Policy Studies Commons

The Affordable Care Act: Dispersing the Fog of Misinformation

Max J. Skidmore — Wed, 21 Mar 2012 10:22:09 PDT

Editor Max J. Skidmore provides a concise history and political analysis of the attacks on American efforts to achieve near universal health care, and also reviews an innovative history of the 2010 Patient Protection and Affordable Care Act.

The Millennium Development Program: Poised to Miss 2015 Dead Line

Siraj U. Ahmed — Wed, 21 Mar 2012 10:22:08 PDT

The attached article provides a comprehensive analysis of the UN Millennium Development Program that was implemented to reduce poverty around the globe. It first describes what the program itself is and then explores each of program goals by each region in the globe. It also provides author's suggestions into how improvements can be made in certain areas that have been struggling after the author has provided the reasons for the struggle.

Lifetime Risk Factors Associated with Level of Housing Among Australian Poor

Taryn Braver et al. — Wed, 21 Mar 2012 10:22:06 PDT

We investigated a group of Australians, who lived in extreme poverty, by identifying early life and contemporary disadvantages associated with marginal housing or homelessness. Forty nine marginally housed and 51 homeless participants, who sought emergency relief from Melbourne charities, completed a 25 item questionnaire and a follow-up interview about their personal, social and material circumstances. Different combinations of early life and contemporary disadvantages predicted either marginal housing or homelessness. Receipt of disability benefits, vocational qualifications and post secondary education were uniquely and inversely associated with homelessness (positively associated with marginal housing). Being older, single and male were uniquely associated with homelessness. Level of housing insecurity among the poor was characterised by accumulation of early life and contemporary disadvantages, differentially predisposing individuals to marginal housing or homelessness.

Implementing a Strategy for Economic Reform: An Assessment of Nigeria's Privatization Program

Paul G. Adogamhe — Wed, 21 Mar 2012 10:22:04 PDT

The Nigerian Government re-launched a program of privatization in 1999 with the aim of reducing government’s participation in business management, attracting foreign and local investments, transferring of technology and skills into the public enterprises in order to create more jobs and boost economic growth. This policy thrust was based on the premise that private investment and business initiative would result in improved profitability, greater efficiency, and the promotion of rapid economic expansion. This paper examines the merits of the above hypothesis, noting the unanticipated legal, economic, and political dilemmas that came to be associated with the implementation of the privatization program in Nigeria. The program appears to have been a major failure through the very poor net returns on investments from the sale/concessioning of the enterprises, loss of several jobs, corruption through process default and new economic dangers from its infraction of creating monopolies/oligopolies in sensitive economic sectors. Therefore, the paper recommends that there is urgent need to rethink the process of reforming the public enterprise sector in Nigeria in order to tackle corruption, review the Public Enterprises Act of 1999 and other laws for assuring competitive business environment as well as improve transparency and accountability in public governance.

Low Expectations: Reference-Dependent Preferences and Labor Supply in Cape Town, South Africa

Dean Spears — Wed, 21 Mar 2012 10:22:03 PDT

Reference-dependent decision-making – the core of behavioral economics’ prospect theory – makes people more likely to choose an outcome that they expect to receive. Reference-dependence therefore may imply the perpetuation of disadvantage: people who do not expect an opportunity may be less likely to “seize the day” if one unexpectedly arrives. We find evidence of this possibility in labor supply decision-making in two datasets about a high-unemployment part of Cape Town, South Africa, including a panel. People with low expectations for finding a job – that is, people who expect to be unemployed – are less likely to report accepting several hypothetical job offers. This result is robust to a range of respecifications, including adding a range of control variables for desire and ability to work, including reservation wages. The finding appears to arise according to the theorized mechanisms. To our knowledge, this is the first indication of reference-dependent labor supply in a developing country, where especially low expectations could have particularly important consequences.

Does Early Voting Change the Socio-Economic Composition of the Electorate?

Martha E. Kropf — Wed, 21 Mar 2012 10:22:01 PDT

Political representation should be a key issue for poverty scholars. Schattschneider said more than 30 years ago, “[t]he flaw in the pluralist heaven is that the heavenly chorus sings with a strong upper-class accent.” How do election reforms affect the composition of the electorate? In 2005, Adam Berinsky made the argument that election reforms such as early voting magnify the existing socioeconomic bias in the electorate. This occurs because early voting may retain those who comprise the highest SES, rather than stimulating the turnout of new voters who may be of lower SES status. This paper advances a test of Berinsky’s hypothesis by examining early voting in North Carolina in 2008 using the state’s voter registration database. The analysis shows that despite on-the-ground mobilization efforts, those who voted early were primarily those of higher income who had been registered a long time, though they were not necessarily those who had voted habitually in the past. Normatively, this work raises questions about who has access to the franchise and who appears to be left behind.

