States and Capitals of Health: Multilevel Health Governance in Brazil

2018 ◽  
Vol 61 (1) ◽  
pp. 54-77 ◽  
Author(s):  
Jorge Antonio Alves ◽  
Christopher L. Gibson
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Local Governments ◽  
Care Delivery ◽  
Comparative Case Study ◽  
Federal State ◽  
Participatory Institutions ◽  
State And Local ◽  
Belo Horizonte ◽  
The Impact

AbstractScholars of Brazil’s public health system commonly note the intertwined roles that federal, state, and municipal governments play in delivering care, yet few studies systematically examine varying service performance in areas with overlapping mandates, such as state capitals. This study addresses that gap by developing and analyzing a novel measure of municipal primary care provision that accounts for the proportion of the population without access to private services in 11 large capital cities, then comparing them to the noncapital municipalities in their states. The study finds that capitals generally underperform the noncapital municipalities in primary service delivery. It then draws on a comparative case study in two major capitals, Salvador and Belo Horizonte, and their encompassing states to explore how a history of cooperative or adversarial relations between state and local governments conditions the impact of partisanship, participatory institutions, and public health activists on primary care delivery.

Emergency Legal Preparedness Among Select US Local Governments

2009 ◽  
Vol 3 (S2) ◽  
pp. S176-S184 ◽  
Author(s):  
Evan D. Anderson ◽  
James G. Hodge
Keyword(s):  
Public Health ◽  
Emergency Preparedness ◽  
Local Governments ◽  
H1n1 Influenza ◽  
Federal State ◽  
Home Rule ◽  
Influenza Outbreak ◽  
Key Issues ◽  
State And Local ◽  
The Impact

ABSTRACTLegal preparedness is an essential component of effective public health emergency response, evinced recently by the numerous emergency declarations issued at the federal, state, and local levels to address the 2009 H1N1 influenza outbreak. Although the impact of these emergency laws at the federal and state levels has been studied extensively, the scope and role of local emergency laws have not been similarly assessed. In this article, we examine key issues of emergency laws among select US localities in the context of the recent H1N1 outbreak and their application to volunteer health professionals, who are often needed to meet patient surge capacity during local emergencies.Localities represent the front line of emergency preparedness and must address an array of legal challenges before and during declared emergencies. Local legal preparedness differs based on overarching restrictions such as the degree of home rule provided to localities under state law. Some localities take innovative legal approaches to address emergency preparedness. Although beneficial in many respects, these variations add additional complexity to legal preparedness and intensify the need for predisaster planning, exercises, and coordination. (Disaster Med Public Health Preparedness. 2009;3(Suppl 2):S176–S184)

scholarly journals A Framework for Rigorous Qualitative Research as a Component of Mixed Method Rapid-Cycle Evaluation

2018 ◽  
Vol 29 (2) ◽  
pp. 279-289 ◽  
Author(s):  
Megan Skillman ◽  
Caitlin Cross-Barnet ◽  
Rachel Friedman Singer ◽  
Christina Rotondo ◽  
Sarah Ruiz ◽  
...  
Keyword(s):  
Qualitative Research ◽  
Mixed Method ◽  
Local Governments ◽  
Care Delivery ◽  
Rapid Assessment ◽  
Evaluation Framework ◽  
Federal State ◽  
Annual Reporting ◽  
Multiple Cycles ◽  
State And Local

As federal, state, and local governments continue to test innovative approaches to health care delivery, the ability to produce timely and reliable evidence of what works and why it works is crucial. There is limited literature on methodological approaches to rapid-cycle qualitative research. The purpose of this article is to describe the advantages and limitations of a broadly applicable framework for in-depth qualitative analysis placed within a larger rapid-cycle, multisite, mixed-method evaluation. This evaluation included multiple cycles of primary qualitative data collection and quarterly and annual reporting. Several strategies allowed us to be adaptable while remaining rigorous; these included planning for multiple waves of qualitative coding, a hybrid inductive/deductive approach informed by a cross-program evaluation framework, and use of a large team with specific program expertise. Lessons from this evaluation can inform researchers and evaluators functioning in rapid assessment or rapid-cycle evaluation contexts.

