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The article addresses further debate and decision-making by the American Public Health Association (APHA) on a public policy statement on safe drinking water. The paper provides the scientific basis and justification for the importance of improving water supplies in the U.S. The quality and safety of drinking water in the U.S. continues to be an important public health issue. Specific contaminants of concern include microbial contaminants and chemical contaminants. Recommended goals for the APHA are to foster greater involvement of the public health professional as advisor, educator and advocate on issues related to drinking water and health, and to promote understanding in public health practice and policy making of the potential public impact of water contamination.

The article examines how the "American Journal of Public Health," the official organ of the American Public Health Association cope with the changes in the health policy in the U.S. During the period of editorship of Dr. George Rosen, both the Journal's circulation and its sponsoring organization's membership has doubled. The source of offerings to the Journal expanded far beyond the lists of Association members and the papers presented at public health meetings during the years of Rosen's editorship.

A widely publicized but unpublished study of the relationship between gun shows and gun violence is being cited in debates about the regulation of gun shows and gun commerce. We believe the study is fatally flawed. A working paper entitled "The Effect of Gun Shows on Gun-Related Deaths: Evidence from California and Texas" outlined this study, which found no association between gun shows and gun-related deaths. We believe the study reflects a limited understanding of gun shows and gun markets and is not statistically powered to detect even an implausibly large effect of gun shows on gun violence. In addition, the research contains serious ascertainment and classification errors, produces results that are sensitive to minor specification changes in key variables and in some cases have no face validity, and is contradicted by 1 of its own authors' prior research. The study should not be used as evidence in formulating gun policy. [ABSTRACT FROM AUTHOR]

Public health agencies increasingly use electronic means to acquire, use, maintain, and store personal health information. Electronic data formats can improve performance of core public health functions, but potentially threaten privacy because they can be easily duplicated and transmitted to unauthorized people. Although such security breaches do occur, electronic data can be better secured than paper records, because authentication, authorization, auditing, and accountability can be facilitated. Public health professionals should collaborate with law and information technology colleagues to assess possible threats, implement updated policies, train staff, and develop preventive engineering measures to protect information. Tightened physical and electronic controls can prevent misuse of data, minimize the risk of security breaches, and help maintain the reputation and integrity of public health agencies.

This paper models the prevailing political attack on government as a heuristic, a judgmental strategy that simplifies complex phenomena by applying simple tests to a limited set of relevant data. The heuristic of market individualism offers three tools for analyzing the problems of governing: the supremacy of the free market as a regulatory device, a belief in individual freedom of choice and personal responsibility, and the elevation of individual satisfaction as the chief goal of society. Because public health is inherently concerned with the health of the population rather than individual health, because the market itself is a major source of ill health, and because individual choice is socially mediated, use of the heuristic precludes the recognition of the value of public health work. Although some degree of accommodation to current political realities is a practical necessity, public health advocates must not neglect the task of fashioning radically different alternative visions over the long term.

Objectives: This article examines health policy implications of providing smokers with numerical tar yield information in cigarette advertising., Methods: Results of a national probability telephone survey regarding smokers' knowledge and understanding of numerical tar yields and deliveries are reported., Results: Few smokers knew the tar level of their own cigarettes (the exception being smokers of 1- to 5-mg tar cigarettes), and a majority could not correctly judge the relative tar levels of cigarettes. Smokers were unsure whether switching to lower-tar cigarettes would reduce their personal health risks. Many smokers relied on absolute numbers in making trade-offs between number of cigarettes smoked and their tar levels, thus confusion machine-rated tar-yields with actual amounts ingested., Conclusions: The wisdom of the present method of providing tar and nicotine numbers in ads and recommendations for modifying the test protocol are now under discussion. This research indicates that these tar numbers and their implications are poorly understood. The paper recommends revisions in tar ratings to make them more useful and a required statement on cigarette packages to more explicitly relate tar levels to major health risks.

