Operating in a Constricted Space: Policy Actor Perceptions of Targeting to Address U.S. Health Disparities

Policy actors design and implement targeted interventions to eliminate disparities that exist between groups. Although necessary for achieving health equity, the use of targeting as a policy tool carries the potential for political backlash and social debate, which may influence whether and how policy actors use it. In this research, the authors examine policy actor perceptions regarding the use of targeting in the implementation of health policy. The authors conduct elite interviews with policy actors to better understand their work to design and implement interventions to address health disparities. Findings identify key tensions and trade-offs faced by policy actors related to targeting and reveal sociopolitical influences that shape whether and how targeted programs are considered, who receives them, and by what means they are delivered. The authors discuss the implications of the findings for the use of targeting and related marketing practices by policy actors to address health disparities and other significant public health concerns.

Download Full-text

End of life breast cancer care in women with severe mental illnesses

Scientific Reports ◽

10.1038/s41598-021-89726-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Guillaume Fond ◽

Vanessa Pauly ◽

Audrey Duba ◽

Sebastien Salas ◽

Marie Viprey ◽

...

Keyword(s):

Breast Cancer ◽

Palliative Care ◽

Health Disparities ◽

Major Depression ◽

End Of Life ◽

High Intensity ◽

Bipolar Disorders ◽

Mental Illnesses ◽

Targeted Interventions ◽

Eol Care

AbstractLittle is known on the end-of-life (EOL) care of terminal breast cancer in women with severe psychiatric disorder (SPD). The objective was to determine if women with SPD and terminal breast cancer received the same palliative and high-intensity care during their end-of-life than women without SPD. Study design, setting, participants. This population-based cohort study included all women aged 15 and older who died from breast cancer in hospitals in France (2014–2018). Key measurements/outcomes. Indicators of palliative care and high-intensity EOL care. Multivariable models were performed, adjusted for age at death, year of death, social deprivation, duration between cancer diagnosis and death, metastases, comorbidity, smoking addiction and hospital category. The analysis included 1742 women with SPD (287 with bipolar disorder, 1075 with major depression and 380 with schizophrenia) and 36,870 women without SPD. In multivariate analyses, women with SPD had more palliative care (adjusted odd ratio aOR 1.320, 95%CI [1.153–1.511], p < 0.001), longer palliative care follow-up before death (adjusted beta = 1.456, 95%CI (1.357–1.555), p < 0.001), less chemotherapy, surgery, imaging/endoscopy, and admission in emergency department and intensive care unit. Among women with SPD, women with bipolar disorders and schizophrenia died 5 years younger than those with recurrent major depression. The survival time was also shortened in women with schizophrenia. Despite more palliative care and less high-intensity care in women with SPD, our findings also suggest the existence of health disparities in women with bipolar disorders and schizophrenia compared to women with recurrent major depression and without SPD. Targeted interventions may be needed for women with bipolar disorders and schizophrenia to prevent these health disparities.

Download Full-text

Understanding rationales for collaboration in high-intensity policy conflicts

Journal of Public Policy ◽

10.1017/s0143814x16000301 ◽

2017 ◽

Vol 38 (1) ◽

pp. 1-25 ◽

Cited By ~ 15

Author(s):

Christopher M. Weible ◽

Tanya Heikkila ◽

Jonathan Pierce

Keyword(s):

New York ◽

High Intensity ◽

Professional Competence ◽

Questionnaire Data ◽

Policy Actor ◽

Policy Positions ◽

Policy Actors ◽

Shared Beliefs ◽

Policy Debates ◽

Policy Conflicts

AbstractWhy people collaborate to achieve their political objectives is one enduring question in public policy. Although studies have explored this question in low-intensity policy conflicts, a few have examined collaboration in high-intensity policy conflicts. This study asks two questions: What are the rationales motivating policy actors to collaborate with each other in high-intensity policy conflicts? What policy actor attributes are associated with these rationales? This study uses questionnaire data collected in 2013 and 2014 of policy actors from New York, Colorado and Texas who are actively involved with hydraulic fracturing policy debates. The results show that professional competence is the most important rationale for collaborating, whereas shared beliefs are moderately important, and financial resources are not important. Policy actor attributes that are associated with different rationales include organisational affiliation and extreme policy positions. This article concludes with a discussion on advancing theoretical explanations of collaboration in high-intensity policy conflicts.

