How the United States exports managed care to developing countries.

As their expansion slows in the United States, managed care organizations will continue to enter new markets abroad. Investors view the opening of managed care in Latin America as a lucrative business opportunity. As public-sector services and social security funds are cut back, privatized, and reorganized under managed care, with the support of international lending agencies such as the World Bank, the effects of these reforms on access to preventive and curative services will hold great importance throughout the developing world. Many groups in Latin America are working on alternative projects that defend health as a public good, and similar movements have begun in Africa and Asia. Increasingly, this organizing is being recognized not only as part of a class struggle but also as part of a struggle against economic imperialism--which has now taken on the new appearance of rescuing less developed countries from rising health care costs and inefficient bureaucracies through the imposition of neoliberal managed-care solutions exported from the United States.     

Persisting failure to protect populations at risk from HIV transmission: African American women in the United States (US)

High and steady rates of HIV transmission to African American women expose problems in the US approach to prevention. Vulnerability of African American women, rooted in the broader experience of African American communities in the United States, relates not only to individual behaviors, but also to structural factors beyond individual control. These - poverty, employment, education, and incarceration - greatly influence risk of infection, late diagnosis, and death from HIV-related causes. The creation, implementation, evaluation, and replication of US prevention programs helps explain both their benefits and specific shortcomings. Can we improve effectiveness of prevention for African American women and other underserved groups in the United States - and in some 50 countries where the US uses its own domestic approaches when providing guidance through President's Emergency Plan for AIDS Relief? Creative additions to known strategies may come from small organizations working within affected communities, but implementation, evaluation, and scale up of more effective activities will require greater government support of community-based initiatives.     

Eliminating tobacco-related health disparities: directions for future research

Certain groups in the United States remain at high risk and suffer disproportionately from tobacco-related illness and death despite progress made in reducing tobacco use. To address gaps in research on tobacco-related disparities and develop a comprehensive agenda aimed at reducing such disparities, representatives from funding agencies, community-based organizations, and academic institutions convened at the National Conference on Tobacco and Health Disparities in 2002. Conference participants reviewed the current research, identified existing gaps, and prioritized scientific recommendations. Panel discussions were organized to address research areas affecting underserved and understudied populations. We report major research recommendations made by the conference participants in several scientific domains. These recommendations will ultimately help guide the field in reducing and eliminating tobacco-related disparities in the United States.     

Converting ICD-9 to ICD-10

Implementing the International Classification of Diseases, Ninth Revision (ICD-9) to International Classification of Diseases, Tenth Revision (ICD-10) conversion on October 1, 2015, in the United States has been a long-term goal. While most countries in the world converted more than 10 years ago, the United States was still using ICD-9. Many countries in the world have a single-payer healthcare system, while there are thousands of different healthcare organizations (providers and payers) that presently exist in the United States. With so many different software platforms for healthcare providers and payers, the conversion had become that much more complicated and capital intensive for all healthcare organizations in the country. A few of the present delay reasons to the ICD-10 conversion in past years were the concurrent timelines for meeting meaningful use requirements for the electronic health record, testing with external payers and upgrades from vendors which added complexities and extra costs. The authors examine the reasoning behind the conversion as well as the delays, before making the conversion on October 1, 2015, and review the question regarding whether the government's decision to push the date back a year would have been helpful.     

Protecting children's health. CHA's immunization program helps organizations increase vaccination rates in their communities

In response to the increasing outbreaks of vaccine-preventable diseases in the United States, the Catholic Health Association (CHA) has developed a new resource to help its members launch programs that will increase immunization rates among children in their service area. Vaccines are the building blocks of basic primary care. But society and the healthcare system have erected barriers that prevent children from being fully immunized. Impediments include missed opportunities, cost barriers, and facility and resource barriers. Catholic healthcare providers can help eliminate these barriers and ensure that all children in their service areas are vaccinated by assessing their immunization resources, seeking out unvaccinated children, and collaborating with community organizations and agencies. CHA's immunization campaign will guide Catholic healthcare providers as they protect children from preventable diseases. Immunization may help reduce the costs of emergency and acute care for conditions that could have been prevented.     