This paper discusses what the goals of national drug policy have been and suggests an alternative set of goals. The past emphasis on use reduction is found wanting. Total harm related to drugs can be viewed as the product of use and harm per use. Thus, reducing use usually serves to reduce harm. However, in some cases, use reduction programs may increase harm per use so much that they increase overall harm even as they succeed in reducing use. Hence, use reduction goals can be usefully augmented with the explicit objective of reducing the total harm created by the production, distribution, consumption, and control of drugs. Numerous programmatic recommendations flow from this approach.

As the recent increase in cases of tuberculosis is addressed, there is a danger that the need for increased protection of the public health will create a climate in which the rights of individuals with tuberculosis and human immunodeficiency virus (HIV) infection may be disregarded. This paper considers ethical and policy issues in the control of tuberculosis. The authors conclude that mandatory HIV testing is not critical to effective tuberculosis control, and that although individuals infected with HIV are at increased risk for developing tuberculosis, exclusionary employment practices are not justified. Because failure to complete the course of tuberculosis treatment increases the prospect that drug-resistant strains will develop, it is crucial to require all those who commence treatment to complete their therapy. To ensure the completion of treatment, special attention must be paid to the needs of the homeless, drug users, and those with psychiatric impairments. In addition, all tuberculosis patients should begin their posthospital care under direct observation. Patients who fail to complete treatment despite efforts to encourage and facilitate their cooperation should be subject to confinement after a hearing with full due process protections.

The President's Committee on Health Education was created by Richard M. Nixon in September 1971 and submitted its final report in September 1973. The committee resulted from the convergence of (1) a perceived national domestic policy need in response to escalating medical costs, (2) Nixon's personal and political ambitions, and (3) the dynamic political context of the late 1960s and early 1970s. Its work led to both private and public initiatives designed to influence the public's health through education; its findings and recommendations also laid the foundation for the National Consumer Health Information and Health Promotion Act of 1976 and thus contributed significantly to the development of subsequent national policy in health promotion and disease prevention. This paper places the work and contributions of the committee into historical perspective by analyzing the committee's origins and methods and the underlying politics that shaped its work and final report. The impact of the President's Committee is traced from the emergence of health education in the early 1970s as a potentially cost-effective alternative to medical care to the pivotal role health education now plays in health promotion and disease prevention efforts.

President Clinton recently announced his reform plan for health care in the United States. The United Kingdom, along with other countries, has already enacted reforms in an effort to overcome the basic problem of having insufficient funds to provide a health service to meet modern demands. This paper briefly describes the recent health reforms in the United Kingdom and highlights some lessons for the United States, which include the need to choose procedures that should be universally provided. Health reforms that involve some fundamental restructuring need to be evaluated everywhere and agreed to by the staff in advance. [ABSTRACT FROM AUTHOR]

Abstract: The tobacco industry has lobbied successfully to obtain the support of the United States government for opening Asian Markets to American tobacco products. This paper comments on two issues arising from these efforts: the development of an atmosphere of invasion and resistance to invasion in Asia; and the change in the image of the United States in Asian nations from that of a leader in health to that of an exporter of death. The threat of sanctions and the effects of the open market and United States tobacco company advertising in Japan, Taiwan, and South Korea are noted. Parallels are drawn between the opium wars a century and a half ago in China and the current threat of trade sanctions. Reacting to American policy, an Asia-Pacific Association for Control of Tobacco has been formed and linked with the US Coalition Against Smoking. (Am J Public Health 1990;80:659-662.) [ABSTRACT FROM AUTHOR]

