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Policies governing the sale of raw milk-making the sales of raw milk more permissive-are gaining traction on the legislative agendas of dozens of states. This paper examines one contributor to this movement on the policy agenda: the role of competitive framing. By combining theoretical approaches from policy studies and political psychology theories of competitive framing, we offer evidence supporting the recent relative success of raw milk activists in several state legislatures. Using an Internet survey-based experiment with a sample size of 1,630 respondents from seven Midwestern states, we show that a frame emphasizing consumer choice and food freedom is more effective than the frame that dominates among the policy establishment, that emphasizing public health risks. This is true in both one-sided and competitive framing contexts. We further show that those previously aware of this issue were less influenced by the public health frame than those naïve to the issue. Our results suggest that the pro-raw milk movement may be making strides on the state policy agenda because their frames are more resonant among the public. We also highlight the advantages gained from considering psychological and policy processes simultaneously to understand policy change. [ABSTRACT FROM AUTHOR]

In this paper, we offer a critical examination of Let's Move!, the comprehensive anti-obesity program initiated by the First Lady of the United States, Michelle Obama, that aims to solve the problem of childhood obesity within a generation. We argue that Let's Move! is not just a campaign against obesity but is emblematic of the nature of (and assumptions underpinning) the health education of children in the contemporary United States. Drawing on the concept of ‘governmentality,’ we examine how Let's Move! functions as a biopolitical strategy (a solution to the problem of childhood obesity), framed by the political rationalities of neoliberalism. In particular, we identify and explore three interrelated bio-techniques mobilized within, and through, the Let's Move! campaign. First, in an effort to ‘responsibilize’ citizens, the initiative is framed as a social movement whereby all segments of society can (and should) be empowered to take collective action against childhood obesity. Second, an array of multi-sectoral partnerships, including corporate sponsors and non-profit organizations, are being mobilized, resulting in a range of initiatives underpinned by the rhetoric of consumer choice and responsibility as well as the outsourcing of physical education to private entities. Third, the adoption of standardized fitness testing techniques based on the logic of chronic disease epidemiology, and related notions of ‘risk,’ aim to produce the disciplined child-citizen who monitors his/her health goals with the aid of Web 2.0 technologies. In contextualizing Let's Move! in this way, we illustrate how, in line with the soft authoritarian imperatives of the neoliberal enabling state, the campaign functions as a national biopedagogy, working to empower every citizen to be an ‘active partner’ in the fight against childhood obesity, so as to optimize the health of the next generation and allow them, in the words of Michelle Obama, to ‘pursue their dreams.’ [ABSTRACT FROM PUBLISHER]

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 absence of universally available language services is a national healthcare system failure, the burden of which is suffered by patients with limited English proficiency and their healthcare providers. Conceptualizing mandatory provision of language access as an unfair, unfunded mandate ignores massive and fundamental social changes taking place. Overcoming language barriers is essential to safe, quality health care. This paper, informed by the experience of Hablamos Juntos, a national demonstration project funded by the Robert Wood Johnson Foundation, argues that national and health industry investments are needed to develop population-based approaches supported by communication and information technology, and that these investments may prove useful to improving healthcare communication for English-speaking patients as well. [ABSTRACT FROM AUTHOR]

Abstract: This paper analyzes recent union efforts to organize low-wage workers in the home- and community-based segments of homecare, childcare, and services to people with developmental disabilities in the US. In these sectors, consumer demand has combined with privatization to create an army of “flexible”, part-time, poverty-wage workers, most of them women, people of color, and immigrants. This workforce is profoundly fragmented due to the preponderance of small nonprofit employers, widespread self-employment, and spatially atomized labor performed within myriad private homes. However, service sector unions have adapted creatively to these opportunities and constraints by implementing two interlinked scale-jumping strategies to overcome care workers’ spatial and organizational atomization. One is state-by-state policy advocacy to raise labor (and service) standards industry-wide and to aggregate employment through various organizational and legal interventions. The other is coalition building with consumers and advocates at the local, state, and national level to generate essential political support for these measures. We find that the success of this strategy has been shaped in large part by the political landscape of region and the political economy of distinct care industry segments. Finally, the resulting care industry unionism constitutes a distinct strand of an emergent public services unionism—in which consumers and workers struggle to define care labor as a socially necessary public good, and workers pushed into the nebulous zone between state and market struggle to define themselves as public workers. [Copyright &y& Elsevier]

This paper assesses the evolving "facilitated consumerism" model of health care at the community level using data from the Community Tracking Study (CTS). We find that in a relatively short time, large employers and health plans have made notable progress in putting the building blocks in place to support their vision of consumerism. However, developments in the CTS communities suggest that the consumerism strategy evolving in local markets is more nuanced than implied by some descriptions of health care consumerism. [ABSTRACT FROM AUTHOR]

Resource mobilization theory focuses on the necessity of outside support in the mobilization of social movements with powerless beneficiaries. This theory has evolved and taken root since its initial formulation in the 1970s. Using examples from the 1991 efforts to reform private psychiatric hospitals in Texas, the authors argue that frame bridging brings together constituents and beneficiaries. In the Texas case, the media promoted a particular frame of the typical private psychiatric patient, the beneficiary, and that frame helped to unite isolated constituents and other beneficiaries interested in mental health care reform. The similarity in the image portrayed by the media of potential constituents and patients facilitated resource mobilization and resulted in an increase in the membership in related social movement organizations. It is argued that, in general, conscience constituents are more likely to become involved when beneficiaries are framed in a way that emphasizes commonalities with conscience constituents. Before addressing the framing process, the paper describes how health issues have evolved into a social movement industry. This discussion is followed by an application of the basic components of resource mobilization theory to the Texas case. Finally, it presents the discussion of how mobilization is dependent on frame bridging and how the bridging can be generalized to other cases.