The evolving demography of aging in the United States of American and the former USSR.

In the United States of America and in the republics of the former USSR, the elderly (persons aged 60 and over) will comprise the same proportion of their respective societies by the year 2000, namely 17%. In both countries, this population subgroup is growing at a faster rate than the rest of the population and living longer, although there are now more differences than similarities between the two countries in respect of the elderly, as summarized below. Similarities. In both countries today, the age group 50 years and over represents 26% of the total population, and by the year 2000 it is expected that 17% of the population will be 60 years and over. Diseases of the circulatory system and neoplasms are the major causes of death in both countries. Life expectancy beyond retirement age (i.e. the number of years a person is expected to live after having retired) is about the same in both, but this is due to the statistical fact that in the former USSR women are expected to have an extra year of life expectancy compared to their United States counterparts, while men are expected to live 2.5 years less beyond retirement than their United States counterparts. Differences. Mortality rates in the former USSR are higher than those in the United States. Life expectancy for men in the former USSR is 6.5 years below the figure for United States males. By age 65, the differences are 2.7 years for women and 2.4 years for men. Today, the proportion of the population having reached retirement age is larger in the former USSR than in the United States (17% vs 15%) because of lower retirement age in the former USSR. By the year 2000, these figures are expected to be 19% and 25%, respectively. Men make up 27% of the pension-age population in the former USSR against 41% in the United States. Life expectancy at birth could increase by 4 years for men in the former USSR if they had the same mortality rates from diseases of the circulatory and respiratory systems as their United States counterparts. Similarly, women in the former USSR would gain 4 years of life from these two causes alone. Older women are more likely to be married in the United States than in the former USSR, and this difference increases with age: at age 65, 25% of the former USSR's women are married versus 41% in the United States.     

Community-based organizations and CDC as partners in HIV education and prevention.

By 1982, community responses to the acquired immunodeficiency syndrome (AIDS) epidemic were evident in some cities in the United States. Community responses were planned, developed, and coordinated largely by service-oriented, community-based organizations. Indirect evidence suggests that such organizations' activities mainly were in the form of attempting to discourage behaviors associated with the transmission of human immunodeficiency virus. During 1984, Centers for Disease Control (CDC) assessed the educational activities of community-based organizations and public health agencies in several cities nationwide. Investigators found that in those cities where health education had become a secondary activity within a health department, prevention activities tended to be ineffective. They noted that the challenge of the epidemic lay in finding effective strategies for disseminating relevant information. They concluded that prevention efforts directed to groups at risk needed to be appropriate to the lifestyle, language, and environment of a particular risk group. CDC recognized these findings by adopting a policy of support of community-based organizations in its overall AIDS prevention strategy.     

U.S. Government engagement in support of global disease surveillance

Global cooperation is essential for coordinated planning and response to public health emergencies, as well as for building sufficient capacity around the world to detect, assess and respond to health events. The United States is committed to, and actively engaged in, supporting disease surveillance capacity building around the world. We recognize that there are many agencies involved in this effort, which can become confusing to partner countries and other public health entities. This paper aims to describe the agencies and offices working directly on global disease surveillance capacity building in order to clarify the United States Government interagency efforts in this space.     

