Discourse on the idea of sustainability: with policy implications for health and welfare reform

Medicine, Health Care and Philosophy - Sustainability has become a major goal of domestic and international development. This essay analyzes the transitions of normative ideas embedded in the...     

The implications of managed care and welfare reform for the integration of health and welfare services

In this era of managed care and welfare reform, the two systems of public health and public welfare are increasingly focused on a shared population and the services designed to promote self-sufficiency and good health among low-income individuals, families and communities. The two service systems are often constrained by categorical funding mechanisms that contribute to service fragmentation, discontinuity and redundancy. This paper focuses on the changing nature of health and welfare, the impact of categorical funding mechanisms, the barriers to service integration, the potentials for partnership, and concludes with implications for enhancing service integration and the quality of services.     

Health promotion for persons with disabilities: moving beyond rehabilitation

Abstract Persons with disabilities are at significant risk for additional or secondary disabilities. Because of this increased risk, especially for persons suffering from the "disuse syndrome," it is important that a comprehensive health promotion component is included in the rehabilitation program for disabled individuals. Current concepts of disability are discussed as well as the distinctions between primary and secondary disabilities. Specific types and causes of disabilities are identified and described. Each type of secondary disability is assessed in terms of its "preventability." Examples and characteristics of quality programs for health promotion for disabled persons are presented. Recommendations for further research and study are discussed to include the need for determining effective components of successful programs and ways to encourage the field of rehabilitation to incorporate health promotion into the rehabilitation process for its disabled clients.     

Reality ignored: health reform and people with disabilities

The current health system reform debate largely has omitted the impact of different proposals on people with disabilities. Yet this population has a profound impact on the health care system and vice versa. The perspective of people with disabilities is different from that of other consumers and should be included in any health reform plan.     

Waiting time for rehabilitation services for children with physical disabilities

BACKGROUND: Early rehabilitation may minimize disability and complications. However, children often wait a long time to gain admission to rehabilitation centres. OBJECTIVES: To describe waiting times for paediatric physical and occupational therapy and to determine factors associated with these waiting times. RESEARCH DESIGN: The study was a prospective cohort design. Patients were followed from 1 January 1999 to 1 March 2000. SUBJECTS: All children with physical disabilities, aged 0-18 years, referred in 1999 from the Montreal Children's Hospital to paediatric rehabilitation centres. MEASURES: Data on date of referral, date of first appointment at the rehabilitation centre, age, gender, diagnosis, region and language were obtained from the rehabilitation transfer database. Primary family caregivers of children who were transferred to a rehabilitation facility participated in a telephone interview regarding their perceptions of the transfer process. RESULTS: There were 172 children referred to rehabilitation facilities. The mean age of the children was 2.5 years. Average waiting time was 157.4 days (SD 57.1) for occupational therapy and 129.4 days (SD 51.6) for physical therapy. Decreased waiting time was associated with living in the city as opposed to the suburbs (hazard ratio=1.77; 95% confidence interval=0.92-3.41) and inversely associated with age (hazard ratio=0.46; 95% confidence interval=0.34-0.62). Among the 41 primary family caregivers who participated in the survey, higher empowerment scores were associated with shorter waits for rehabilitation. CONCLUSION: Waiting time for rehabilitation services needs to be reduced. Empowered parents appear to manoeuvre within the system to reduce waiting times for their children.     

Infant mortality and family welfare: policy implications for Indonesia

STUDY OBJECTIVE: To examine the effect of family welfare index (FWI) and maternal education on the probability of infant death. DESIGN: A population based multistage stratified clustered survey. SETTING: Women of reproductive age in Indonesia between 1983-1997. DATA SOURCES: The 1997 Indonesian Demographic and Health Survey. Main results: Infant mortality was associated with FWI and maternal education. Relative to families of high FWI, the risk of infant death was almost twice among families of low FWI (aOR=1.7, 95%CI=0.9 to 3.3), and three times for families of medium FWI (aOR=3.3,95%CI=1.7 to 6.5). Also, the risk of infant death was threefold higher (aOR=3.4, 95% CI=1.6 to 7.1) among mothers who had fewer than seven years of formal education compared with mothers with more than seven years of education. Fertility related indicators such as young maternal age, absence from contraception, birth intervals, and prenatal care, seem to exert significant effect on the increased probability of infant death. CONCLUSIONS: The increased probability of infant mortality attributable to family income inequality and low maternal education seems to work through pathways of material deprivation and chronic psychological stress that affect a person's health damaging behaviours. The policies that are likely to significantly reduce the family's socioeconomic inequality in infant mortality are implicated.     