Conditional Cash Transfers in Latin America and Anti-Poverty Policies in Chile: Why is Chile’s Market Economy Unable to Reduce Poverty and Inequality?

Silvia Borzutzky — Wed, 21 Mar 2012 10:21:59 PDT

The purpose of this paper is to provide a brief overview of Conditional Cash Transfers (CCTs) in Latin America and to assess Chile’s anti-poverty policies, including Chile Solidario and the Ethical Wage. The paper has a summary evaluation of the most important CCTs in Latin America, an analysis of the nature and limited impact of Chile Solidario, a discussion of poverty and vulnerability in Chile, and the Ethical Wage approach pursued by the Piñera administration The paper concludes by questioning the capacity of market oriented approaches to poverty reduction and argues that because poverty is a multifaceted situation, poverty reduction requires a multidimensional approach that includes at the very least educational, employment and labor policies.

Editor's Letter

Max J. Skidmore — Wed, 21 Mar 2012 10:21:55 PDT

Editor-in-Chief Max J. Skidmore shares his introductory thoughts about the first issue of PPP's Fourth Volume.

The Importance of Effect Measure Modification When Using Demographic Variables to Predict Evacuation

Jennifer A. Horney et al. — Fri, 09 Mar 2012 00:33:23 PST

INTRODUCTION: Previous studies have identified a number of demographic characteristics (e.g., age, income, level of education, household composition, and race or ethnicity) that affect hurricane evacuation. However, the magnitude and direction of these associations vary widely, even when the area of landfall or the intensity of the storm is similar. We propose that the associations of demographic characteristics and hurricane evacuation are modified by psychosocial factors such as social cohesion, social capital, and social control. Additional variability may be the result of the changing prevalence of these demographic variables over time or between study locations.
METHODS: Ninety census blocks in three eastern North Carolina counties affected by Hurricane Isabel were selected probability proportionate to population and seven interviews were conducted at random locations within each of the selected blocks. Risk differences (RD) and 95% confidence intervals (CI) were produced for stratified data to test for heterogeneity.
RESULTS: There was statistical evidence of effect measure modification on the additive scale of the effect of home type, homeownership, age, race, gender, marital status, and having children under age 18 living at home on hurricane evacuation based on Wald p-values of the interaction terms of ≤ 0.20 and strata-specific RDs which crossed the null value. Social cohesion, volunteerism, property preparation, church attendance, neighbor’s evacuation, and the number of local friends and family modified the RDs for the demographic characteristics.
CONCLUSIONS: The associations between demographic characteristics and hurricane evacuation failure are modified by social factors. Effect measure modification on the additive scale may help explain the inconsistency of previously published results and is the appropriate measure for targeted interventions that can increase evacuation among certain groups that are missed when average risks are calculated across the population.

Six Steps to a Quick Hazards Assessment at Village Level: A Participatory Assessment Approach Applied in Nawalparasi District, Nepal

Yuwan Malakar et al. — Fri, 09 Mar 2012 00:33:22 PST

The use of participatory approaches in devising disaster risk reduction strategies has increased. With the emergence of this new risk management approach, the concepts of vulnerability assessment and hazards analysis have been put into practice. This paper introduces an efficient, empirically tested, and user-friendly hazards assessment tool (HAT). HAT follows six steps for a quick hazards assessment. They are i) identification of hazards, ii) historical overview of disasters, iii) severity and frequency analyses, iv) hazard ranking of communities, v) vulnerability scenario building, and vi) summary of hazards analysis. This paper describes each step in a very detailed way demonstrating its application in three village development committees of Nawalparasi District in Nepal. The applicability of HAT is reviewed in terms of promoting learning, fostering local empowerment and building participation, which are the basis of participatory methods of assessment. HAT bears generic criticism of participatory approaches which can be resolved with proper preparation and facilitation. HAT is an attempt to analyze people’s perception of vulnerability and suffering from hazards by fostering their active participation in the process that pave the way to holistic disaster risk reduction strategies.