Translating HIV interventions into practice: community-based organizations' experiences with the diffusion of effective behavioral interventions (DEBIs)

Efficacious behavioral interventions developed to address the spread of HIV/STIs are currently being disseminated in the USA through a national diffusion program (DEBI) spearheaded by the Centers for Disease Control and Prevention (CDC). Understanding how interventions are translated to real world settings is necessary to further scientific knowledge of this process and to facilitate future translation efforts in public health. Prior studies have begun to elucidate how agencies translate behavioral interventions into practice, but further work is needed. Guided by the ADAPT framework, we examined agencies' assessment, preparation, and implementation of interventions. Our qualitative interview-based study focused on six community-based agencies in California (United States) funded to implement three group-level HIV interventions. Findings showed considerable variation in the extent to which agencies engaged in assessment and broad-based preparation and in the ease with which agencies implemented the interventions. The findings provide insight into the process that agencies undergo in the translation of effective behavioral interventions and illustrate how agencies can inform logic models that guide translation. We also identify relevant dimensions of existing models, including the ADAPT framework and Rogers's (1995, 2005) diffusion of innovations in organizations, that have value for agencies that are translating research to practice.     

Governance in a period of strategic change in U.S. healthcare

The increased enrollment in managed care plans, merger mania and the development of politically and financially powerful integrated delivery systems have significantly complicated the governance of U.S. healthcare organizations. These modifications in fiscal incentives and the corporate restructuring undertaken by American health organizations has resulted in limited fiscal savings or improvements in access to care. As a result, trustees are now faced with divesting their losers, and shuttering facilities and services to reduce fixed costs. Decision-making by trustees will be further thwarted in the future by: their institutions being forced to deliver more care without a proportional increase in revenues; physicians seeking to obtain more ambulatory revenues at a hospital's expense; the inability to adequately finance mental health and long-term care services except among the wealthy; the number of divestitures increasing so that eventually the organizational focus for most IDSs will once again be on regionally oriented hospital systems; and much more difficulty being experienced in attracting sufficiently qualified personnel to deliver high quality health services. Finally, many of these findings relevant to the United States also are being shared by governing boards in Canada, Germany, The Netherlands and the United Kingdom.     

Are shorter work hours good for the environment? A comparison of U.S. and European energy consumption.

European employees work fewer hours per year, and use less energy per person, than their American counterparts. This article compares the European and U.S. models of labor productivity, supply, and energy consumption. It finds that if employees in the EU-15 worked as many hours as those in the United States, they would consume at least 15 percent more energy. This aspect of the debate over Europe's economic model reaches globally. Over the coming decades, developing countries will decide how to make use of their increasing productivity. If, by 2050, the world works as do Americans, total energy consumption could be 15 to 30 percent higher than it would be if following a more European model. Translated directly into higher carbon emissions, this could mean an additional 1 to 2 degrees Celsius in global warming.     

Differences in teenage pregnancy rates among five developed countries: the roles of sexual activity and contraceptive use.

CONTEXT: Adolescent pregnancy, birth, abortion and sexually transmitted disease (STD) rates are much higher in the United States than in most other developed countries. METHODS: Government statistics or nationally representative survey data were supplemented with data collected by private organizations or for regional or local populations to conduct studies of adolescent births, abortions, sexual activity and contraceptive use in Canada, the United States, Sweden, France and Great Britain. RESULTS: Adolescent childbearing is more common in the United States (22% of women reported having had a child before age 20) than in Great Britain (15%), Canada (11%), France (6%) and Sweden (4%); differences are even greater for births to younger teenagers. A lower proportion of teenage pregnancies are resolved through abortion in the United States than in the other countries; however, because of their high pregnancy rate, U.S. teenagers have the highest abortion rate. The age of sexual debut varies little across countries, yet American teenagers are the most likely to have multiple partners. A greater proportion of U.S. women reported no contraceptive use at either first or recent intercourse (25% and 20%, respectively) than reported nonuse in France (11% and 12%, respectively), Great Britain (21% and 4%, respectively) and Sweden (22% and 7%, respectively). CONCLUSIONS: Data on contraceptive use are more important than data on sexual activity in explaining variation in levels of adolescent pregnancy and childbearing among the five developed countries; however, the higher level of multiple sexual partnership among American teenagers may help explain their higher STD rates.     