The National Cancer Institute (NCI) estimates on the basis of current knowledge alone that, at a minimum, 30,000 lives could be saved in the year 2000 if Americans would modify their dietary habits. A recent innovative way of responding to this challenge was the Kellogg Company/NCI All-Bran advertising campaign. This paper will describe the campaign, and its impact on consumers, cereal industry sales, food industry advertising practices, health regulatory policy, and the organizational credibility of both NCI and Kellogg. For the past three years, Kellogg has included NCI's cancer prevention messages in their advertisements for All-Bran cereal and on their bran cereal boxes. This collaborative effort has stimulated considerable controversy over whether the health claims made on the cereal label are in violation of federal food labeling regulations. Meanwhile, research has demonstrated the positive impact of the campaign on consumer's knowledge and behavior regarding fiber as well as on Kellogg's profits. Other manufacturers are anxious to jump on the "branwagon"; however, many unanswered questions remain about this new approach to health advertising. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents analyses of recent natioanl survey data on access to medical care. In particular, information on major access indicators and special problems associated with the economic and political climate of the 1980s collected in a 1982 national telephone survey of 6.610 United Scales adults and children, representing some 4.802 families, is compared with previous national stirrers for kef population subgroups--by age. place of residence, income, race, insurance coverage, and type of regular source of care In general, the findings show that favorable progress has been made, but some inequities continue to persist. Some traditionally disadvantaged groups are more likely to have a regular family doctor, private insurance coverage, have been to a doctor, or had certain preventive tests and procedures than was true for them in the past. On the other hand, compared to the more economically and/or socially advantaged groups in 1982, they have still not "caught up" entirely. There also is evidence that they may be hardest hit by the exacerbation of the financial barriers to care thai result from unemployment, inflation, and cutbacks in health program eligibility and benefits that have characterized the decade of the 1980s. [ABSTRACT FROM AUTHOR]

Abstract: The paper provides an overview of public policy issues pertaining to the use of gene-splicing (recombinant DNA [deoxyribonucleic acid]) techniques in research and for industrial applications. Included is a discussion of the regulatory framework at the federal and institutional levels. The principal limitation of the current federal guidelines is its failure to provide mandatory coverage for private sector activities. Four municipalities and two states have passed their own legislation to remedy the situation. These enactments and their tie-in to the public health sector are examined. (Am J Public Health 69:1252-1259, 1979.) [ABSTRACT FROM AUTHOR]

This paper describes changes in the population for which General Motors provides health benefits using data from domestic personnel records. Total population size grew from 2.01 million in 1983 to 2.14 million in 1987, twice as fast as the US populations. Dependents, particularly spouses, fueled the population growth. Trends suggest that nonworker eligibility for employer-provided health benefits may receive more attention in health care cost containment efforts. [ABSTRACT FROM AUTHOR]

Dr. Salk's comments on our paper fall into four major categories: our use of the techniques of decision analysis, the assumptions we used, the fact that we did not include individual and social values in the model, and the way in which vaccine policies are developed in the United States. We believe that the methods were used correctly, that the assumptions we used are defensible, and that our conclusions were both appropriate and appropriately worded. We explicitly did not include individual and social values since we were addressing the scientific and epidemiologic issues rather than ethical and moral issues. Vaccine policy development in the United States is carried out in public forums with opportunity for presentation of all sides of an issue.

There is a national movement among community health workers (CHWs) to improve compensation, working conditions, and recognition for the workforce through organizing for policy change. As some of the key advocates involved, we describe the development in Massachusetts of an authentic collaboration between strong CHW leaders of a growing statewide CHW association and their public health allies. Collaborators worked toward CHW workforce and public health objectives through alliance building and organizing, legislative advocacy, and education in the context of opportunities afforded by health care reform. This narrative of the path to policy achievements can inform other collaborative efforts attempting to promote a policy agenda for the CHW workforce across the nation. [ABSTRACT FROM AUTHOR]

