Because it represents a revival of citizen responsibility, the Healthy Communities movement is not only a health and quality-of-life movement but a civic and democratic movement as well. Healthy Communities efforts need to seek meaningful partnerships with local governments and work their collaborative and citizen-based efforts into formal local political structures. As the foundation of the Healthy Communities movement, civic renewal should be elevated as a major theme and goal for its future. (+info)
The female condom: tool for women's empowerment.
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International and US experience with the female condom has shown that the device empowers diverse populations of women, helping them negotiate protection with their partners, promoting healthy behaviors, and increasing self-efficacy and sexual confidence and autonomy. This commentary reflects on some approaches that have been taken to study empowerment and makes several observations on the political and scientific initiatives needed to capitalize on this empowerment potential. Women's interest in the female condom indicates a need for more women's barrier methods to be made available. For some women, cultural proscriptions against touching the genitals may create initial hesitancy in trying these methods. But the disposition of regulatory agencies and the attitudes of health care providers has unfortunately exaggerated this reticence, thereby effectively reducing access to these methods. Also, lack of important detail in clinical studies restricts our capacity to introduce the female condom, or similar methods, under optimal conditions. Future trials should prioritize community-based designs and address a range of other critical health and social issues for women. Women's need for HIV/AIDS prevention technologies remains an urgent priority. Both political and scientific efforts are needed to realize the public health potential embodied in the female condom. (+info)
Research, politics, and needle exchange.
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We now have had 15 years of public discussion of and research on needle exchange programs. The data have shown these programs to be usually, but not always, effective in limiting HIV transmission among injection drug users. Needle exchange programs are conceptualized within a larger framework of providing ready availability of sterile injection equipment for injection drug users. Continuing research is clearly needed regarding how to maximize the availability of sterile injection equipment and how to integrate this with other needed health and social services for drug users. Many initial opponents of needle exchange programs have become supporters of the programs. The number of programs in the United States has been increasing by about 20% per year, and this can be considered substantial progress in reducing HIV infection among injection drug users. Important opposition remains, however, based primarily on the symbolic values expressed in government support for the programs. These value conflicts over needle exchange, which have existed since it was first considered in the United States, cannot be resolved with data. In the late 1980s, the value conflicts greatly hampered the collection of relevant data--there was no federal funding of research on needle exchange programs. Currently, there is considerable research on needle exchange, but many researchers are quite concerned about possible misuse of findings. This may be considered progress to an important but modest degree. Whether current and future research will be used to improve HIV prevention efforts remains to be seen. (+info)
A tale of four cities: Medicare reform and competitive pricing.
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The current payment system for Medicare + Choice (M + C) plans is based on prices calculated from administrative records. This system has been criticized as arbitrary, inefficient, and unfair. Most Medicare reform proposals would replace the current payment system with some form of competitive pricing. However, efforts over the past five years to demonstrate competitive pricing for M + C plans have been blocked repeatedly by Congress, even when the demonstrations were directly responsive to a congressional mandate. In the absence of political support, a demonstration of competitive pricing may be infeasible, and Congress could be forced to take the risky step of implementing broad Medicare reforms with very little information about their effects. (+info)
Who really wants price competition in Medicare managed care?
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There is much policy talk about making Medicare more competitive, like private markets. But when reform proposals near implementation, local opponents of competition are often able to stop reform experiments. This paper reports on one recent example, the Competitive Pricing Advisory Committee, created by the 1997 Balanced Budget Act (BBA) to bring competitive bidding to Medicare + Choice plans. After design and site-selection choices were announced, members representing local interests were able to delay and perhaps kill competitive bidding before it could start, once again. A public report of this story may save future market-based Medicare reforms from a similar fate. (+info)
Prefunding Medicare without individual accounts.
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It has recently been proposed that Medicare be prefunded through the creation of individual medical retirement accounts. There is a strong case for prefunding Medicare in anticipation of the retirement of the numerous baby boomers. But the creation of individual accounts would involve a new departure for Medicare with serious potential shortcomings. This paper shows how Medicare can be prefunded without the creation of individual accounts--through a Medicare trust fund reform. (+info)
Is premium support the right medicine for Medicare?
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This paper assesses the desirability of transforming Medicare into a premium-support system. I focus on three areas crucial to the future of Medicare: cost savings, beneficiary choice, and the stability of traditional Medicare. Based on my analysis of the Bipartisan Commission on the Future of Medicare plan, I find substantial problems with adopting premium support for Medicare. In particular, projections of premium-support savings are based on questionable assumptions that the slowdown in health spending during 1993-1997 can be sustained and extrapolated to future Medicare performance. Consequently, premium support may inadvertently destabilize public Medicare and erode beneficiary choice without achieving substantial savings. (+info)
Political economy of tobacco control in low-income and middle-income countries: lessons from Thailand and Zimbabwe. Global Analysis Project Team.
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Crucial to the success of the proposed Framework Convention on Tobacco Control will be an understanding of the political and economic context for tobacco control policies, particularly in low-income and middle-income countries. Policy studies in Thailand and Zimbabwe employed the analytical perspective of political economy and a research strategy that used political mapping, a technique for characterizing and evaluating the political environment surrounding a policy issue, and stakeholder analysis, which seeks to identify key actors and to determine their capacity to shape policy outcomes. These policy studies clearly revealed how tobacco control in low-income and middle-income countries is also being shaped by developments in the global and regional political economy. Hence efforts to strengthen national control policies need to be set within the context of globalization and the international context. Besides the transnational tobacco companies, international tobacco groups and foreign governments, international agencies and nongovernmental organizations are also playing influential roles. It cannot be assumed, therefore, that the tobacco control strategies being implemented in industrialized countries will be just as effective and appropriate when implemented in developing countries. There is an urgent need to expand the number of such tobacco policy studies, particularly in low-income and middle-income countries. Comprehensive guidelines for tobacco policy analysis and research are required to support this process, as is a broader international strategy to coordinate further tobacco policy research studies at country, regional and global levels. (+info)