Toward full mental health parity and beyond.
The 1996 Mental Health Parity Act (MHPA), which became effective in January 1998, is scheduled to expire in September 2001. This paper examines what the MHPA accomplished and steps toward more comprehensive parity. We explain the strategic and self-reinforcing link of parity with managed behavioral health care and conclude that the current path will be difficult to reverse. The paper ends with a discussion of what might be behind the claims that full parity in mental health benefits is insufficient to achieve true equity and whether additional steps beyond full parity appear realistic or even desirable. (+info)
AIDS and ethics: an analytic framework.
The acquired immunodeficiency syndrome (AIDS) pandemic has raised difficult ethical issues in public policy formulation and in the care of patients infected with the human immunodeficiency virus (HIV). Many issues relate to measures proposed for the protection of the public from HIV infection. This article presents an analytic framework from which these measures can be rationally evaluated. Specific measures are assessed on the basis of their likelihood of success, in relation to their justification for infringement on individual rights, and with reference to other less intrusive measures that could accomplish the same objective. Case histories are discussed which raise ethical dilemmas in the care of HIV infected and high-risk patients. The application of this framework could assist physicians in analysing public health policy and making judgements in individual clinical situations. (+info)
Health promotion and the First Amendment: government control of the informational environment.
Government efforts to protect public health often include controlling health information. The government may proscribe messages conveyed by commercial entities (e.g., false or misleading), recommend messages from commercial entities (e.g., warnings and safety instructions), and convey health messages (e.g., health communication campaigns). Through well-developed, albeit evolving, case law, government control of private speech has been constrained to avoid impinging on such values as free expression, truthfulness, and autonomous decision making. No simple legal framework has been developed for the government's own health messages to mediate between the legitimate goals of health protection and these other values. Nevertheless, government recommendations on matters of health raise difficult social and ethical questions and involve important societal trade-offs. Accordingly, this article proposes legal and ethical principles relating to government control of the health information environment. (+info)
Indicators of deprivation, voting patterns, and health status at area level in the Republic of Ireland.
STUDY OBJECTIVE: To determine what relation, if any, exists between mortality patterns, indicators of deprivation, general lifestyle and social attitudes, as exemplified by general election voting pattern, in the Republic of Ireland. A relation has been demonstrated previously between voting and mortality patterns in the United Kingdom. DESIGN: Cross sectional ecological study using three data sources. Standardised mortality ratios (SMR) were based on mortality rates at county level and 1996 census data from the Central Statistics Office, 1997 general election first preference voting data in all 41 constituencies were aggregated to county level. Selected reported measures of health status, lifestyle and social circumstances are from the first ever National survey on lifestyles, attitudes and nutrition (SLAN). This study comprised adults over 18 years sampled by post using the electoral register from 273 representative district electoral divisions. Univariate inter-relations were examined at individual level for the dataset as a whole, adjusting for age and at aggregated level for 26 county borough areas, which included the two largest cities and for 22 county areas, which afforded correlation with voting pattern, using the method of Pearson's correlation coefficient. PARTICIPANTS: 1,806,932 votes were cast nationally at the 1997 general election, representing a voter turnout of 65.92 %. There was an overall response rate of 62% to SLAN comprising 6539 adults (47% male). The demographic pattern of survey respondents was consistent with that of the general population over 18 years. MAIN RESULTS: At individual level there was a large number of highly significant inter-relations between indicators of deprivation, various measures of self rated health status and lifestyle factors. Aggregated at 26 county level percentage unemployed (r=0.408, p=0.038), and level of education (r=0.475, p=0.014) related significantly to SMR and inversely to both fruit and vegetable consumption (r= -0.672, p=0.001) and excess alcohol consumption among men (r= -595, p=0.003). Those rating their health as fair or poor were more likely to report a poor quality of life (r=0.487, p=0.022), to have none or primary school education only (r=0.428, p=0.047), or to have a means tested medical services card (r=0.428, p=0.047). There was no significant relation between SMR and voting pattern for the two main political parties (67.28% first preferences) but a significant relation with left wing voting (r=0.446, p=0.037). Fianna Fail voting pattern was inversely related to level of dissatisfaction with health (r= -0.59, p<0.05). There was a positive significant relation between left wing voting and dissatisfaction with health (r=0.51, p<0.02) and rate of smoking (r=0.47, p=0.03). Smoking pattern also related positively to rates of voter abstention (r=0.526, p=0.12). CONCLUSIONS: These data are consistent with those in other countries in showing a relation between deprivation indicators and lifestyle, but differ in that no relation with SMR and the votes cast for the main parties was seen in a country with a mainly centre right voting pattern. The relation between left wing voting pattern and some indicators of deprivation and lifestyle suggest that party political voting patterns and affiliations could be a useful indicator of vertical social capital. However, its variability as a measure across countries suggests that the inter-relation between sociocultural and economic factors and the consequent influence on health status is not straightforward. (+info)
Corporate speech and the Constitution: the deregulation of tobacco advertising.
In a series of recent cases, the Supreme Court has given businesses powerful new First Amendment rights to advertise hazardous products. Most recently, in Lorillard Tobacco Co v Reilly (121 SCt 2404 ), the court invalidated Massachusetts regulations intended to reduce underage smoking. The future prospects for commercial speech regulation appear dim, but the reasoning in commercial speech cases is supported by only a plurality of the court. A different First Amendment theory should recognize the importance of population health and the low value of corporate speech. In particular, a future court should consider the low informational value of tobacco advertising, the availability of alternative channels of communication, the unlawful practice of targeting minors, and the magnitude of the social harms. (+info)
Tobacco, commercial speech, and libertarian values: the end of the line for restrictions on advertising?
In June of 2001, the Supreme Court overturned a set of antitobacco measures adopted by the state of Massachusetts designed to protect young people from advertising. Once again, the court expressed its hostility toward measures designed to restrict commercial speech in the name of the social good. In so doing, the court underscored the enduring tension between the libertarian and social welfare dimensions of contemporary democracy and placed into relief the divisions within the American liberal tradition. (+info)
Expressive freedom and tobacco advertising: a Canadian perspective.
In 1989, Canada enacted the Tobacco Products Control Act (TPCA), which prohibited tobacco advertising, required health warnings on tobacco packaging, and restricted promotional activities. Canada's tobacco companies challenged the TPCA's constitutionality, arguing that it infringed on freedom of expression. Although it seemed likely that the Canadian Supreme Court would uphold the legislation, in 1995 the court declared the impugned provisions to be unconstitutional. The decision is testimony to the constraining force of liberalism on tobacco regulation, but it is also evidence of the power of political will. While the Canadian government could have used the decision to justify withdrawing from further confrontations with powerful commercial interests, it chose instead to enact new tobacco control legislation in 1997. (+info)