As soon as the authority of the Public Health and Welfare Section (PHW) of the Supreme Commander for Allied Powers waned in May 1951. the Japanese government overturned several measures it had implemented. Although the PHW contributed greatly toward improving public health conditions, not all of Its activities were models of cooperative success. Many Japanese perceived some measures — terminated pensions for wounded Japanese veterans, lack of support for segregated orphanages for mixed-race children, and suppression of Japanese atomic bomb medical reports — as promoting US national interest at the expense of Japanese public health needs. Similarly, the PHW's upgrade of nursing education and separation of the professions of medicine and pharmacy were reversed because neither professionals nor the public saw these measures as urgent. Their reinstitution toward the end of the twentieth century suggests that the progressive measures were sound, but broke too sharply with Japanese tradition and were enforced prematurely. (Am J Public Health. 2009; 99:1364-1375. doi:10.2105/AJPH.2008.150532) [ABSTRACT FROM AUTHOR]

A list of the policy statements adopted by the Governing Council of the American Public Health Association on November 15, 2000 is presented. It includes Supporting Access to Midwifery Services in the U.S., Effective Interventions for Reducing Racial and Ethnic Disparities in Health, Public Health Role of the National fire Protection Association in Setting Codes and Standards for the Built Environment, the Need for Continued and Strengthened Support for Immunization Programs, and the Criteria for Assessing the Quality of Health Information on the Internet.

Recent strategies in managed care and managed competition illustrate how health care reforms may reproduce the patterns of economic organization of their times. Such a reform approach is not a new development in the United States. The work of the 1927-1932 Committee on the Costs of medical Care examplifies an earlier effort that applied forms of economic organization to medical care. The committee tried to restructure medicine along lines consistent with its economic environment while attributing its models variously to science, profession, and business. Like current approaches, the committee's reports defined costs as the major problem and business models of organization as the major solution. The reports recommended expanded financial management and group medicine, which would include growth in self-supporting middle-class services such as fee clinics and middle-rate hospital units. Identifying these elements as corporate practice of medicine, the American Medical Association-based minority dissented from the final report in favor of conserving individual entrepreneurial practice. This continuum in forms of economic organization has limited structural reform strategies in medicine for the remainder of the century. [ABSTRACT FROM AUTHOR]

The article comments on the public health promotion policy in the U.S. proposed by J. B. Richmond and M. Kotelchuck in their paper titled "Coordination and Development of Strategies and Policy for Public Health Promotion in the United States," that was published in the book "Oxford Textbook of Public Health." According to the authors, the health policy model devised by Richmond and Kotelchuck posits that there are three necessary ingredients that make preventive action happen, namely, the knowledge base; the political will to support change; and a social strategy to accomplish change.

Objectives. In national and local discussions of health care reform, there is disagreement about whether a national health insurance plan should he mandatory or voluntary. This study describes characteristics of low-income people who were more likely or less likely to be covered by a voluntary plan. Methods. Survey data were available from an evaluation of Washington State's Basic Health Plan, which offered subsidized health insurance to low-income residents. For those subjects who were eligible and uninsured at baseline, those who joined were compared with those who did not join on a variety of demographic and health-related characteristics. Results. There were substantial differences between those who did and did not join the Basic Health Plan. Those who did not enroll were generally less well-off, with less education, lower income, and worse health. Many had never had health insurance. Conclusions. If health care reform results in a voluntary plan, additional measures may be needed to ensure that less advantaged citizens have adequate access to health care. [ABSTRACT FROM AUTHOR]

The article reports on the apartheid and the health pattern differences between South Africa and the United States. The Nationalist Party made apartheid as government policy in year 1948. It gave Blacks the chance to share economic power in finance and industry with English-speaking Whites but excluding them from political power, economic power, and landownership. Whites usually die of developed world diseases while Blacks die of Third World diseases.

