Moving from intersection to integration: Public health law research and public health systems and services research
Douglas Scutchfield, F
SubjectPublic health law research
legislation and jurisprudence
public health systems and services research
public health practice
public health administration
Permanent link to this recordhttp://hdl.handle.net/20.500.12613/6002
MetadataShow full item record
AbstractContext: For three decades, experts have been stressing the importance of law to the effective operation of public health systems. Most recently, in a 2011 report, the Institute of Medicine recommended a review of state and local public health laws to ensure appropriate authority for public health agencies; adequate access to legal counsel for public health agencies; evaluations of the health effects and costs associated with legislation, regulations, and policies; and enhancement of research methods to assess the strength of evidence regarding the health effects of public policies. These recommendations, and the continued interest in law as a determinant of health system performance, speak to the need for integrating the emerging fields of Public Health Law Research (PHLR) and Public Health Systems and Services Research (PHSSR). Methods: Expert commentary. Findings: This article sets out a unified framework for the two fields and a shared research agenda built around three broad inquiries: (1) the structural role of law in shaping the organization, powers, prerogatives, duties, and limitations of public health agencies and thereby their functioning and ultimately their impact on public health ("infrastructure"); (2) the mechanisms through which public health system characteristics influence the implementation of interventional public health laws ("implementation") ; and (3) the individual and system characteristics that influence the ability of public health systems and their community partners to develop and secure enactment of legal initiatives to advance public health ("innovation") . Research to date has laid a foundation of evidence, but progress requires better and more accessible data, a new generation of researchers comfortable in both law and health research, and more rigorous methods. Conclusions: The routine integration of law as a salient factor in broader PHSSR studies of public health system functioning and health outcomes will enhance the usefulness of research in supporting practice and the long-term improvement of system performance. © 2012 Milbank Memorial Fund.
Citation to related workWiley
Has partMilbank Quarterly
ADA complianceFor Americans with Disabilities Act (ADA) accommodation, including help with reading this content, please contact firstname.lastname@example.org
Showing items related by title, author, creator and subject.
Examining the relationship between choice, therapeutic alliance and outcomes in mental health servicesStanhope, V; Barrenger, SL; Salzer, MS; Marcus, SC (2013-01-01)Background: Self-determination within mental health services is increasingly recognized as an ethical imperative, but we still know little about the impact of choice on outcomes among people with severe mental illnesses. This study examines whether choice predicts outcomes and whether this relationship is mediated by therapeutic alliance. Method: The study sample of 396 participants completed a survey measuring choice, therapeutic alliance, recovery, quality of life and functioning. Multivariate analyses examined choice as a predictor of outcomes, and Sobel tests assessed alliance as a mediator. Results: Choice variables predicted recovery, quality of life and perceived outcomes. Sobel tests indicated that the relationship between choice and outcome variables was mediated by therapeutic alliance. Implications: The study demonstrates that providing more choice and opportunities for collaboration within services does improve consumer outcomes. The results also show that collaboration is dependent on the quality of the relationship between the provider and consumer. © 2013 by the authors; licensee MDPI, Basel, Switzerland.
Exploiting social influence to magnify population-level behaviour change in maternal and child health: Study protocol for a randomised controlled trial of network targeting algorithms in rural HondurasShakya, HB; Stafford, D; Hughes, DA; Keegan, T; Negron, R; Broome, J; McKnight, M; Nicoll, L; Nelson, J; Iriarte, E; Ordonez, M; Airoldi, E; Fowler, JH; Christakis, NA; Airoldi, Edoardo|0000-0002-3512-0542 (2017-03-01)© 2017 Published by the BMJ Publishing Group Limited. Introduction: Despite global progress on many measures of child health, rates of neonatal mortality remain high in the developing world. Evidence suggests that substantial improvements can be achieved with simple, low-cost interventions within family and community settings, particularly those designed to change knowledge and behaviour at the community level. Using social network analysis to identify structurally influential community members and then targeting them for intervention shows promise for the implementation of sustainable community-wide behaviour change. Methods and analysis: We will use a detailed understanding of social network structure and function to identify novel ways of targeting influential individuals to foster cascades of behavioural change at a population level. Our work will involve experimental and observational analyses. We will map face-to-face social networks of 30 000 people in 176 villages in Western Honduras, and then conduct a randomised controlled trial of a friendship-based network-targeting algorithm with a set of well-established care interventions. We will also test whether the proportion of the population targeted affects the degree to which the intervention spreads throughout the network. We will test scalable methods of network targeting that would not, in the future, require the actual mapping of social networks but would still offer the prospect of rapidly identifying influential targets for public health interventions. Ethics and dissemination: The Yale IRB and the Honduran Ministry of Health approved all data collection procedures (Protocol number 1506016012) and all participants will provide informed consent before enrolment. We will publish our findings in peer-reviewed journals as well as engage non-governmental organisations and other actors through venues for exchanging practical methods for behavioural health interventions, such as global health conferences. We will also develop a 'toolkit' for practitioners to use in network-based intervention efforts, including public release of our network mapping software.
