Public health policy : issues, theories, and advocacy

513 Pages·2013·5.04 MB·English

by  Bhattacharya

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PUBLIC
HEALTH
POLICY
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PUBLIC
HEALTH
POLICY
Issues, Theories, and Advocacy
Dru Bhattacharya
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Bhattacharya,Dru,author.
Publichealthpolicy:issues,theories,andadvocacy/DhrubajyotiBhattacharya.—Firstedition.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN978-1-118-16435-8(pbk.),ISBN978-1-118-22619-3(pdf),ISBN978-1-118-23952-0(epub)
I.Title.
[DNLM:1.PublicHealthPractice—UnitedStates.2.HealthPolicy—UnitedStates.
3.PreventiveHealthServices—UnitedStates.WA100]
RA395.A3
362.10973—dc23
2013014313
PrintedintheUnitedStatesofAmerica
FIRSTEDITION
PBPrinting10987654321
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Contents
Introduction vii
The Author xv
PART1 BUILDINGAFRAMEWORKFORCONDUCTINGA
MULTIDISCIPLINARYANALYSIS
Chapter 1 The Role of Law: Agencies, Legislatures, Courts, and
the Constitution 3
Chapter 2 The Role of Epidemiology and Medicine: Diagnosis,
Prevention, Control, and Evaluation 45
Chapter 3 The Role of Economics: Theories, Modeling, and
Evaluation 77
Chapter 4 The Role of Politics: Players, Processes, and Power 99
Chapter 5 The Role of Ethics: Historical, Contemporary, and
Future Perspectives 141
PART2 CASESTUDIES
Chapter 6 HIV Criminalization 181
Chapter 7 Clean Water Legislation and Mosquito Control 201
Chapter 8 HPV Vaccination 213
Chapter 9 SCHIP and Children with Special Health Care Needs 245
Chapter 10 Overweight and Obesity 265
Chapter 11 Breast Cancer Screening 285
Chapter 12 Medical Transportation: Local Research Focus 295
Chapter 13 Medical Transportation: Local Practice Focus 307
Chapter 14 Taxes, Politics, and Public Health Policy: A Look Back
at the 2008 Presidential Campaign 327
Chapter 15 Supplemental Nutrition Assistance Program and
Modifying Behavior 353
Chapter 16 Medical Readmissions and the Affordable Care Act 365
v
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vi CONTENTS
Chapter 17 Tobacco Control and Cessation Programs 389
Chapter 18 Emergency Preparedness and Infectious Diseases 403
PART3 ADVOCACY
Chapter 19 The Research Policy Brief: A Primer 429
Chapter 20 Letters to the Editor: A Primer 467
Index 475
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Introduction
A company of porcupines crowded themselves very close together one
cold winter’s day so as to profit by one another’s warmth and so save
themselves from being frozen to death. But soon they felt one another’s
quills, which induced them to separate again. And now, when the need
for warmth brought them nearer together again, the second evil arose
once more. So that they were driven backwards and forwards from one
trouble to the other, until they had discovered a mean distance at which
theycouldmosttolerablyexist.1
We are drawn to the field of public health from a myriad of personal and
professional backgrounds, united in a common pursuit to help people live
healthier lives. This diversity creates both opportunities and impediments
to the development and implementation of interventions and what we may
consider sound policy. Public health is inherently multidisciplinary, draw-
ing from such health- and non-health-related disciplines as epidemiology,
medicine, law, economics, politics, and ethics, to name a few.
Eachofthesefieldsunderstandablyleansonitsownassumptions,method-
ologies, and results to understand the nature and scope of problems.
Epidemiologists concern themselves with the determinants and distribution
of disease so as to target high-risk populations for interventions. Lawyers
explainthelegalparametersunderwhichinterventionscanbeimplemented,
orprecluded,inagivenpopulation.Healtheconomistscontemplatearange
of instruments to determine how best to maximize health benefits. Politi-
cians set an agenda for bills that is based on their own existing priorities.
Ethicists provide invaluable guidance on the underlying value and moral
judgments that are made, wittingly or unwittingly, with every measure that
we propose (or oppose).
The fundamental premise of this book is that health is a social construct.
While this concept is central to the work of social epidemiologists, and
has become increasingly acknowledged (perhaps even accepted) by many
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viii INTRODUCTION
public health scholars and practitioners, its translation into conceptual
frameworks in order to explore policymaking, implementation, evaluation,
andadvocacyremainsinadequate,atbest.Thisbookhopestofillthisvoid.
It is an introductory work, so students and practitioners who are eager to
pursue further study are provided with additional sources of information
in the chapter references. Encouraging that desire for continued learning is,
in fact, one objective of this work, consistent with its quiet subtext that
our work is a lifelong endeavor, reified by our willingness to engage others
who may not share our personal or professional perspectives. Securing
the public’s health requires us to cooperate and collaborate in a fashion
that at times may seem superfluous and at other times may give us pause,
challenging us to confront our own assumptions and our expectations of
others or perhaps of ourselves.
Ultimately, the journey is ours, woven through our education, research,
practice, and advocacy, to improve the health and lives of our fellow
citizens. It is a noble pursuit but one that is too easily forgotten, or lost,
in the numbers we deal with. For most (if not all) of us, current trends
are reason enough to inspire our calling to the health professions. Still, the
inadequacy of public health funding and almost exclusive focus on health
insurance in public discourse on health-related issues is a stern reminder
that our public health story will not be an easy sell. I find the claim that
public health is doing well when nobody notices it to be equally unhelpful
by trivializing the explicit recognition of conditions that assure the health
and well-being of the population. Far worse than an incoherent message is
no message, so it should be no surprise when friends, family, or strangers
giveusblanklookswhenwementionpublichealth.Wehaveastorytotell,
but part of our challenge is recognizing multiple plots and subplots, with a
cast of characters as diverse as the practitioners who serve them.
ConstructingOurNarrative
On June 24, 2008, I had the privilege of attending the first congressional
committee hearing on health disparities in over a decade. The number of
attendeeswaslimitedandthelineofhopefulswrappedaroundthehallway,
but I was fortunate enough to slip in, though I had to stand with my back