Abstract: A survey of state developmental disability agencies was undertaken in October 1987 regarding AIDS policy development, education, and training and service provision. Of 44 states responding to the 27-item questionnaire, only 21 had formal AIDS policies. Policies varied considerably from state to state. Twenty-five of the responding states include information on AIDS in their staff training curriculum, with such training more likely to be provided to institutional staff than to community-based staff. Only 10 states reported AIDS prevention to be part of their client training programs, with training more likely to be found in institutional settings. Eleven states reported HIV positive cases, with such cases found more often in institutions than in community settings. Several states reported some type of segregation of HIV positive individuals. Policies, educational programming, and services to meet the special needs of persons with developmental disabilities are called for. (Am J Public Health 1990; 80:54-56.) [ABSTRACT FROM AUTHOR]

Abstract: Partner notification should be standard public health practice in the control of human immunodeficiency virus (HIV) infection. A universal partner notification program for the United States is 'affordable, operationally manageable, and can effectively reach high-risk persons. Such a focused approach personalizes the epidemic and probably enhances the efficacy of risk reduction messages. Confidentiality protections are attainable. Voluntary partner notification is acceptable to our constituents; while counseling is "mandatory," testing is optional. Evidence of partner notification's usefulness as a case prevention tool should be a by-product of program outcomes and not a prerequisite for its implementation. [ABSTRACT FROM AUTHOR]

Estimates from the 1977 National Medical Care Expenditure Survey suggest that divorced women are twice as likely as married women to be uninsured, and also more likely to depend on Medicaid assistance. Divorced women use slightly more health services than married women, but also appear to have somewhat poorer health status. (Am J Public Health 1984: 74:1276-1278.) [ABSTRACT FROM AUTHOR]

The article reports on the American Public Health Association's announcement of the schedule for the annual process of considering proposed policy statements for 1990. These public policy statements form the basis of the association's position on legislative, regulatory, legal and health matters of interest to the public health community. They also provide a record of the association's stand on a variety of health issues, reflecting the diverse interest of its membership. Deadline for receipt of proposed resolutions is on February 26, 1990.

More than half of US jurisdictions have laws criminalizing knowing exposure to or transmission of HIV, yet little evidence supports these laws' effectiveness in reducing HIV incidence. These laws may undermine prevention efforts outlined in the US National HIV/AIDS Strategy, in which the United States has invested substantial federal funds. Future research should include studies of (1) the impact of US HIV exposure laws on public health systems and practices; (2) enforcement of these laws, including arrests, prosecutions, convictions, and sentencing; (3) alternatives to HIV exposure laws; and (4) direct and opportunity costs of enforcement. Policy efforts to mitigate potential negative impacts of these laws could include developing prosecutorial guidelines, modernized statutes, and model public health policies and protocols. [ABSTRACT FROM AUTHOR]

Eliminating health disparities is a Healthy People goal. Given the diverse and sometimes broad definitions of health disparities commonly used, a subcommittee convened by the Secretary's Advisory Committee for Healthy People 2020 proposed an operational definition for use in developing objectives and targets, determining resource allocation priorities, and assessing progress. Based on that subcommittee's work, we propose that health disparities are systematic, plausibly avoidable health differences adversely affecting socially disadvantaged groups; they may reflect social disadvantage, but causality need not be established. This definition, grounded in ethical and human rights principles, focuses on the subset of health differences reflecting social injustice, distinguishing health disparities from other health differences also warranting concerted attention, and from health differences in general. We explain the definition, its underlying concepts, the challenges it addresses, and the rationale for applying it to United States public health policy. INSETS: Social Disadvantage;Health Disparities and Health Equity. [ABSTRACT FROM AUTHOR]

United v Federal Election Commission 130 US 876 (2010) case concerned the plans of a nonprofit organization to distribute a film about presidential candidate Hillary Clinton. The Court ruled that prohibiting corporate independent expenditures for advocacy advertising during election campaigns unconstitutionally inhibits free speech. Corporations can now make unlimited contributions to election advocacy advertising directly from the corporate treasury. Candidates who favor public health positions may be subjected to corporate opposition advertising. Citizen groups and legislators have proposed remedies to ameliorate the effects of the Court's ruling. The public health field needs to apply its expertise, in collaboration with others, to work to reduce the disproportionate influence of corporate political speech on health policy and democracy. INSETS: Corporate Campaign Contributions Related to US Health Care...;Rights of Corporations;Proposed Actions to Ameliorate the Effects of the Citizens.... [ABSTRACT FROM AUTHOR]

