could be ascribed to decriminalisation. The implications for other countries are discussed, with particular attention to the importance of implementation issues, monitoring, and evaluation. Although decriminalisation has succeeded in reducing enforcement and other costs without increasing the problems associated with cannabis use, the same impacts would not necessarily result from the legalisation of cannabis or the decriminalisation of other illicit drugs.

Over half of the people affected by leprosy worldwide are in India, many of whom are severely disabled when they present for care. Changes in policy and the integration of the leprosy programme with general health services has given rise to new challenges for the control of blinding eye disease in leprosy patients. This paper looks at the challenges posed: management, materials, manpower, money, and mobility – all of which are common barriers to the availability, access, and utilization of services – and to monitoring existing programmes. We consider strategies to overcome these challenges and fulfill the goal of VISION 2020 – eliminating avoidable blindness – through the provision of comprehensive eye care and strengthening the existing infrastructure. Formal cooperation between national governments, non-governmental organisations, and International Development Agencies will need to continue, although possibly, in different roles and with plans modified to be relevant to the local needs of leprosy patients.Journal of Public Health Policy (2007) 28, 456–464. doi:10.1057/palgrave.jphp.3200149 [ABSTRACT FROM AUTHOR]

At the World Health Assembly in 1996, the World Health Organization (WHO) declared violence “a leading worldwide public health problem” and called for public health strategies to address it. The WHO's call to action, as well as an international political movement that is gaining strength, has helped galvanize health professionals in many countries to employ the tools of public health and their medical skills to better understand the causes of violence, to use research findings to influence policy, and to animate statistics with a human face. This paper reviews the scope of the problem, with a focus on armed violence with small arms and light weapons. It presents a history of International Physicians for the Prevention of Nuclear War's (IPPNW) involvement in this issue. A case example from IPPNW/Zambia demonstrates how health community involvement can raise awareness about armed violence and its risk factors, and influence policy changes.Journal of Public Health Policy (2007) 28, 389–400. doi:10.1057/palgrave.jphp.3200150 [ABSTRACT FROM AUTHOR]

Prevention in Norway and in Europe more generally, is a multidisciplinary collaboration between many professions, organized largely in municipalities, villages, and counties. This paper addresses three questions: • What relevant legislation on prevention currently exists? • What are the perspectives of ongoing activities and their intentions? • What are the strategic issues? Since 1984, Norway's primary health care system has been based on the Local Authority Health Care Act. In 1995, the Communicable Disease Control Act replaced the chapter on communicable diseases in the old Public Health Act of 1860. The new act emphasizes communicable disease control as more of a right rather than a duty for both the individual and the population. In Europe, future public health policy, practice, and research will need to focus not only causes of disease and injuries, but also on factors promoting health. [ABSTRACT FROM AUTHOR]

Reducing the availability of alcohol through alcohol control policies such as excise taxes and the minimum legal drinking age has been effective in reducing a wide range of alcohol-related problems, including traffic crashes, liver cirrhosis, and violence. Alcohol control policies may be classified into two overlapping categories--public and institutional policies. Some policies such as alcohol server training may be either mandated by governmental jurisdictions or voluntarily adopted by individual institutions, which include alcohol retail establishments, other businesses, worksites, schools, colleges/universities, law enforcement agencies, religious institutions, insurance agencies, and alcohol producers. Public policies may be mandated by national, state/provincial, or local governments to regulate where, when, and how alcohol is sold and consumed. This paper describes the wide array of public and institutional policies available to reduce alcohol-related problems. Summaries of research evaluating specific alcohol control policies are provided when available.

Since the first meeting of the American Public Health Association in 1873, epidemiology and epidemiologists have been central to the activities of the organization. At that meeting, the most prominent American physician of the time, Austin Flint, presented a classic paper entitled "Relations of Water to the Propagation of Fever." In that remarkable paper, Flint reinterpreted observations on the North Boston, N.Y. typhoid fever epidemic made 30 years earlier in which he had correctly concluded that the epidemic had been propagated by contagion, but incorrectly concluded that transmission was not the result of contaminated drinking water. During the last quarter of the 19th century and the first quarter of the 20th, Annual Meetings of the APHA were frequently the locus for reports of epidemic investigations and the Journal of the Association was the vehicle for their publication. When the Association was reorganized to include discipline-oriented sections, the Epidemiology Section was among the first to be established. At the time, 1929, the Section was the only meeting place (outside the small and exclusive American Epidemiological Society) for epidemiologists to exchange ideas and information. The Section was also a place where public health policies were hotly debated. After World War II, academic departments of epidemiology increasingly focused the field on methodological issues and etiological investigations. Furthermore, new organizations and a plethora of epidemiological journals flooded the field. Thus, the Epidemiology Section has remained a major center for translating epidemiological knowledge into policy and is likely to intensify that function in the future. [ABSTRACT FROM AUTHOR]

