Arguments Used in Public Comments to Support or Oppose the US Department of Agriculture’s Minimum Stocking Requirements: A Content Analysis

Background

In 2016, the US Department of Agriculture (USDA)’s Supplemental Nutrition Assistance Program (SNAP) Retailer Rule proposed several changes for SNAP-authorized retailers, including: requiring retailers to have at least 85% of their food sales come from items that are not cooked or heated on site before or after purchase; requiring stores to stock seven varieties of qualifying foods from four staple food groups; requiring stores to carry perishable foods in three of the four staple groups; requiring stores to carry six units of qualifying foods at all times (depth of stock); disqualifying multiple ingredient foods and accessory foods from counting toward depth of stock requirements.

Human rights and political crisis in Brazil: Public health impacts and challenges

In 31 August 2016, Brazilian president Dilma Rousseff was impeached and replaced by her vice president Michel Temer. Herein, we examine how the conservative agenda of Mr Temer and his supporters is influencing key decisions in the human rights and public health arena in Brazil. The government’s austerity agenda includes severe cuts in critical areas such as health, education and science, jeopardising well-known strategies such as the Brazilian Public Health System (SUS) and nationwide cash transfer program, ‘Bolsa Familia’ – both benefited millions and were the largest of their kind in the world. Mr Temer’s decisions show not only severe cuts in critical areas but also a political agenda that clearly demonstrates a broad shift away from the progressivism and social agenda presented and supported by its predecessors. Most vulnerable groups such as the LGBTQ community, women, people who use drugs and disenfranchised communities have been severely affected. Mr Temer’s administration is putting Brazil far from its once nationwide goal to foster free and universal health care access and social equity for all its citizens. The near future for Brazil is unknown, but both national and international communities anticipate severe problems within the national human rights arena, if nothing changes.

Abbreviations: CCT: Conditional Cash Transfer; LGBTQ: Lesbian, Gay, Bisexual, Transgender and Queer (and/or Questioning); SUS: Brazilian Public Health System     

我院辅助药品加锁政策管理效果评价

摘 要 目的：分析我院辅助药品加锁政策管理效果,并对效果进行评价,为促进我院医生合理用药,为医院合理用药管理提供参考。方法：使用间断时间序列方法对两组辅助药品2013年1月～2017年1月使用量月度数据进行分析,同时对加锁政策进行评价。结果：研究结果发现,舒肝宁和血栓通注射液使用量都有下降趋势,都具有统计学意义（P<0.05）。单唾液酸四己糖神经节苷脂和钠钾镁钙葡萄糖注射液使用量有下降趋势,但下降并不明显,单唾液酸四己糖神经节苷脂针下降没有统计学意义(P>0.05)。结论：加锁政策对药品使用量管理效果明显,可提高医生合理用药,但应针对不同药物进行分级别管理。     

珠海市某三甲医院药品和医用耗材零差率政策实施效果分析

摘 要 目的：评估药品和医用耗材零差率政策对医院的影响。方法: 运用描述性统计和对比分析方法,对珠海市某三甲医院2014年4月～2017年3月的部分业务指标、盈亏测算、患者次均费用进行分析。结果:零差率政策实施两年后,珠海市某三甲医院门急诊人次、普通门诊人次下降。平均住院日为8.88 d,药占比为34.10%。专家门诊人次、出院人次、手术治疗占比增加。虽让利患者,但次均费用仍然增长;医院存在政策性亏损。结论:改革促进了分级诊疗政策的实施,优化了医院收入结构,药占比显著降低,一定程度上达到政策设计的初衷。     

Effects on Alcohol Consumption and Alcohol Related Harm of a Community-Based Prevention Intervention With National Support in Sweden

Background: In order to strengthen local alcohol prevention work in Sweden the Swedish government has for the past almost 15 years commissioned the Public Health Agency of Sweden to initiate a series of community-based alcohol prevention projects. The latest of these, labeled local development with ambitions (LUMA), included 25 municipalities in Sweden. Objectives: Aim of this study is to examine if LUMA municipalities that received financial support, with requirements, increased local alcohol prevention and if alcohol consumption and harm declined. Methods: Twenty-five Swedish municipalities that received financial support aiming to strengthen local alcohol preventing activities (intervention group) were compared to municipalities that did not receive such support (control group, N = 224), before, during, and after the intervention period. Two composite measures of policy and activity were created and used. The composite activity measure includes seven activity indicators and the composite policy measure includes six policy indicators. Harm measures have been selected based on several recommended indicators for monitoring alcohol, tobacco, and other drugs in Sweden. A fixed effects model was used to analyze data. Results: The results reveal that prevention activities increased and several alcohol-related harm indicators were reduced in intervention municipalities (LUMA) compared with in control municipalities. Conclusions: It seems as if financial support, combined with specific requirements and support from the regional and national level, can stimulate local alcohol prevention activities and have a significant effect on alcohol consumption and alcohol-related harm. Similar evaluations in other countries would be of great value for assessing the generalizability of findings.     