Although researchers acknowledge that health disparities have multiple determinants, most recommendations for reducing inequities focus on a single approach. We suggest integrating 2 approaches for reducing disparities: improving access to primary care and updating and more vigorously enforcing consumer and environmental protection laws. This strategy could reduce the main causes of disparities, such as chronic diseases and injuries; win public and policymaker support; and provide a cost-effective start for achieving equity. Most of the scientific knowledge needed to implement this strategy exists, thus years of additional research would not be needed. Developing targeted regulatory and health care policies to reduce deaths from chronic diseases and injuries would be a major step forward in eliminating health disparities in the United States. [ABSTRACT FROM AUTHOR]

Translational, transdisciplinary, and transformational research stands to become a paradigm-shifting mantra for research in health disparities. A windfall of research discoveries using these 3 approaches has increased our understanding of the health disparities in racial, ethnic, and low socioeconomic status groups. These distinct but related research spheres possess unique environments, which, when integrated, can lead to innovation in health disparities science. In this article, we review these approaches and propose integrating them to advance health disparities research through a change in philosophical position and an increased emphasis on community engagement. We argue that a balanced combination of these research approaches is needed to inform evidence-based practice, social action, and effective policy change to improve health in disparity communities. [ABSTRACT FROM AUTHOR]

Objectives. We used cartograms to visually communicate the state-specific prevalence of obesity and its association with socioeconomic variables over time to benefit and inform decisions by national health policymakers who address geographic and social inequities in health. Methods. We generated density-equalizing maps, known as cartograms (in which geographic regions are sized in proportion to some variable), that illustrate indicators of population and educational attainment. We also provide an innovative presentation of the obesity choropleth map (which presents values for areas by shading). Results. The maps depict the absolute burden of obesity, the inverse association between obesity and education, and geographic patterns in the prevalence of obesity over time. Conclusions. The prevalence of obesity in the United States continues to increase. These cartograms can help stakeholders interpret surveillance data and their relation to demographic and socioeconomic characteristics to inform decisions. (Am J Public Health. 2009;99:308-312. doi:10.2105/AJPH.2008.138750) [ABSTRACT FROM AUTHOR]

Recently, many states have implemented requirements for scientific or medical accuracy in sexuality education and HIV prevention programs. Although seemingly uncontroversial, these requirements respond to the increasing injection of ideology into sexuality education, as represented by abstinence-only programs. I describe the process by which health professionals and government advisory groups within the United States reach scientific consensus and review the legal requirements and definitions for medical accuracy. Key elements of this scientific process include the weight of scientific evidence, the importance of scientific theory, peer review, and recognition by mainstream scientific and health organizations. I propose a concise definition of medical accuracy that may be useful to policymakers, health educators, and other health practitioners. (Am J Public Health. 2008;98: 1786-1792. doi:10.2105/AJPH. 2007.119602) [ABSTRACT FROM AUTHOR]

Medicare research has shown that there are substantial disparities by race and socioeconomic status In use of services. In this article, I review past research and discuss how findings apply specifically to vulnerable men aged 65 years or older. Six lessons from this review are identified and illustrated here. Disparities in certain measures of health are growing; to reverse this trend, substantial efforts are needed, including dissemination of information about disparities as well as testing of hypotheses regarding underlying causes. (Am J Public Health. 2003;93:753-759) [ABSTRACT FROM AUTHOR]

Because of the importance of grassroots social movements, or "change from below," in the history of US reform, the relationship between social movements and demands for universal health care is a critical one. National health reform campaigns in the 20th century were initiated and run by elites more concerned with defending against attacks from interest groups than with popular mobilization, and grassroots reformers in the labor, civil rights, feminist, and AIDS activist movements have concentrated more on immediate and incremental changes than on transforming the health care system itself. However, grassroots health care demands have also contained the seeds of a wider critique of the American health care system, leading some movements to adopt calls for universal coverage. [ABSTRACT FROM AUTHOR]