Citizen Participation in Post-disaster Flood Hazard Mitigation Planning in Peterborough, Ontario, Canada

Greg Oulahen et al. — Fri, 09 Mar 2012 00:33:21 PST

Citizen participation is recognized as a standard feature of democratic planning. This article examines the role of citizen participation in a post-disaster flood hazard mitigation planning program in Peterborough. The “six strategic planning choices” outlined by Brody, Godschalk, and Burby (2003) served as an analysis framework which was applied to Peterborough’s post-disaster flood hazard mitigation program. Primary data were derived from semi-structured key informant interviews (n=15) with senior local government officials, consultants, and community group representatives. Secondary data and direct observation were used to contextualize and extend research findings. The research revealed that post-disaster flood hazard mitigation in Peterborough has featured strong citizen participation, and for that reason was relatively successful. However, there are at least three areas of post-disaster planning where citizen participation could have been improved. The article concludes that the Brody, Godschalk, and Burby (2003) framework is a valuable guide for planning practice and an evaluative research tool that revealed a number of significant strengths and several weaknesses of the Peterborough flood hazard mitigation planning process.

Evaluation of Recent Developments in Laws and Regulations for Earthquake Risk Mitigation and Management in Iran

Kambod Amini-Hosseini et al. — Fri, 09 Mar 2012 00:33:19 PST

Most of the urban and rural areas in Iran are subjected to earthquakes. Moreover, due to the high vulnerability of buildings and infrastructure in most parts of the country, severe damages and casualties can be expected in the case of strong earthquakes. Several activities have been carried out in recent decades in order to reduce the vulnerability of the country to potential earthquakes and improve disaster management capacity. This paper discusses the evolution of relevant legislation and policy, focusing on the developments of the last 30 years. Additionally, a methodology to evaluate the disaster risk management laws and plans of Iran is presented and discussed. This methodology can be applied to other countries facing similar challenges. Finally, recommendations are made that might be helpful not only to Iran when the country updates its disaster management laws and regulations, but also to countries in the process of policy development.

Displacement and Disaster Recovery: Transnational Governance and Socio-legal Issues Following the 2010 Haiti Earthquake

Alka Sapat et al. — Fri, 09 Mar 2012 00:33:18 PST

The 2010 earthquake in Haiti and its aftermath have highlighted inherent but understudied transnational governance and socio-legal complexities of disaster recovery and displacement. The aftermath of the earthquake and issues related to recovery were experienced not only domestically within in Haiti, but also transnationally, particularly in the South Florida region. This region has been particularly important in the recovery process, as it is home to over 300,000 Haitians, it served as a receiving area for severely injured earthquake survivors and for school-aged displacees, and it is an area that is rich with Haitian-American organizations, including activists who have for decades been fighting causes of immigration equality for people of Haitian descent. The specific objectives of this paper are to examine and analyze the key transnational governance and socio-legal issues that have arisen in the South Florida region for four distinct groups: (i) displacees and their related legal, social, cultural, and economic issues; (ii) host communities and governance, legal, and monetary complexities associated with compensation payments (e.g., to hospitals for their services to earthquake survivors); (iii) immigrants within the United States and related legalization and citizenship issues; and (iv) diaspora communities and socio-legal issues related to dual citizenship and their ongoing struggles to have a louder voice in the future of Haiti. Our methodology and data sources include interviews with key members of the Haitian-American diaspora, school districts, city and county governments, non-profit organizations, relief task forces, and local government agencies. We also looked at relevant plans/ policies modified or adopted by governmental and non-governmental institutions in response to governance and socio-legal issues that have arisen as part of our analysis and when referred to by our interviewees. We find that social constructions of the different groups in our study, along with other social, political and economic factors, were important in understanding policy responses to the issues that emerged.

The Anatomy of a Brand: Shaping Nuclear Discourse to Create the Perception of a "Clean World"

John Eyles et al. — Fri, 09 Mar 2012 00:33:14 PST

We examine how over the past 25 years the Canadian nuclear industry has used various strategies to diminish or remove perceptions of any environmental health risks that emanate from its practice and activities. Using both industry and critical website materials, we demonstrate how the industry “removes” risk by emphasizing its own safety culture in a complex process, its green credentials, its role in producing local energy options, and the scientific ignorance of its critics, the suppression of opposing views, and a narrow risk assessment approach to potential environmental and health hazards in the marketing of a specific brand. We suggest that the same strategies are being used after the recent Japanese nuclear disaster.