A framework for cultural competence in health care organizations

Increased racial and ethnic diversity in the United States brings challenges and opportunities for health care organizations to provide culturally competent services that effectively meet the needs of diverse populations. The need to provide more culturally competent care is essential to reducing and eliminating health disparities among minorities. By removing barriers to cultural competence and placing a stronger emphasis on culture in health care, health care organizations will be better able to address the unique health care needs of minorities. Organizations should assess cultural differences, gain greater cultural knowledge, and provide cultural competence training to deliver high-quality services. This article develops a framework to guide health care organizations as they focus on establishing culturally competent strategies and implementing best practices aimed to improve quality of care and achieve better outcomes for minority populations.     

The diffusion of a community-level HIV intervention for women: lessons learned and best practices

Abstract Early in the HIV/AIDS epidemic in the United States, relatively few women were diagnosed with HIV infection and AIDS. Today, the epidemic represents a growing and persistent health threat to women in the United States, especially young women and women of color. In 2005, the leading cause of HIV infection among African American women and Latinas was heterosexual contact. In addressing HIV prevention needs among women, community-level strategies are needed to increase consistent condom use by women and their partners and to change community norms to support safer sex behaviors. The Real AIDS Prevention Project (RAPP) is a community-based HIV prevention intervention for women and their partners. RAPP is based on a community mobilization model that involves a combination of activities, including street outreach, one-on-one discussions called stage-based encounters, role model stories, community networks, and small group activities. The objectives of RAPP are to increase consistent condom use by women and their partners and change community norms associated with perceptions of condom use and high-risk behaviors in an effort to make safer sex practice more acceptable. This paper describes the Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention (DHAP) effort to nationally diffuse RAPP from March 2003 through May 2007 and lessons learned from that diffusion experience. The paper specifically discusses (1) collaborating and planning with researchers, (2) a diffusion needs assessment that was designed to assess prior implementation experiences among select agencies, (3) developing the intervention package, (4) developing and piloting training for community-based organizations (CBOs), (5) a rollout of national trainings for health departments and community-based organizations interested in implementing RAPP, and (6) ongoing quality assurance activities and the provision of technical assistance and support. RAPP has been proven effective in reducing HIV transmission risk behaviors and improving communication and negotiation skills necessary for African American women and Latinas to reduce their risk for HIV infection and improve their overall health status.     

HIV and tuberculosis trends in the United States and select Sub-Saharan Africa countries

Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) are two catastrophic diseases affecting millions of people worldwide every year; and are considered to be pandemic by the World Health Organization. This study aims to compare the recent trends in TB and HIV in the United States and Sub-Saharan African Countries. Data (incidence, prevalence and death rates of HIV and TB) for the United States, Cameroon, Nigeria, and South Africa were collected from The Joint United Nations Programme for HIV/AIDS (UNAIDS), US Census Bureau and World Health Organization (WHO) databases and analyzed using Statistical Analysis Software (SAS v 9.1). Analysis of Variance (ANOVA) was performed to compare the variables of interest between the countries and across time. Results showed that percent rates of TB cases, TB deaths, HIV cases and HIV deaths were significantly different (P<0.001) among these countries from 1993 to 2006. South Africa had the highest rates of HIV and TB; while US had the lowest rates of both diseases. Tuberculosis and HIV rates for Cameroon and Nigeria were significantly higher when compared to the United States, but were significantly lower when compared to South Africa (P<0.001). There were significant differences (P<0.001) in the prevalence of TB and HIV between the United States and the Sub-Saharan African countries, as well as differences within the Sub-Saharan African countries from 1993 to 2006. More analysis needs to be carried out in order to determine the prevalence and incidence of HIV and TB among multiple variables like gender, race, sexual orientation and age to get a comprehensive picture of the trends of HIV and TB.     

MEDICALIZED MENOPAUSE,U.S. STYLE

The construction of menopause as an estrogen deficiency condition originated primarily in the United States and is being exported to many other countries throughout the world. I have identified specific cultural assumptions and policies in the United States as well as the ubiquitous gender biases that have contributed to the medicalization of menopause. Since medicalized menopause is causing harm to women worldwide, it is imperative that it be addressed by the international community.     