ENTHRONING HEALTH: THE NATIONAL NEGRO HEALTH MOVEMENT AND THE FIGHT TO CONTROL PUBLIC HEALTH POLICY IN THE AFRICAN AMERICAN COMMUNITY, 1915-1950Collier-Thomas, Bettye; Simon, Bryant; Berman, Lila Corwin, 1976-; Downs, James (Temple University. Libraries, 2020)In the early 1900s, African Americans died at higher rates, got sick more often, and had worse health outcomes for almost all diseases when compared to whites. This disparity was due to a combination of racism, discrimination, and segregation. Most blacks could only afford to live in unhealthy conditions and had little or no access to medical professionals. Problematically, poor black health led many whites to think of blacks as being inherently diseased, promoting the segregation and discrimination that contributed to black ill health in the first place. This project examines Negro Health Week (NNHW), which became National Negro Health Week (NNHW), a public health campaign designed by African Americans as a systematic effort to improve their health that lasted between 1915 and 1950. The dissertation reveals the strategies African Americans used to empower themselves to combat ill health and the ways medical ideas became accessible to blacks. The racism of the white medical establishment limited the ability of African Americans to enter the medical profession. The small number of black doctors and nurses meant that NHW had to rely on non-medical professionals to teach health practices. Originally begun as a local campaign in Savannah, Booker T. Washington adopted Negro Health Week as a program to teach formerly enslaved blacks in Tuskegee, Alabama how to live. Working as sharecroppers and living in the small cabins they had inhabited as enslaved people, the majority of blacks lived in squalor. Margaret Murray Washington, who co-founded the National Association of Colored Women in 1896, laid the groundwork for NHW at Tuskegee. During her tenure as Lady Principal of Tuskegee, she created the Tuskegee Woman’s Club and brought together local organizations and women’s clubs to work with women in improving their homes by providing advice on basic hygiene and sanitation that they could implement with little cost. Booker T. Washington coopted the TWC program and brought Monroe Work from Savannah to Tuskegee to head up a more ambitious program which he envisioned expanding throughout the rural South. In 1900 Washington founded the National Negro Business League (NNBL) which included key black business men from throughout the nation, especially the South. The NNBL was instrumental in helping Washington to expand and publicize Negro Health Week. Under the leadership of Booker T. Washington and his successor, Robert Moton, NHW continued to focus on providing advice on basic hygiene and sanitation in one’s home and neighborhood. The emphasis on low-cost individual health practices, such as basic privy sanitation or proper whitewash technique, gave African Americans the ability to take ownership of their health. The Week explained how blacks could improve their health and that of the community even without medical professionals. After Booker T. Washington’s death in 1915, Moton succeeded in getting the support of the national Public Health Service (PHS) and National Negro Health Week came into existence in 1921. The Service’s vast network of health professionals and connections with state and local health departments allowed the campaign to expand out of the South. However, with the involvement of the PHS, the Week began to change. As hygiene practices became more accepted, the Service reframed NNHW to focus on vaccinations and regular physician and dentist visits. As medical professionals became NNHW leaders, the campaign’s message transformed from emphasizing how individuals could improve health on their own to describing how much people needed physicians to obtain good health. Under the PHS, lay people could do little to improve their health. Instead, they had to rely on the medical profession. The PHS used NNHW to reposition the medical establishment as the ultimate arbiter of African American health. Today, there is still a wide racial disparity in participation in, and access to, public health, and indeed in health outcomes in the United States. Understanding the Week can better position scholars and public health officials to understand how race and health intersect and the ramifications of health policies on race relations.