Groups for parents of pre-school children with severe disabilities

Summary The emotional impact upon the family following the diagnosis of a child's disability is significant although parents feel that their needs are not specifically addressed by professionals. A series of groups for the parents of pre-school children with severe disabilities are described. The groups are designed to provide parents with an opportunity to discuss in depth the impact of their childs' disability upon themselves, their partners and their families. Feedback from group members is reported and the practical issues in providing such groups discussed.     

Restrictions on undocumented immigrants' access to health services: the public health implications of welfare reform

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 greatly restricts the provision of many federal, state, and local public services to undocumented immigrants. These restrictions have prompted intense debates about the provision of free and discounted primary and preventive health care-services and have placed significant burdens on institutions that serve large undocumented immigrant populations. Intended to serve as a tool for reducing illegal immigration and protecting public resources, federal restrictions on undocumented immigrants' access to publicly financed health services unduly burden health care providers and threaten the public's health. These deleterious effects warrant the public health community's support of strategies designed to sustain provision of health services irrespective of immigration status.     

Paternalistic welfare reform: current perceptions and behavioral models

Most of the current welfare reform incentives make assumptions about the behavior of AFDC clients. Among these assumptions are that clients will seek to maximize their financial resources; that they understand the requirements of the welfare reform; and that they can control the behaviors targeted by the welfare reform effort. Using survey data gathered from AFDC clients involved in Maryland's welfare reform initiative, the authors suggest that the assumptions underlying these welfare reform initiatives may be too simplistic. For welfare reform to be effective, the authors argue that these initiatives must reflect the complexity of the problems and concerns faced by the AFDC client.     

Psychiatric disabilities and the Americans with Disabilities Act: implications for policy and practice

People with psychiatric disabilities are often victims of job discrimination. The Americans with Disabilities Act (ADA) of 1990 makes it very clear that job discrimination based on a psychiatric impairment is illegal. The Equal Employment Opportunity Commission (EEOC) reports that psychiatric disability is one of the leading causes why persons file discrimination complaints. Given this situation, an analysis is offered of what constitutes a psychiatric disability under the ADA. An overview, an analysis, and examples of the kinds of accommodations employers can be expected to provide people with psychiatric disabilities are offered. The policy and practice implications of the employment provisions (Title I) in the area of psychiatric disabilities are presented.     

Meaningful work: Questions for vocational rehabilitation and a call for action

Experiences in different cultures may lead astute observers to question existing schemes and ways of life, often taken for granted. The arena and nature of work, for instance, may differ radically from one society to another. Based on a lengthy visit to Tanna, Vanuatu, the author found that the indigenous people had qualitatively different concepts of work. Using the ideas gained from cross-cultural opportunity, questions can and should be raised about the meaningfulness of work activities, vocational rehabilitation, and the importance of examining assumptions as to what constitutes meaningful work.     

Organizational socialization of employees with disabilities: Critical issues and implications for workplace interventions

Organizational socialization is the process whereby newcomers to work organizations become insiders. The socialization process has been linked to various outcomes including newcomer job satisfaction, organizational commitment, job knowledge and performance, promotion and advancement rate, salary, and turnover. The purpose of the present paper is threefold: (1) to examine issues facing persons with disabilities during organizational socialization in order to help guide future research on this topic; (2) to provide an awareness of potential aditional barriers (unrealistic newcomer expectations, interaction avoidance, norm to be kind, low work group expectations) that face newcomers with disabilities as they begin jobs; and (3) to suggest some possible policies, programs, and interventions that might help persons with disabilities to overcome those barriers.     

Increasing National Health Service funding: implications for welfare and justice

Two of the fundamental purposes for establishing the National Health Service (NHS) were to increase social welfare and improve social justice. Decisions to increase NHS investment should ideally be taken with these fundamental objectives in mind. Given that society faces resource constraints, increased financial investment in the NHS will always involve forgone investment elsewhere, and it may never be possible to determine with any degree of certainty whether further real investment in the NHS will increase overall social welfare. If the Government decides to increase NHS investment for political reasons, it should therefore at least try to ensure that the methods by which it raises extra revenue improve social justice. The introduction of an NHS premium payment for high earners would be a progressive measure consistent with this objective.