Variation in Nutritional Quality of School Lunches With Implementation of National School Lunch Program Guidelines

BACKGROUND

School lunches must meet National School Lunch Program (NSLP) requirements to receive reimbursement. In this study, we sought to determine whether there are significant differences in nutrient content and nutritional quality between 2 menus meeting NSLP requirements.

METHODS

A cross‐sectional content analysis compared 6 weeks of a typical school lunch menu (TM) from an actual school district to a best practice school lunch menu (BPM) created by a registered dietitian based on Child and Adult Care Food Program (CACFP) best practices and Dietary Guidelines for Americans (DGA) healthy meal pattern recommendations. Daily nutrient content was determined using nutrient analysis software. Nutritional quality was computed using Healthy Eating Index (HEI) 2010.

RESULTS

For nutrients required for analysis, the BPM was lower in calories, saturated fat, and sodium and higher in protein, carbohydrate, and fiber (ps < .01). For other nutrients of concern, the BPM was higher in vitamin A, vitamin D, phosphorus, and magnesium (ps < .01). The BPM had higher HEI scores for nutritional quality (p < .001).

CONCLUSIONS

Results indicate the possibility for significant variation in nutritional quality of NSLP‐qualifying lunches. Using CACFP best practices and DGA recommendations may significantly impact school lunch dietary quality.

     

“Enticing case study” or “celebrated anomaly”? Policy learning from the Cuban health system

Cuba is regarded as having achieved very good health outcomes for its level of economic development. It has adopted policies and programs that focus on prevention, universal access to healthcare, a strong primary care system, the integration of health in all policies, and public participation in health. It has also established a strong and accessible system of medical education and provides substantial medical aid and support to other countries. Why then, it may be asked, has the Cuban experience not had greater influence on health policies and reforms elsewhere? This article, based on a literature review and new primary sources, analyzes various factors highlighted in the policy transfer literature to explain this. It also notes other factors that have created greater awareness of Cuban health achievements in some countries and which provide a basis for learning lessons from its policies.     

“There is always a better way”: Managing uncertainty in decision making about new cancer drugs in Canada

Policy decisions about the approval and funding of new cancer drugs must often be made in an environment of complex uncertainty about clinical and cost‐effectiveness data. The focus of this article is on the results from qualitative interviews with senior officials (n = 16) who make decisions about or influence cancer drug policy in various organizations in the Canadian cancer control system. Most participants identified the use of a limited number of informal approaches to address uncertainty, such as grounding decisions in evidence and advice from expert groups. People tended to focus on evidence informed decisions including price negotiations, the ability to implement policy changes, and stakeholder values. Lessons from the Canadian context related to continuing efforts to build a public culture of understanding into how policy decisions like cancer drug funding are made may result in greater acceptance and increased confidence in health policy decision‐making processes across multiple sectors internationally.     

A retrospective public health analysis of the Republic of Ireland's Food Harvest 2020 strategy: absence,avoidance and business as usual

The concept of an Ecological Approach to health and including Health in All Policies warrants inter-sectoral and transdisciplinary collaboration to improve health determinants and reduce health inequities. Agriculture policies, which greatly influence food production and its environmental impacts as well as food availability and dietary consumption, are therefore of interest to public health. Increasing rates of non-communicable diseases linked to diets containing high levels of processed foods, increasing numbers of households unable to access nutritious food and the environmental consequences of the food system are amongst the major health challenges of today, both globally and in Ireland. In 2010, Ireland’s Department of Agriculture, Food and Fisheries published Food Harvest 2020 a roadmap for Irish agriculture for the subsequent decade prepared against a backdrop of rising diet-related ill-health and increasing environmental concerns. This article critically analyses the process of consultation and stakeholder involvement in the development of Food Harvest 2020 from a public health perspective. Publically available documents including submissions to the Food Harvest 2020 consultation process were the primary source of data. This study highlights a distinct absence of public health representation in the process, an avoidance of some key public health challenges and the dominance of a ‘business as usual’ approach.