This paper describes the need and rationale for developing a phases model for guiding alcohol-problem prevention research. A phased approach to prevention research is consistent with such models developed for other health areas including heart disease, cancer, and drug testing. Such a model in alcohol prevention research can provide a means for (1) locating how far research has progressed along a continuum from basic or pre-intervention research to full implementation of preventive action, (2) identifying gaps in research, and (3) determining the level of empirical proof which exists for one or more prevention strategies prior to widespread dissemination.

This paper is based on the statement in the Ottawa Charter for Health Promotion that "The fundamental conditions and resources for health are peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice and equity. Improvement in health requires a secure foundation in these basic prerequisites." It attempts to formulate a progressive political platform for a number of these prerequisites, offering a series of recommendations regarding education, employment, income, and housing, and urging that the proposed programs be funded by progressive taxation and major reductions in the military budget.

Public support is crucial to sustained success for alcohol policies--but some may be supported precisely because they are expected to have the least impact on most drinkers. This paper offers an in-depth look at this "prevention dilemma," in an analysis of two alcohol control policies, higher alcohol taxes and health warning labels. In a recent national survey (n = 2000), respondents were asked about their perceptions of these policies' effects on moderate drinkers, on heavy drinkers, and on their drinking. Those who believed the label had affected their drinking were more likely to support the label policy, but the corresponding perception about higher prices' effect was not a significant predictor of support for higher taxes; heavier drinkers were less likely than others to endorse either policy. These data do not offer evidence that policy endorsement hinges on the belief that one's drinking is unaffected by the policy.

We must enter the second decade of AIDS with the knowledge that existing public health efforts have failed to stop the disproportionate spread of HIV disease among Americans of African descent. This article presents the cold epidemiological facts which lay bare the moral tragedy that Black Americans are being killed by a disease which is almost totally preventable. This paper discusses the primary behavioral risk factors for HIV infection and the context in which HIV disease emerged in the 1980s. Additionally, we present results from cross-sectional surveys of selected black populations to demonstrate how AIDS knowledge deficits and attitudinal barriers have shaped the perceptions of Black Americans toward needle exchange programs as an HIV prevention strategy advocated by public health authorities. A model that may be utilized to educate the Black community and facilitate their involvement in the development of needle exchange policy is described.

Injuries have now become a recognizable public health problem in developing countries. However, no definite policies regarding their surveillance and control are yet available in most of these countries. This paper, using Ghana as a prototype, examines the need for policy and action which has been accentuated in recent times by public outcry. The paper also provides some recommendations to solve this problem: the urgent need to initiate programs such as needs assessment, the establishment of a surveillance system for injuries at various levels of health services, creation of public awareness and provision of health education, and the institution of simple first-aid measures. Specific policies regarding injuries from motor vehicle accidents and fires are also given.

This paper debunks three widely believed myths about the former Yugoslavia's health care system: that it was characterized by: (1) social ownership of "self-managing" provider organizations; (2) a commitment to primary health care; and (3) a faith in what might be called the "march of progress"--the health system's continuous expansion and improvement. In contrast to this picture, we present an alternative view and conclude with a word of caution for American consultants and health care reformers in Eastern European countries and newly independent states: If universal health coverage is to be maintained, beware of reforms that do no more than substitute private for public organizational forms.

In 1988, a new Constitution was adopted in Brazil in which guidelines for community participation in the development and implementation of the national health system were delineated. The health and welfare of women and children were given priority. Implementation of these guidelines presents a major challenge in a city such as São Paulo with a population of 15 million, of which an estimated 5.8 million are women of childbearing age. In order to determine the extent to which community organizations are actively participating in planning health services for women and children in São Paulo, a study was undertaken to examine the experience of community and professional organizations in public health advocacy. This paper describes a sample of these organizations, their constituents, membership, history, funding, advocacy objectives, and strategies used and results obtained. The information gathered indicates that the community organizations are involved in activities that include major efforts to improve access to health care by providing specialized courses in women's health, including the status of women's work, sexuality, discrimination, family planning, and the politics of health; publishing newsletters; producing radio programs; engaging in legal action; and using petitions, demonstrations, and public meetings to garner public support on specific issues.