Single-payer national health insurance could cover the uninsured and upgrade coverage for most Americans without increasing costs; savings on insurance overhead and other bureaucracy would fully offset the costs of improved care. In contrast, proposed incremental reforms are projected to cover a fraction of the uninsured, at great cost. Moreover, even these projections are suspect; reforms of the past quarter century have not stemmed the erosion of coverage. Despite incrementalists' claims of pragmatism, they have proven unable to shepherd meaningful reform through the political system. While national health insurance is often dismissed as ultra left by the policy community, it is dead center in public opinion. Polls have consistently shown that at least 40%, and perhaps 60%, of Americans favor such reform. (Am J Public Health. 2003;93: 102-105) [ABSTRACT FROM AUTHOR]

Objectives. We reviewed literature on comparative social policy and life course research and compared associations between health and socioeconomic circumstances during an 11-year period in the United States and the United Kingdom. Methods. We obtained data from the US Panel Study of Income Dynamics and the British Household Panel Survey (1990-2002). We used latent transition analysis to examine change in self-rated health from one discrete state to another; these health trajectories were then associated with socioeconomic measures at the beginning and at the end of the study period. Results. We identified good and poor latent health states, which remained relatively stable over time. When change occurred, decline rather than improvement was more likely. UK populations were in better health compared with US populations and were more likely to improve over time. Labor market participation was more strongly associated with good health in the United Kingdom than in the United States. Conclusions. National policies and practices may be keeping more US workers than UK workers who are in poor health employed, but British policies may give UK workers the chance to return to better health and to the labor force. [ABSTRACT FROM AUTHOR]

The history of motorcycle helmet legislation in the United States reflects the extent to which concerns about individual liberties have shaped the public health debate. Despite overwhelming epidemiological evidence that motorcycle helmet laws reduce fatalities and serious injuries, only 20 states currently require all riders to wear helmets. During the past 3 decades, federal government efforts to push states toward enactment of universal helmet laws have faltered, and motorcyclists' advocacy groups have been successful at repealing state helmet laws. This history raises questions about the possibilities for articulating an ethics of public health that would call upon government to protect citizens from their own choices that result in needless morbidity and suffering (Am J Public Health. 2007;97:208-217) [ABSTRACT FROM AUTHOR]

Health impact assessment (HIA) methods are used to evaluate the impact on health of policies and projects in community design, transportation planning, and other areas outside traditional public health concerns. At an October 2004 workshop, domestic and international experts explored issues associated with advancing the use of HIA methods by local health departments, planning commissions, and other decisionmakers in the United States. Workshop participants recommended conducting pilot tests of existing HIA tools, developing a database of health impacts of common projects and policies, developing resources for HIA use, building workforce capacity to conduct HIAs, and evaluating HIAs. HIA methods can influence decisionmakers to adjust policies and projects to maximize benefits and minimize harm to the public's health. [ABSTRACT FROM AUTHOR]

Objectives. We assessed the relation between the work promotion, welfare reduction, and marriage goals of welfare reform and the stability of health insurance of parents in transition from welfare to work. Methods. We analyzed a panel survey (1999-2002) of a stratified random sample of Illinois families receiving welfare in 1998 (n = 1363). Results. Medicaid remains the foremost source of health insurance despite a significant decline in the proportion of parents with Medicaid. Regardless of work/welfare status in year 1, transitioning to work only or no work/no welfare increased the likelihood of having unstable health insurance in years 2 and 3 compared with those who remained on welfare only. Conclusions. Parents who meet the welfare reform goals of work promotion and reduction of welfare dependence experience significant loss and instability of health insurance. (Am J Public Health. 2005;95:279-285.). [ABSTRACT FROM AUTHOR]