Download Full-text

Managing External Volatility

IMF Working Papers ◽

10.5089/9781513564562.001 ◽

2020 ◽

Vol 20 (288) ◽

Author(s):

Helene Poirson Ward ◽

Nathan Porter ◽

Ghada Fayad ◽

Itai Agur ◽

Ran Bi ◽

...

Keyword(s):

Global Financial Crisis ◽

Policy Instruments ◽

Unintended Consequences ◽

External Shocks ◽

Policy Tool ◽

Financial Conditions ◽

Trade Offs ◽

External Pressures ◽

Highly Sensitive ◽

The Global Financial Crisis

Since the global financial crisis, non-reserve-issuing economies (NREs) have been highly sensitive to episodes of external pressures. With monetary policy independence constrained by this sensitivity, many NREs have utilized other policy instruments. This paper confirms the vulnerability of NREs to external shocks and finds that in some circumstances managing such shocks with multiple instruments can both lessen the policy response required from any one policy tool to financial and external shocks and increase the effectiveness of policies in stabilizing macro-financial conditions. Effectiveness however does not always imply appropriateness, which rests on an evaluation of potential trade-offs and unintended consequences.

Download Full-text

A tool to identify potential primary care presentations in the hospital emergency department

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.598 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

H Schütze ◽

R Rees ◽

S Asha ◽

K Eagar

Keyword(s):

Primary Care ◽

Emergency Department ◽

Public Health Issue ◽

Accurate Data ◽

Hospital Emergency ◽

Targeted Interventions ◽

International Trends ◽

Significant Public Health ◽

Access To Primary Care ◽

The Impact

Abstract Background Access to primary care has an impact on health outcomes and is a significant public health issue. Limited access to primary care has seen non-urgent presentations to hospital emergency departments continue to rise globally. A lack of a universal workable definition of what a primary care presentation is has impeded national and international estimations of the true burden. Our aim was to develop a standardised code frame to identify potential primary care patients in the emergency department to allow accurate data estimations to be made, and help inform future interventions. Methods An audit of medical records was conducted in two major hospitals in Sydney, Australia. A code frame was developed, tested and applied retrospectively to five years of data. Results Of 601,168 presentations to the emergency department, 171,906 (29%) were deemed to be potential primary care presentations. The code frame had a sensitivity of 99.9% and a specificity of 49.0%. Conclusions This standardised code frame enables accurate retrospective local and national data estimations of the impact of primary care presentations in the emergency department, which was previously not available. The code frame could be used prospectively to evaluate interventions such as diverting patients to primary care settings, and to identify populations for specifically targeted interventions. The conservative nature of the code frame ensures that only those that can safely receive care in a primary care setting are identified as potential primary care. Key messages This robust tool will enable more accurate data estimations of primary care appropriate presentations in the emergency department, which can assist planning and policy efforts. It can be easily adapted to incorporate triage codes in international settings and provides a useful tool for comparing international trends.

Download Full-text

TRIPS to Where? A Narrative Review of the Empirical Literature on Intellectual Property Licensing Models to Promote Global Diffusion of Essential Medicines

Pharmaceutics ◽

10.3390/pharmaceutics14010048 ◽

2021 ◽

Vol 14 (1) ◽

pp. 48

Author(s):

Shiri Mermelstein ◽

Hilde Stevens

Keyword(s):

Intellectual Property ◽

Access To Medicines ◽

Essential Medicines ◽

Empirical Literature ◽

Future Research ◽

Middle Income ◽

Compulsory Licensing ◽

Parallel Import ◽

Policy Tool ◽

Trade Offs

Governed through the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) since 1995, the current medical R&D system requires significant trade-offs between innovation and high monopoly prices for patented drugs that restrict patient access to medicines. Since its implementation, few amendments have been made to the original TRIPS agreement to allow low- and middle-income countries (LMICs) to facilitate access by generic manufacturers through flexible provisions, such as compulsory licensing and parallel import. Although a useful policy tool in theory, the routine use of TRIPS flexibilities in LMICs in the procurement of new essential medicines (EMs) is regarded as a ‘last resort’ due to strong political response in high-income countries (HICs) and new trade agreements’ restrictions. In this context, access-oriented biomedical Public-Private Partnerships (PPPs) have emerged. More recently, leading multilateral health organizations have recommended different types of intellectual property (IP) interventions, voluntary biomedical patent pools, as strategies to reduce prices and increase the diffusion of novel EMs in LMICs. Nevertheless, the recent Ebola and COVID-19 outbreaks highlight growing concerns regarding the use of TRIPS flexibilities and the limited success of voluntary mechanisms in promoting access to medicines in the Global South amidst health crises. This review aims at describing the state-of-the-art empirical research on IP-related options and voluntary mechanisms applied by emerging PPPs to guarantee timely and affordable access to EM in LMICs and reflect on both models as access paradigms. Some suggestions are put forward for future research paths on the basis of these analyses and in response to contemporary debates on waiving key IP rights on COVID-19 therapies, diagnostics, and vaccines.

