Health policies and politicized health? An analysis of sexual and reproductive health policies in Peru from the perspective of medical ethics, quality of care, and human rights

Health professionals view medical ethics as a discipline that provides the basis for more adequate patient care. In recent years the concepts of quality of care and human rights - with their attending discourses - have joined the concept of medical ethics among the paradigms to consider in care for humans both at the individual and health policy levels. The current study seeks to analyze such paradigms, based on a case study of sexual and reproductive health policies in Peru in the last 10 years.     

‘Healthy Ageing’ policies and anti-ageing ideologies and practices: on the exercise of responsibility

This paper explores how the exercise of the ethics of ‘responsibility’ for health care advanced through ‘healthy ageing’ and ‘successful ageing’ narratives in Western countries animates an array of ‘authorities’, including the ‘anti-ageing medicine’ movement as a strategy to address the anxieties of growing old in Western societies and as a tool to exercise the ethos of ‘responsibility’. The choice of this type of authority as a source of guidance for self-constitution and the exercise of the ‘responsible self’, this paper will argue, enables the enactment of a type of late modernity notion of citizenship for ageing individuals based on principles of agelessness, health, independence and consumption power. Through interviews with anti-ageing consumers, however, it is also possible to argue the existence of tensions and contradictions that such a rigid model of self-constitution in later life produces, and the potential forms of resistance and contestations that may emerge as a result. In this way the current ‘war on anti-ageing medicine’ (Vincent 2003) becomes also symptomatic of bigger ‘wars’ taking place not only between institutions competing for control over knowledge and management of ageing, but between those in favour and against the homogenisation of life under the language of universal science, reason and market rationality.     

Are pro-welfare state and full-employment policies possible in the era of globalization?

There is a widely held belief in U.S. and European economic, political, and academic circles that economic globalization has considerably diminished states' power to follow public policies identified with the social democratic tradition, such as full-employment policies, comprehensive and universal provision of welfare state services, and state regulatory interventions in labor markets and economic policies. And large sectors of the European center-left and left parties believe that European monetary integration made expansionist and full-employment policies practically impossible, except when realized at the European continental level. This article presents empirical information that questions these positions. It documents how specific governments in Europe have been able to carry out such public policies during these years of economic globalization and monetary integration. Some countries (such as Sweden and Finland) that had carried out these policies then later weakened their implementation did so in response to political changes mostly unrelated to globalization of the economy or monetary integration. The article also analyzes and documents how countries that had followed expansionist and full-employment policies have responded to the globalization of financial markets.     

More than words? The status and impact of smoking policies in Scottish schools

The aim of this study was to investigate the current status of smoking policies in Scottish schools, and the relationship between policy status, enforcement of smoking restrictions and perceptions of smoking behaviour among pupils and teachers. A representative sample of 15-year-old school pupils from 77 Scottish secondary schools was surveyed in 1998 regarding their perceptions of smoking in several locations within and outside the school building. Two staff members from each school were also surveyed regarding school smoking policies for pupils and teachers, the nature of the school's smoking restrictions, and the extent to which the restrictions were enforced. The results showed that more schools had a written policy on teacher smoking than on pupil smoking. All schools in the sample banned smoking by pupils, but the majority allowed smoking by teachers in restricted areas. Irrespective of the type of policy or restrictions on smoking, pupils reported seeing smoking among both pupils and teachers on school premises in all of the sample schools. Whether or not a school had a written policy appeared to be unrelated to pupil smoking in the toilets or teacher smoking outdoors on school premises. However, pupils were less likely to be aware of pupils smoking outdoors and teachers smoking in the staff rooms in schools where there were written policies on pupil and teacher smoking, respectively. Consistent enforcement of a ban on pupil smoking was associated with lower levels of perceived smoking among pupils. Where a complete ban on teacher smoking existed, smoking among teachers was seen less often in the staff rooms, but more often in outside areas on school premises. The results have implications for the use of policy in promoting a healthy school environment.     

Are migrants health policies aimed at improving access to quality healthcare? An analysis of Spanish policies

Although until April 2012, all Spanish citizens regardless of their origin, residence status and work situation were entitled to health care, available evidence suggested inadequate access for immigrants. Following the Aday and Andersen model, we conducted an analysis of policy elements that affect immigrants’ access to health care in Spain, based on documentary analysis of national policies and selected regional policies related to migrant health care. Selected documents were (a) laws and plans in force at the time containing migrant health policies and (b) evaluations. The analysis included policy principles, objectives, strategies and evaluations. Results show that the national and regional policies analyzed are based on the principle that health care is a right granted to immigrants by law. These policies include strategies to facilitate access to health care, reducing barriers for entry to the system, for example simplifying requirements and raising awareness, but mostly they address the necessary qualities for services to be able to attend to a more diverse population, such as the adaptation of resources and programs, or improved communication and training. However, limited planning was identified in terms of their implementation, necessary resources and evaluation. In conclusion, the policies address relevant barriers of access for migrants and signal improvements in the health system's responsiveness, but reinforcement is required in order for them to be effectively implemented.     