scholarly journals The impact of household connection to public network wastewater systems: regulatory impact assessment

2019 ◽  
Vol 79 (6) ◽  
pp. 1060-1070
Author(s):  
Bruno Eustaquio de Carvalho ◽  
Samuel Alves Barbi Costa ◽  
Rui Cunha Marques ◽  
Oscar Cordeiro Netto
Keyword(s):  
Impact Assessment ◽  
Urban Areas ◽  
Local Governments ◽  
Federal State ◽  
Public Network ◽  
Policy Tool ◽  
Regulatory Impact ◽  
State And Local ◽  
The Impact ◽  
Regulatory Impact Assessment

Abstract Brazil faces a severe lack of wastewater coverage. Even in urban areas, wastewater is directly disposed of in watercourses without any treatment for a large part of the population. Although the federal, state, and local governments have invested in water and wastewater services (WWS), the expected results have not been achieved. To overcome this problem, the present paper provides an opportunity to observe an ex-ante regulatory impact assessment (RIA) as a policy tool in Brazil. The regulatory policy options will be appraised through the multiple criteria decision analysis (MCDA) according to the following objectives: (i) protect the customers with respect to social aspects; (ii) safeguard the economic, operational and infrastructure sustainability; and (iii) protect the environment. The results show that by making decisions based on evidence, policy makers should reduce the households not connected to wastewater services by 75% and for that they should incur BRL 33 million to the year 2023. Hence, the extra revenues to be obtained with these new connections are capable of making a surplus estimated as BRL 42 million for the same period. This study promotes the use of RIA as a rational, robust and transparent decision framework by the regulatory agencies worldwide.

scholarly journals The Impact of Alternative Distribution Formulas on the Allocation of Revenue Sharing Funds in New York State

1974 ◽  
Vol 3 (2) ◽  
pp. 124-134
Author(s):  
Harry P. Mapp
Keyword(s):  
New York ◽  
Local Governments ◽  
New York State ◽  
Federal State ◽  
Public Expenditures ◽  
Dramatic Rise ◽  
Local Government Expenditures ◽  
State And Local ◽  
The Impact

Over the past decade, a fundamental transformation has occurred in the attitudes of our citizens regarding the range, quantity and quality of services desired of all levels of government. One result has been a dramatic rise in public expenditures to provide the diverse set of services desired. For example, between 1960 and 1972, expenditures of federal, state and local governments increased from $151.3 billion to $410.3 billion, about 171 percent. Local government expenditures, which were pushed upward by expanding school enrollments and welfare caseloads, maintained their relative importance by growing from $29.0 billion to $75.4 billion, about 169 percent.

The impact of correctional institutions on public health during a pandemic or emerging infection disaster

2008 ◽  
Vol 3 (3) ◽  
pp. 165 ◽  
Author(s):  
Rachel D. Schwartz, PhD
Keyword(s):  
Public Health ◽  
Disaster Response ◽  
Medical Community ◽  
Federal State ◽  
Correctional Facilities ◽  
Local Planning ◽  
Global Pandemic ◽  
Planning Processes ◽  
State And Local ◽  
The Impact

With the growing threat of a naturally occurring or man-made global pandemic, many public, private, federal, state, and local institutions have begun to develop some form of preparedness and response plans. Among those in the front lines of preparedness are hospitals and medical professionals who will be among the first responders in the event of such a disaster. At the other end of the spectrum of preparedness is the Corrections community who have been working in a relative vacuum, in part because of lack of funding, but also because they have been largely left out of state, federal local planning processes. This isolation and lack of support is compounded by negative public perceptions of correctional facilities and their inmates, and a failure to understand the serious impact a jail or prison facility would have on public health in the event of a disaster. This article examines the unique issues faced by correctional facilities responding to disease disasters and emphasizes the importance of assisting them to develop workable and effective preparedness and response plans that will prevent them from becoming disease repositories spreading illness and infection throughout our communities. To succeed in such planning, it is crucial that the public health and medical community be involved in correctional disaster planning and that they should integrate correctional disaster response with their own. Failure to do so endangers the health of the entire nation.

scholarly journals Urban Tree Growth and Longevity: An International Meeting and Research Symposium White Paper