Download Full-text

A Decade of Nutrition and Health Disparities Research at NIH, 2010–2019

Current Developments in Nutrition ◽

10.1093/cdn/nzab056_001 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 1263-1263

Author(s):

Alison Brown ◽

Scarlet Shi ◽

Samantha Adas ◽

Josephine Boyington ◽

Cotton Paul ◽

...

Keyword(s):

Health Disparities ◽

Minority Health ◽

Kidney Diseases ◽

Nutrition And Health ◽

Targeted Interventions ◽

Blood Institute ◽

The Past ◽

Funding Sources ◽

Research Areas ◽

Nutrition Research

Abstract Objectives Nutrition health disparities include the differences in incidence, prevalence, morbidity, and mortality of diet-related diseases and conditions that disproportionally affect disadvantaged groups (e.g., race, ethnicity, socioeconomic status, disability, rural, immigration status). These disparities arise from the complex interaction of individual, interpersonal, community, and societal factors within the biological, behavioral, and environmental domains. The purpose of this study is to describe the scope of nutrition health disparities research supported by the National Institutes of Health (NIH) over the past decade to identify research gaps and opportunities relevant to NIH's mission. Methods Data were extracted from an internal reporting system from 2010 to 2019 using the Research, Condition, and Disease Categorization (RCDC) spending categories for “Nutrition” and “Health Disparities.” Results Over the past decade, the number of NIH supported nutrition and health disparities research studies have generally increased, with 860 grants funded in 2010 and 937 grants in 2019, while total nutrition and health disparities funding remained relatively stable. The top 5 Institutes/Centers that funded nutrition and health disparities research included the National Institute of Diabetes and Digestive and Kidney Diseases, National Heart Lung and Blood Institute, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Cancer Institute, and National Institute on Minority Health and Health Disparities. Conclusions Consistent with the mission of the top funding ICs, the top research areas were obesity, diabetes, digestive diseases, cancer, heart disease, clinical research, prevention, and behavioral and social sciences. Cross-cutting topics relevant to all NIH ICs included special populations areas such as pediatric and minority health followed by aging and women's health. Consistent with the Strategic Plan for NIH Nutrition Research, it is critical to advance health equity through the application of precision nutrition approaches that acknowledge the influence of biologic, behavioral, psychosocial, environmental, and social factors on nutrition health disparities, and to develop effective targeted interventions to address these disparities. Funding Sources None.

Download Full-text

Trade-offs of Solar Geoengineering and Mitigation under Climate Targets

10.5194/esd-2020-95 ◽

2020 ◽

Author(s):

Mohammad M. Khabbazan ◽

Marius Stankoweit ◽

Elnaz Roshan ◽

Hauke Schmidt ◽

Hermann Held

Keyword(s):

Policy Option ◽

Solar Radiation Management ◽

Value System ◽

Policy Tool ◽

Climate Targets ◽

Trade Offs ◽

Solar Geoengineering ◽

Pros And Cons ◽

Radiation Management ◽

Do So

Abstract. So far scientific analyses have mainly focused on the pros and cons of solar geoengineering or solar radiation management (SRM) as a climate policy option in mere isolation. Here we put SRM into the context of mitigation by a strictly temperature-target based approach. As a main innovation, we present a scheme by which the applicability regime of temperature targets is extended from mitigation-only to SRM-mitigation analyses. Hereby we explicitly account for a risk-risk comparison of SRM and global warming, while minimizing economic costs for complying with the 2 °C temperature target. To do so, we suggest precipitation guardrails that are compatible with the 2 °C target. Our analysis shows that the value system enshrined in the 2 °C target would be almost prohibitive for SRM, while still about half to nearly two-third of mitigation costs could be saved, depending on the choice of extra room for precipitation. In addition, assuming a climate sensitivity of 3 °C or more, in case of a delayed enough policy, a modest admixture of SRM to the policy portfolio might provide debatable trade-offs compared to a mitigation-only future. In addition, in our analysis for climate sensitivities higher than 4 °C, SRM will be an unavoidable policy tool to comply with the temperature targets.