The State of Medical and Health Care Education: A Review and Commentary on the Lancet Commission Report

David Gordon et al. — Tue, 28 Feb 2012 02:05:12 PST

Medicine and the other healing arts advance through new knowledge, improved practices, and increasing engagement with their responsibilities to the patients and societies that they serve. Does the education of doctors and other healthcare professionals lead in these changes, or does it follow?

Failures in education are often blamed for defects in health care systems. The Lancet Commission Report on Education of Health Professions for the 21st Century, published in late 2010 (Frenk et al. 2010), argued that education needed transformation to meet the needs of health systems.

This commentary argues that there is not a general crisis in education of health professions. Education often leads, rather than follows. Problems in healthcare require engagement by politicians and decision makers in a concerted and coordinated plan for capacity building in education, and for targeted solutions to problems of inadequate resources. Health professionals, and education systems, should continue to lead and innovate, through initiatives for the improvement of institutions and programmes.

In the News

Arnauld Nicogossian — Tue, 28 Feb 2012 02:05:11 PST

In the Editors' opinion, the information summarized for this section has the potential for development of health policies, standards, or for use in the daily practice and counseling of patients in preventative care. For additional information, readers might wish to visit Internet-based medical news websites, some free of charge, such as PLoS Medicine, MedScape, Stone Heart, Cochrane Collaboration, American College of Physicians, and the World Medical Association.

2011 Reviewers

Bonnie Stabile — Tue, 28 Feb 2012 02:05:10 PST

Thanks to our 2011 Reviewers

Review of Health Policy and Ethics: A Critical Examination of Values from a Global Perspective

Bonnie Stabile — Tue, 28 Feb 2012 02:05:10 PST

Health Policy and Ethics makes the case that an examination of health law, health policy and professional standards not only sheds light on the intrinsic values of a society, but more importantly offers insights that will have practical policy implications and lead to improved health practice. Case studies from around the world illustrate central themes.

Lactating Women's Perception of the Free Health Care Initiative in Rural Sierra Leone

Fredanna A. D. M'Cormack et al. — Tue, 28 Feb 2012 02:05:08 PST

Introduction: On April 27, 2010 Sierra Leone implemented the Free Health Care Initiative (FHCI) for pregnant women, lactating mothers and children under age five to address high mortality and morbidity. This study examined participant satisfaction with health services before and after the FHCI implementation.

Methods: This was a retrospective study that assessed healthcare satisfaction in rural Sierra Leone after the implementation of the FHCI. Participants were interviewed using a structured satisfaction questionnaire about the FHCI.

Conclusions: Results find a positive, statistically significant difference in participant satisfaction with ambulance services after the implementation of the FHCI compared to the level of satisfaction prior to the FHCI. Although results indicate a very slight increase in overall satisfaction with healthcare services, and a slight decrease in satisfaction with drug availability after the implementation of FHCI, the results are not statistically significant. Findings also indicate that participants attending emergency obstetric care (EmOC) facilities were less satisfied with the services provided than those attending the non-EmOC facility or hospital.

The Spread of Obesity in Developing and Transitional Countries: A Focus on the Mekong Region, Southeast Asia

Lisa R. Pawloski et al. — Tue, 28 Feb 2012 02:05:06 PST

Introduction: Obesity policies in transitional countries are limited as most have needed to focus resources on reducing hunger, poverty, and infectious diseases. The Mekong Region is one such area that is still facing issues of undernutrition and infectious disease, yet has a growing population at risk of obesity related diseases. Such a dual burden creates a dilemma regarding which issue to address first, given limited resources. This review addresses this problem from a policy perspective.

Materials and Methodology: Comparative analyses of literature reviews, existing policy, and previous research were synthesized among countries within the Mekong Region.

Results: Traditional diets, quickly emerging fast food markets, and urbanization add levels of complexity to managing and creating obesity policy. Existing policies have not been successful and there are few measurable outcomes.

Conclusion and Policy Implications: Obesity-related policies have been initiated in the Mekong Region, but with few resources and conflicting priorities, several countries are at risk of being left behind. Suggested policies in the region include utilizing mass media education campaigns, modeling other successful public health programs, and promoting culturally and regionally appropriate interventions.