Health enhancing physical activity in all policies? Comparison of national public actors between France and Belgium

Despite evidence on the benefits of health enhancing physical activity (HEPA), only few countries have developed “health in all policies” and specifically integrated HEPA policies. Paucity of studies have questioned the role of public national actors in PA policies enactment and delivery, the barriers and levers for adopting cross-sectoral HEPA. The present work seeks at comparing France and Belgium in regard to their competencies of ministries promoting HEPA, the presence of leadership and coordination in HEPA policies implementation, their key public legal entities working on HEPA. Expert interviews and document analysis were realized to complete the HEPA policy audit tool in each country. Results have shown that HEPA cross-sectoral policies are at their early stage. A broad diversity of sectors was implicated in HEPA policies: sport, health, transport, environment, and education, but often with weak activity. No leadership or coordination exist to implement HEPA policies, although different public legal entities could work on this aim. Ministries relationships were principally coming from formal co-interventions mandated by national public plans in France, where in Belgium relationships were punctual. Lobbying within each sector and in key public legal entities to promote HEPA is needed, and the development of official national coordination is essential.     

Who does the hat fit? Teenager heterogeneity and the effectiveness of information policies in preventing cannabis use and heavy drinking

This paper models heterogeneity in the relationship between exposure to information at school or in the media and cannabis use and heavy drinking, using latent class techniques applied to data on French teenagers collected in 1993. Teenagers cluster in five classes which differ in their tastes for drunkenness and cannabis, and in the correlations between information exposure and cannabis use or heavy drinking. Teenager heterogeneity and habit-formation or precociousness effects limit the effectiveness of general information policies. Improving the impact of prevention requires that interventions be better targeted and personalised. We show how economic theory, latent class techniques and existing psychometric questionnaires can be used to build simple statistical tools for targeting prevention policies.     

Support for tobacco control policies: how congruent are the attitudes of legislators and the public?

OBJECTIVES: To examine the congruence in perceptions and attitudes of legislators and the public regarding tobacco and tobacco control policies. METHODS: Two cross-sectional surveys were used, one of elected federal and provincial legislators and one of adult residents in Ontario, Canada. Perceptions and attitudes were analyzed as dependent variables using multiple logistic regression, and adjusted for age, sex, educational attainment, and smoking status. FINDINGS: Congruence was found in most instances, however, some differences were found. Legislators were more likely than the public to agree that most smokers are addicted and were more supportive of a smoking ban in workplaces, but these differences disappeared after controlling for socio-demographic characteristics. Legislators were also more aware than the public of the magnitude of deaths due to tobacco compared to alcohol, whereas the public was more supportive of strong penalties against stores that sell cigarettes to minors. CONCLUSIONS: Our findings provide considerable evidence for congruence in the "real-world" (unadjusted) perceptions and attitudes of Ontario legislators and the Ontario public toward tobacco control policies. Such findings are positive for tobacco control advocates and should be leveraged to bring forward strong tobacco policies in the political arena.     

Smoke-free policies and non-smokers’ reactions to SHS exposure in small and medium enterprises

Introduction

Non-smoker employees can significantly improve the existing smoke-free policies in the workplace by asserting their right for smoke-free air and confronting smoker colleagues. The aim of the study was to assess the psychological and social drivers of non-smokers’ readiness to assert their right for smoke-free air in the workplace.

Materials and Methods

Twenty-six small-and-medium enterprises (SME) with diverse background were randomly selected, and 284 employees agreed to participate in the study. Our study focused on the responses of 85 non-smokers (M age = 34 years, SD = 7.98, 84.2% worked in indoor offices). A cross-sectional design was used and participants completed a structured anonymous questionnaire assessing background and demographic characteristics, and psychosocial predictors of assertiveness intentions.

Results

Although more than half of non-smokers reported they were often/almost always bothered by exposure to SHS, roughly one third of them reported having asked their colleagues not to smoke at work. Regression analysis showed that the effects of distal predictors (i.e. annoyance due to SHS exposure) were mediated by past behaviour, attitudes (protection motivation beliefs), social norms, and self-efficacy.

Conclusions

Health beliefs related to SHS exposure, and concerns about workplace health and job performance, social norms and self-efficacy can increase the assertiveness of non-smokers in workplace settings. Related campaigns should focus on communicating normative messages and self-efficacy training to empower non-smoker employees to act assertively towards protecting their smoke-free rights.     

Do health reception policies in the Nordic region recognize the rights of asylum-seeking and resettled refugee children?