Family planning has long been acknowledged as an effective public health intervention. In recent years, however, family planning has come under increased scrutiny from conservative politicians and constituents. National US policies instituted since 2001 are resulting in cutbacks in family planning programs worldwide. In the long run, these conservative initiatives may set back several decades of progress in reproductive health and reproductive rights. In promoting an ideologically driven approach to sexual and reproductive health, the recent policy developments threaten to subvert ethical standards of medical care and the principle of evidence-based policy. (Am J Public Health. 2004;94:15-18) [ABSTRACT FROM AUTHOR]

Medicare research has shown that there are substantial disparities by race and socioeconomic status in use of services. In this article, I review past research and discuss how findings apply specifically to vulnerable men aged 65 years or older. Six lessons from this review are identified and illustrated here. Disparities in certain measures of health are growing; to reverse this trend, substantial efforts are needed, including dissemination of information about disparities as well as testing of hypotheses regarding underlying causes. (Am J Public Health. 2003;93: 753-759) [ABSTRACT FROM AUTHOR]

Objectives: This study examined (1) descriptive patterns in perceived environmental and policy determinants of physical activity and (2) associations between these factors and behavior. Methods: A cross-sectional study was conducted from 1999 to 2000 among US adults; individuals at lower income levels were oversampled. Results: Availability of areas for physical activity was generally higher among men than among women. The 4 most commonly reported personal barriers were lack of time, feeling too tired, obtaining enough exercise at one's job, and no motivation to exercise. Neighborhood characteristics, including the presence of sidewalks, enjoyable scenery, heavy traffic, and hills, were positively associated with physical activity. There was a high level of support for health policy-related measures. Up to one third of individuals who had used environmental supports reported an increase in physical activity. Conclusions: An array of environmental and policy determinants, particularly those related to the physical environment, are associated with physical activity and should be taken into account in the design of interventions. [ABSTRACT FROM AUTHOR]

Deals with a study on the relationship between state policies on Temporary Assistance to Needy Families (TANF), declines in both TANF and Medicaid caseloads and the rise in the number of uninsured in the United States. Methodology of the study; Results; Discussion of findings. [ABSTRACT FROM AUTHOR]

Objectives. This evaluation of a state Medicaid dental program describes dental treatment received, relates treatment needed to treatment received, and describes enrollment and use over an 8-year period. Methods. Three databases were linked: (1) clinical records from a 1986/87 statewide epidemiological survey, providing data on treatment need; (2) Medicaid dental claims from 1984 through 1992, providing data on treatment received; and (3) Medicaid enrollment files from 1984 through 1992. Results. Half of Medicaid-enrolled children never used dental services. Among users of dental services, 45% and 25% of children needed restorations in primary and permanent teeth, respectively. In this group, 29% had all needs met, 28% had needs partially met, and 43% had not needs met. Forty-six percent of children sought care for only 1 year. Conclusions. Federal guidelines for dental care are not met in this typical Medicaid population of short-term enrollees who use services sporadically. Programs should aim to increase use and ensure that all needed services, especially preventive procedures such as sealants, can be completed within the short period of time a child attends for care. [ABSTRACT FROM AUTHOR]

The article presents the policy statement of the American Public Health Association concerning medically uninsured citizens' health care initiatives of each state in the country. In response to the fact that there is an increasing number of medically uninsured residents in the country and that most states are exerting effort in addressing their needs, the Association agrees in the need for a high quality, universal national health program which has a comprehensive scope, has state and local administration and is equitably financed. It also reorganizes and encourages state health initiatives for the uninsured population.

The article discusses the reactions of the American Public Health Association against the denial of emergency care to uninsured patients in the U.S. The Association opposes the practice of denying care and transferring emergency department patients, including women in labor, for solely economic reasons. It also opposes the refusal of hospitals with specialized services to accept medically appropriate patient transfers. In addition, it urges that private and public hospitals adopt policies that no emergency patients be transferred for non-medical reasons.