Hospital smoking policies: who enforces them?

As opprobrium is increasingly given to the act of smoking, many institutions--hospitals especially--are seeking to curtail the amount of smoking that occurs within their buildings through various policies. This, however, raises two necessary questions: What does policy enforcement mean? And who shall enforce the rules? The article below discusses the results of a survey of North Carolina hospitals that asked these questions and more.     

Food policies: a threat to health?

Food policies deliver large quantities of food relatively safely, but they are failing to deliver healthy diets. Policies fall into three broad categories: the supply of sufficient amounts of food (food security); the provision of food free from contamination (food safety); the provision of a healthy diet available to all (nutritional quality). These three aspects are dealt with by institutions that rarely engage with each other, let alone coordinate their strategies. Greater financial support has been given to agricultural policy than to any other joint EU endeavour. In the last decade food safety has dominated headlines and has influenced recent changes to EU food policies. New food authorities and agencies have been established and ministerial responsibilities have been redefined. Yet, it is nutrition, or rather 'mis-nutrition', that is the largest single cause of death and disease within the region, and indeed worldwide. This need not be the case. Nutrition and dietary policies may find themselves in close alliance with policies for sustainable agriculture. However, the change in thinking that will be required will mean reconsidering the role of commercial food production. Successful nutrition policies may yet prove to be the next major step in the improvement of public health.     

Public health policies: a Scandinavian model?

AIM: To identify how public health problems are identified, explained, and addressed in Scandinavian public health programmes. METHODS: Recent public health white papers from Denmark, Norway, and Sweden have been studied asking the following questions. How are policies and activities justified? Which problems and causes are identified? What is to be done? To what extent are the interpretations and suggested interventions in accordance with liberal or social democratic political ideals? RESULTS: The programmes studied give similar reasons for dealing with public health, namely the wish to create good lives for citizens and to improve the economy of society. The health problems identified are almost the same: cancer, heart disease, diabetes, musculoskeletal diseases, and mental illness. The Danish programme differs from its Norwegian and Swedish counterparts with regard to explanations and suggested solutions to the problems. It may be characterized as more liberal. While the Danish programme stresses the importance of individual behaviour, responsibility, and autonomy, the two others emphasize social relations, living conditions, and participation in addition to behavioural factors. Political responsibility for the health of the population is emphasized in the Norwegian and Swedish programmes. The Swedish programme, in particular, stresses common values such as equality and equal rights, and the significance of the welfare state. The Norwegian programme underlines the importance of empowering the individual, an ambition that could also be seen as a social liberal ambition to increase the self-determination of citizens. CONCLUSION: There is not one Scandinavian model in public health policy but several: a Danish model mainly adhering to liberal ideals, a Norwegian one that could tentatively be labelled social liberal, and a Swedish model adhering to more social democratic ideals.     

Complementary or alternative? Stronger vs weaker integration policies

Scientific research is particularly important as a guide to health care policy regarding the "integration" of complementary and alternative medicine (CAM) into conventional medical practices. A spectrum of possibilities has emerged around the question of balancing integration toward complementary vs alternative usages. Although scientific research can guide policies and practices, it has become subject to greater scrutiny and linked to differences on policy issues. Using CAM cancer therapies as a case study, this commentary explores relationships between methodology and policy regarding the integration of CAM therapies.     

Can government policies help adolescents avoid risky behavior?

BACKGROUND: This study examines the extent to which policies influence participation of adolescents in alcohol and tobacco consumption and in unsafe sex. METHODS: Data were obtained from the 1995 Youth Risk Behavior Surveys (YRBS) conducted by 20 different states and cities in the U.S. These data were combined with state data on cigarette taxes, vending machine laws, beer taxes, and family planning clinic availability. A model of teenage risk taking suggested that the three risk behaviors were codetermined by a common latent risk-taking propensity. We used a structural equation model (SEM) accounting for this shared latent propensity to estimate the extent of participation in terms of frequency of smoking, drinking, and the number of sex partners. RESULTS: Estimating simultaneous equations for all three risk behaviors was statistically more efficient than equation-by-equation estimates of each behavior. Estimates indicated significant deterrent effects of beer taxes, vending machine restrictions, and increased density of family planning clinics on teenage risk behavior. CONCLUSIONS: State policies, such as taxes on beer, and restrictions on location of cigarette vending machines, and placement of family planning clinics influence adolescents' behavior. Because there is interrelationship between these behaviors, systems estimators, can offer improved estimates of these effects.     

Food and nutrition policies of Nordic countries: how have they been developed and what evidence substantiates the development of these policies?

The present paper addresses the emergence and development of Nordic food and nutrition policies, with some reference to the types of nutrition policies characteristic of other North European countries. Nutrition programmes aimed at dietary change have a long history of public responsibility in several Nordic and North European countries. The extent of involvement, the orientation and (indication of) success have, however, varied considerably between countries. First, different types of policies are characterised by their choice of programmes and measures, e.g. information campaigns v. market regulation or catering and public services. Second, the distinctions are associated not only with programmes, but also with the status and validity of nutritional advice and dietary guidelines in public policy making. Third, when focusing on how and on what grounds the governments have developed nutrition policies, it is evident that while more or less the same participants and issues are involved, their roles and relationships may be different. In this case the role and involvement of nutritional expertise and scientific arguments in various countries will be discussed. Finally, nutrition policies may entail conflicts of interest, particularly when health concerns are confronted with food industry and agricultural interests. This situation is quite evident in the question of animal fat. The present paper addresses how these issues have been dealt with quite differently in various countries.     

Asset disposal: follow company policies or follow the law?

Several ethical issues can arise in disposing of assets. The proper management of these issues involves awareness of the applicable laws and development of policies and enforcement that respect those laws. Several examples of appropriate policy, following classical management principles, served to document the points under discussion.     

Addressing refugee health through evidence-based policies: a case study

The cumulative total of persons forced to leave their country for fear of persecution or organized violence reached an unprecedented 24.5 million by the end of 2015. Providing equitable access to appropriate health services for these highly diverse newcomers poses challenges for receiving countries. In this case study, we illustrate the importance of translating epidemiology into policy to address the health needs of refugees by highlighting examples of what works as well as identifying important policy-relevant gaps in knowledge. First, we formed an international working group of epidemiologists and health services researchers to identify available literature on the intersection of epidemiology, policy, and refugee health. Second, we created a synopsis of findings to inform a recommendation for integration of policy and epidemiology to support refugee health in the United States and other high-income receiving countries. Third, we identified eight key areas to guide the involvement of epidemiologists in addressing refugee health concerns. The complexity and uniqueness of refugee health issues, and the need to develop sustainable management information systems, require epidemiologists to expand their repertoire of skills to identify health patterns among arriving refugees, monitor access to appropriately designed health services, address inequities, and communicate with policy makers and multidisciplinary teams.