Download Full-text

The value of agenda-setting in media relations: Examining how the Business Community Anti-Poverty Initiative used agenda-setting to leverage its role as a policy actor in New Brunswick’s 2014 provincial election

The McMaster Journal of Communication ◽

10.15173/mjc.v12i2.2465 ◽

2020 ◽

Vol 12 (2) ◽

pp. 8-28

Author(s):

Claire Ryan

Keyword(s):

New Brunswick ◽

Public Interest ◽

Agenda Setting ◽

Media Coverage ◽

Poverty Reduction ◽

Business Community ◽

Media Relations ◽

Policy Actor ◽

Policy Actors

This case study explores how and to what extent the Business Community Anti‑Poverty Initiative (BCAPI), in Saint John, New Brunswick, used agenda-setting in media relations leading up to the 2014 provincial election. Research, including interviews with three people involved with BCAPI, a literature review, an analysis of media coverage, and a review of BCAPI’s strategy, indicated that BCAPI proactively engaged the provincial daily print newspaper, the Telegraph-Journal, to help influence party platforms and public interest on poverty reduction and ultimately received $300,000 in provincial funding for its initiatives. Keywords: media relations, agenda-setting, policy actors, framing, elections

Download Full-text

Inferential challenges when assessing racial/ethnic health disparities in environmental research

Environmental Health ◽

10.1186/s12940-020-00689-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Tarik Benmarhnia ◽

Anjum Hajat ◽

Jay S. Kaufman

Keyword(s):

Health Disparities ◽

Environmental Health ◽

Descriptive Analysis ◽

Environmental Epidemiology ◽

Epidemiologic Studies ◽

Environmental Research ◽

Targeted Interventions ◽

Environmental Health Research ◽

Causal Framework ◽

Racial Ethnic

AbstractNumerous epidemiologic studies have documented environmental health disparities according to race/ethnicity (R/E) to inform targeted interventions aimed at reducing these disparities. Yet, the use of R/E under the potential outcomes framework implies numerous underlying assumptions for epidemiologic studies that are often not carefully considered in environmental health research. In this commentary, we describe the current state of thinking about the interpretation of R/E variables in etiologic studies. We then discuss how such variables are commonly used in environmental epidemiology. We observed three main uses for R/E: i) as a confounder, ii) as an effect measure modifier and iii) as the main exposure of interest either through descriptive analysis or under a causal framework. We identified some common methodological concerns in each case and provided some practical solutions. The use of R/E in observational studies requires particular cautions in terms of formal interpretation and this commentary aims at providing a practical resource for future studies assessing racial/ethnic health disparities in environmental research.

Download Full-text

Political support

Public Policy Resources ◽

10.1332/policypress/9781447345053.003.0016 ◽

2018 ◽

pp. 237-248

Author(s):

Peter Knoepfel

Keyword(s):

Public Policies ◽

Political Support ◽

Third Party ◽

Common Interest ◽

Policy Actor ◽

The Public ◽

Policy Actors ◽

The Core ◽

Specific Policy

No actor from a specific policy community is capable of controlling the relatively volatile but nonetheless necessary resource Political Support enjoyed by substantive policies. Hence, this chapter is structured differently from the other nine chapters dealing with the public action resources. Political Support consists of the primary legitimation (as opposed to the secondary legitimation delivered by the resource Consensus) by parliamentary bodies whose agendas cover hundreds of public policies which may be opposed. Thus, all three policy actor groups have a common interest in fighting this risk by means of common ‘external’ policy. This chapter illustrates the role of the resource Political Support and the modalities of its maintenance and use with examples from agricultural policy, energy policy and anti-money-laundering policy. It stresses the crucial role of third party winners and losers (actors positioned between the core policy actors and their environment), political parties and changes in the composition of the basic triangular structure of public policies. It demonstrates strategies deployed by each one of the three policy actor groups for recovering Political support.

Download Full-text