The road to recovery: Egypt's healthcare reform

As many industrial and third-world countries recover from the severe economic crisis of a global recession, they continue to struggle with its negative effect on their healthcare systems. Healthcare reform has become a leading policy agenda item for most countries. This is especially true for countries in the developing world who are struggling to allocate very limited resources to meet the growing health needs of their residents and the expectations of global health. In the late 1990s, the Egyptian government, in conjunction with the United States Agency for International Development, initiated a Health Sector Reform Program (HSRP) to completely reform the way healthcare was financed, organized and delivered with the intent to extend healthcare coverage to all of its citizens. Although some successes have resulted from the HSRP, Egypt's new government leaders will need to be informed on policies that may more effectively improve the health of the Egyptian population.     

Improving care and interactions with racially and ethnically diverse populations in healthcare organizations

The need for healthcare managers to develop strategies that address culturally appropriate care for racial and ethnic populations continues to grow in importance. Healthcare organizations within the United States serve a range of diverse people, but they are not adequately meeting the needs of specific populations. Cultural and linguistic barriers are posing problems for an industry that is already financially strained. If strategies to provide more culturally appropriate care are not implemented, financial pressures will continue to rise and quality of care will suffer. Healthcare organizations can and should promote cultural competence among their physicians and employees. This article attempts to define the scope of the problem through literature and case studies. It also offers healthcare managers strategies for improving cultural understanding and competency within their organization.     

Disability and global development

The United States invests billions of taxpayer dollars each year into foreign assistance programs that foster international diplomacy and development directed toward improving the quality of life for people around the world. These programs develop economies and combat poverty, promote democracy and governance, build new infrastructure, advance and protect human rights, among other development goals. The United States cannot effectively accomplish the goals of foreign assistance programs unless it undertakes measures to ensure that the programs are accessible to and inclusive of people with disabilities. The United States has been a leader in advancing the rights of people with disabilities and must continue to promote disability rights through its international development work. Overseas economic development will not be successful unless people with disabilities are included. Because of the significant number of people with disabilities in developing countries, if they are not included, the very economic growth the United States is trying to foster will be hindered. The goals of democracy and governance programs cannot be achieved without the inclusion of people with disabilities. In many countries, domestic law contains blatant discriminatory provisions for people with disabilities that undermine access to justice and full participation in society. The provisions that discriminate against people with disabilities include arbitrary exclusions in electoral codes, sweeping plenary guardianship laws with no due-process protections, discriminatory banking practices, and inaccessible court proceedings. National disability legal frameworks remain underdeveloped throughout the world.     

Tobacco industry sponsorship of community-based public health initiatives: why AIDS and domestic violence organizations accept or refuse funds.

The objective of this study was to understand the reasons community-based public health organizations in the United States accept or refuse tobacco industry sponsorship. A formative pilot study involving 13 interviews with representatives of AIDS and Domestic Violence organizations in California or the Northeast was used. Semistructured interviews were conducted with leaders and fund-raisers working at AIDS and domestic violence organizations that either accepted grants from the tobacco industry or explicitly refused tobacco corporate support. Respondents that accepted grants did so because they believed that the tangible benefits of additional capacity to serve their constituents outweighed the minimal effect they believed refusing funds could have on tobacco control and prevention. Organizations that refused sponsorship either saw tobacco prevention as part of their mission of promoting overall health or social justice, or expressed concern about public association with the tobacco industry. Public health responses to this phenomenon are most effective when they are informed by the realities facing nonprofit leaders as they grapple with the question of whether to accept industry funds. Further research is needed to determine whether accepting sponsorship results in a change in public opinion about tobacco control. Possible interventions include creating positive publicity for organizations that refuse tobacco industry philanthropy.