According to the United Nations Committee on the Rights of the Child, it is critical that refugee children’s rights are upheld in all national policies covering vulnerable children. This article examines how health policies in the Nordic region recognize the health needs of newly arrived refugee children, and whether these policies respect their individual rights. The article maps out, compares and contrasts health reception policies in Denmark, Finland, Norway and Sweden, paying particular attention to how each addresses the rights and needs of refugee children. The policy documents were obtained through desk-research conducted from January 2017–January 2018. We analysed 34 national laws and guidelines that support the health reception of refugee children. We find that only a few health reception policies across the Nordic region have been written specifically for refugee children. The policies identified predominantly recognize refugee children’s right of access to somatic healthcare services, and to emergency services. Their rights to mental health services or broader health-enabling contexts were addressed to a lesser extent. We conclude that there is a need for further recognition of refugee children as rights-holders, and for the intentions of health reception policies to be expanded to include mental health services and health-promoting initiatives. Further research is needed on whether and how the current policies play out in actual health reception practices.     

Income transfer policies and the impacts on the immunization of children: the Bolsa Família Program

This paper investigates the impact of the Bolsa Família Program on the immunization of children from 0 to 6 years of age in Brazil and its regions. The Bolsa Família program is a conditional cash transfer program. One of its conditionalities is the compliance of children with the immunization schedule ordered by the Ministry of Health. The evaluation was performed using the Propensity Score Matching technique. We used data from a survey conducted in 2005 evaluating the program - Pesquisa de Avalia??o de Impacto do Programa Bolsa Família. The main findings suggest that the Bolsa Família Program does not affect the immunization status of children.     

Addressing the health disadvantage of rural populations: How does epidemiological evidence inform rural health policies and research?

We reviewed evidence of any apparently significant 'rural-urban' health status differentials in developed countries, to determine whether such differentials are generic or nation-specific, and to explore the nature and policy implications of determinants underpinning rural-urban health variations. A comprehensive literature review of rural-urban health status differentials within Australia, New Zealand, Canada, the USA, the UK, and a variety of other western European nations was undertaken to understand the differences in life expectancy and cause-specific morbidity and mortality. While rural location plays a major role in determining the nature and level of access to and provision of health services, it does not always translate into health disadvantage. When controlling for major risk determinants, rurality per se does not necessarily lead to rural-urban disparities, but may exacerbate the effects of socio-economic disadvantage, ethnicity, poorer service availability, higher levels of personal risk and more hazardous environmental, occupational and transportation conditions. Programs to improve rural health will be most effective when based on policies which target all risk determinants collectively contributing to poor rural health outcomes. Focusing solely on 'area-based' explanations and responses to rural health problems may divert attention from more fundamental social and structural processes operating in the broader context to the detriment of rural health policy formulation and remedial effort.     

Does job strain mediate the effect of socioeconomic group on smoking behaviour? The impact of different health policies in Denmark and Sweden

AIMS: The aim was to compare the impact of socioeconomic groups (SEG) on the risk of being a daily smoker or quitter, and to investigate whether the potentially mediating effect of psychosocial working conditions was similar in the Danish and the Swedish populations. METHODS: The study populations consisted of 10,049 employed participants, aged 18-64 years, 51% women, randomly selected from the general populations in the Oresund region, 1999-2000. Odds ratios (OR) for daily-smokers and "non-quitters' were computed for two age-groups and two SEGs in gender specific models, stratified by country. The association between SEG, current smoking, quitting, and influence at work, job demand and jobstrain, respectively, was tested by means of logistic regression. RESULTS: The contextual determinants defined by country had a different effect on smoking prevalence among men and women and among age groups. Low influence and job strain seemed to have an effect on smoking among Danish women, but not among Swedish women. The OR of being a daily smoker were higher in men than women among younger Danes, but higher in women than men among Swedes. The prevalence of low influence, high demand and job strain was higher and more socially skewed among the Swedes, but did not mediate the effect of SEG on smoking behaviour. CONCLUSIONS: The smoking prevalence was lower and the quit-rates higher among Swedes than Danes. Both countries had social differences in smoking that in absolute terms were rather similar, but in relative terms were higher in Sweden. The mediating effect of psychosocial working conditions was lacking. The determinants of smoking behaviours must be found somewhere else in the social and cultural context.     

Is there a relation between school smoking policies and youth cigarette smoking knowledge and behaviors?

To comply with workplace legislation, New Zealand schools are required to have policies regarding tobacco smoking. Many schools also have policies to prevent tobacco use by students, including education programmes, cessation support and punishment for students found smoking. This paper investigated the associations between school policies and the prevalence of students' cigarette smoking. Furthermore, we investigated the association between school policy and students' tobacco purchasing behavior, knowledge of health effects from tobacco use and likelihood of influencing others not to smoke. Data were obtained from a self-report survey administered to 2,658 New Zealand secondary school students and staff from 63 schools selected using a multi-stage sampling procedure. Components of school policy were not significantly associated with smoking outcomes, health knowledge or health behavior, and weakly related to a punishment emphasis and students advising others to not smoke. Similarly, weak associations were found between not advising others to not smoke and policies with a punishment emphasis as well as smoke-free environments. The results suggest that having a school tobacco policy was unrelated to the prevalence of tobacco use among students, tobacco purchasing behavior and knowledge of the negative health effects of tobacco.