The health effects of asbestos are well known, with lung cancer, mesothelioma and asbestosis recognized as the most common causes of mortality and morbidity among exposed populations. Recognition of these hazards coupled with an explosion of litigation against asbestos manufacturers brought by injured workers has resulted in declining markets for this commodity in the U.S. and other Western democracies. With Western markets for asbestos decreasing, the developing world has become the target of asbestos exporters in an attempt to revitalize an industry in decline. This paper discusses the trends in worldwide asbestos markets over the last two decades and the serious health implications of policies directed at establishing viable markets for this commodity in developing nations.

Alcohol and drug treatment have separate histories in the United States. The large public treatment systems were established as separate institutions in the early 1970s and have developed separate research traditions and treatment programs. However, as a response to current treatment financing policy and epidemiologic descriptions of combined alcohol and other drug use in the population, the two treatment systems are merging at the state and local levels. This large structural change is taking place without the development and evaluation of treatment methods for combined problems and without discussion of overall health service or policy implications. This paper describes the changes occurring, examines the literature for its contributions in providing direction, and presents treatment method and policy issues which need to be part of the overall discourse.

The current turbulence characterizing the health sector has engendered a limited number of state-level experiments to provide health services for the nation's 37 million uninsured. The issues and challenges generated by each program's design and implementation vary. By examining the experience of one such state program, the Washington Basic Health Plan, in some detail, this paper contributes to the policy debate regarding the possible range of solutions available to address the issue of "the uninsured." By analyzing the array of design choices available at the time the program was enacted, and why certain options were chosen rather than others, this paper points to the complex interaction of political dynamics, public policy development, and program implementation.

A potent new tool in the politics of fiscal retrenchment lies in the creation of a framework for policy analysis which implicitly or explicitly "blames" the old for poverty and economic hardships in the young. This paper examines the recent efforts to promulgate this generational equity or "age/race wars" perspective and demonstrates that opinion poll data fail to support the rhetoric of growing age/race group antagonisms over entitlement programs for the old. The assumptions underlying the generational equity framework are critiqued, and the race and ethnic issues embedded within this framework are examined. In particular, we explore spurious assumptions concerning the relative financial wellbeing of the elderly, escalating Social Security and Medicare costs as a primary cause of poverty in the young, and growing resentment of programs for the old among minorities and youth. Attempts to deligitimate the claims of the elderly through the advancement of the ideology of age/race wars are seen to have significant implications for public health policy, with the country's recent experience with the Medicare Catastrophic Coverage Act serving as an important case in point. The need for an alternative policy framework stressing the interdependence of generations is suggested, and some guiding principles put forward toward the development of such an alternative framework.

This paper presents the author's experiences and perceptions of the neoliberal triad of anti-health reforms--government budget cutting, deregulation, and privatization--which have been promulgated worldwide by the World Bank and the International Monetary Fund. The causes of this phenomenon are analyzed, and specific alternative health policies are recommended. The role of epidemiology in documenting the damages to health resulting from the anti-health reforms is discussed. Finally, the paper emphasizes the need not only for national organizational strategies but for action on the international level. The opponents of privatization need to meet together, to exchange experiences, and to develop effective strategies on a world scale that can be applied in industrial and developing nations. [ABSTRACT FROM AUTHOR]

The approaches to the environmental and occupational health regulation of pesticides vary from country to country. This paper looks at some of those approaches with particular reference to the UK. In the UK, control standards for certain pesticides are significantly less stringent than elsewhere in Western Europe and indeed the Americas. The reasons for these differences are examined, with examples given of the more cautious approaches and the wider control philosophies adopted outside the UK. UK pesticide legislation is set in an international context. Alternative strategies for regulating UK pesticides are outlined and new policy options presented.

The principal objective of our research is to examine whether the earned income tax credit (EITC), a broad-based income support program that has been shown to increase employment and income among poor working families, also improves their health and access to care. A finding that the EITC has a positive impact on the health of the American public may help guide deliberations about its future at the federal, state, and local levels. The authors contend that a better understanding of the relationship between major socioeconomic policies such as the EITC and the public's health will inform the fields of health and social policy in the pursuit of improving population health.Journal of Public Health Policy (2009) 30, 198–207. doi:10.1057/jphp.2009.3 [ABSTRACT FROM AUTHOR]