One of the most troubling urban health issues is childhood poisoning caused by lead, the widespread environmental toxin. It is in old plumbing fixtures, solder, paint and other building materials in huge quantities. Despite decades of improvements in blood lead levels among America’s children, the continuing presence of lead on the walls of the nation’s older houses and the known neurological effects of low-level exposures presents a classic problem: in light of the enormous costs of detoxifying the nation’s housing, should society remove this toxin in order to prevent future impacts on IQ, attention deficits disorders, and possibly criminal behavior, or do we remove some of the most pernicious sources, such as window sashes and chipped paint to reduce, not eliminate, the risk to children? Throughout the 1970s and 1980s this issue emerged among public health advocates, HUD officials and housing reformers, and community organizers and activists. Who should bear the responsibility for polluted housing: Industry, housing officials, public health officials, landlords or tenants? The battles began during the 1960s and continue to today. In 2001 the high court in Maryland condemned studies conducted by Johns Hopkins researchers that sought to develop methods for the partial remediation of homes, saying they were akin to Nazi human experiments in which children were used as human guinea pigs. This article traces the evolving debate over responsibility for the public health consequences of polluted housing. [ABSTRACT FROM AUTHOR]

This essay examines the evolution and politics of the Chicano movement in South Texas. Framed around the mysterious death of Dr. Fred E. Logan Jr., the author argues that concerns around public health were at the heart of a long struggle to end poverty and overturn years of Anglo political rule in the small town of Mathis. [ABSTRACT FROM AUTHOR]

Background: Language barriers in medical care are a large and growing problem in the United States. Most research has focused on how language barriers affect patients. Less is known of the physician perspective and the efforts they are making to overcome these barriers.Objective: To learn about current approaches to communicating with limited English-proficient (LEP) patients and the associated financial and nonfinancial constraints that private practice physicians and managers perceive in providing these services.Design: Computer-assisted telephone focus groups with open-ended discussion guide.Setting: Small private practices in geographic areas that have experienced recent dramatic increases in LEP populations.Participants: Primary care physicians, specialists, and practice managers.Approach: Focus group transcripts were systematically coded using grounded theory analysis. The research team then identified common themes that arose across the groups.Results: Citing the cost, inaccessibility, and inconvenience of using professional interpreters, physicians commonly used family and friends as interpreters. Few recalled any actual experience with professional interpreters or were well-informed about the cost of their services. Physicians and office managers voiced uniform concern about how language barriers impede quality and safety of patient care and increased malpractice risk.Conclusions: Health care providers in private practice recognize the importance of overcoming language barriers. However, perceived barriers to implementing cost-effective strategies to these barriers are high. Physicians in private practice would benefit from information about how to best overcome language barriers in their practices efficiently and affordably. [ABSTRACT FROM AUTHOR]

Three methodologic issues (definitions of smoking. period of follow-up, composition of study group) were assessed in 426 persons five years after participation in a stop smoking program of a prepaid medical plan. When smoking was defined by measurement interval or by type or amount of tobacco smoked, smoking rates varied only slightly. Little information was gained by extending the follow-up period beyond the first year. However, study group composition (as defined by attendance at program sessions) had a pronounced effect on smoking rates, Those who attended fewer sessions were more likely to smoke during the follow-up period. (Am J Public Health 1985; 75:634-638.) [ABSTRACT FROM AUTHOR]

This article presents the health conditions of working America, and provides an analysis of the causes of that situation. It is postulated that the main health problems in the U.S. are due not to prevalent life styles--as the behavioralists indicate--but to the dramatic maldistribution of economic and political power in our society, with the absence of control by the majority of the U.S. population--the working and lower-middle classes--over the work process with which they are involved, the economic wealth that they produce, and the political institutions that they pay for. The production of goods and wealth as well as the political institutions of the United States are dominated and controlled by a minority of our population--the corporate and upper-middle classes. Empirical information is presented to support this postulate. In light of this explanation, it is asserted that a major public health task is to deliberately and actively contribute to the political mobilization of forces aimed at bringing about profound changes in the pattern of control of our working insitutions and of the distribution of wealth and political power, changes which seek to shift that control from the few to the many. [ABSTRACT FROM AUTHOR]

The article discusses the impact of the Consumer Council, which serves as an advisory group to management, organized by the Columbia Medical Plan in the U.S. The experiences of the Council provide valuable illustrations of the problems and circumstances inherent in practical consumerism in a developing prepaid group plan. According to the authors, consumer representatives can contribute responsibly to prepaid group health plans in two roles, as members of policy-setting boards, and as advisors to administrators and practitioners on operational matters. Furthermore, it has been inferred that the Consumer Council will be a significant element in determining the success or failure of the Columbia Medical Plan.

A reprint of the article "Lay Movements for the Improvement of the Public Health" which appeared in the July 3, 1909 issue is presented. It deals with lay movements in the U.S. aimed at improving public health. The Committee of One Hundred on National Health is considered an influential organization, which is made more extensive through its publication "American Health." Two resolutions have been passed by the House of Delegates during the Atlantic City Session of the American Medical Association in New Jersey on June 10, focusing on medical societies.