2012 ◽  
Vol 38 (5) ◽  
pp. 237-241
Author(s):  
Rachel Leibowitz
Keyword(s):  
Tree Growth ◽  
Local Governments ◽  
White Paper ◽  
Federal State ◽  
Future Research ◽  
Urban Tree ◽  
State And Local ◽  
Professional Practitioners ◽  
The Impact ◽  
Tree Care

Researchers from around the world gathered at The Morton Arboretum (Lisle, Illinois, U.S.) in September 2011 to share their experiences and knowledge on the topic of urban tree growth and longevity. A roundtable discussion was held at the end of the second day’s program, during which attendees discussed the state of current research in these areas and identified needs for future research. Four distinct subgroups were identified within the broader topic of urban tree growth and longevity: tree production; site design and tree selection; tree and site management; and the need for descriptive studies. Throughout the discussion, it became clear that there must be greater collaboration among researchers investigating tree growth, increased investment in long-term studies, the development of a clearing house for information, and the fostering of productive partnerships between the governmental, industry, and academic sectors. To strengthen the impact of urban tree growth research on the tree care industry, results and conclusions must be summarized and distributed through suitable means for a variety of audiences, which might include federal, state, and local governments; property owners and consumers; nurseries and growers; tree care and other green industry professionals; and urban planners, civil engineers, and landscape architects. To this end, the Urban Tree Growth & Longevity Working Group has been established to support communication between researchers and professional practitioners, enrich scientific exchange, and enhance the quality, productivity, and timeliness of research on tree growth, longevity, and mortality.

scholarly journals The Color of COVID-19: Structural Racism and the Disproportionate Impact of the Pandemic on Older Black and Latinx Adults

2020 ◽  
Author(s):  
Marc A Garcia ◽  
Patricia A Homan ◽  
Catherine García ◽  
Tyson H Brown
Keyword(s):  
Older Adults ◽  
Health Care Access ◽  
Local Governments ◽  
Federal State ◽  
Structural Racism ◽  
Weathering Processes ◽  
Challenges And Opportunities ◽  
State And Local ◽  
The Impact ◽  
Racial Ethnic

Abstract Objectives The aim of this evidence-based theoretically informed article was to provide an overview of how and why the COVID-19 outbreak is particularly detrimental for the health of older Black and Latinx adults. Methods We draw upon current events, academic literature, and numerous data sources to illustrate how biopsychosocial factors place older adults at higher risk for COVID-19 relative to younger adults, and how structural racism magnifies these risks for black and Latinx adults across the life course. Results We identify 3 proximate mechanisms through which structural racism operates as a fundamental cause of racial/ethnic inequalities in COVID-19 burden among older adults: (a) risk of exposure, (b) weathering processes, and (c) health care access and quality. Discussion While the ongoing COVID-19 pandemic is an unprecedented crisis, the racial/ethnic health inequalities among older adults it has exposed are longstanding and deeply rooted in structural racism within American society. This knowledge presents both challenges and opportunities for researchers and policymakers as they seek to address the needs of older adults. It is imperative that federal, state, and local governments collect and release comprehensive data on the number of confirmed COVID-19 cases and deaths by race/ethnicity and age to better gauge the impact of the outbreak across minority communities. We conclude with a discussion of incremental steps to be taken to lessen the disproportionate burden of COVID-19 among older Black and Latinx adults, as well as the need for transformative actions that address structural racism in order to achieve population health equity.

scholarly journals Meeting Personal Health Care Needs in Primary Care: A Response From the Athletic Training Profession

2020 ◽  
Vol 15 (4) ◽  
pp. 278-288
Author(s):  
Wade Green ◽  
Eric Sauers
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Care ◽  
Medical Education ◽  
Athletic Training ◽  
Graduate Medical Education ◽  
Care Delivery ◽  
Graduate Medical ◽  
The Impact ◽  
Training Practice

Context Review of the origins, history, and attributes of primary care demonstrates continued challenges for the future of primary care and care delivery. The profession of athletic training may benefit from a critical self-review to examine its readiness to assist in reinventing primary care. Objective To explore parity between primary care attributes and athletic training practice and promote a timely and relevant discussion of primary care and public health integration native to athletic training practice, competency-based education with an emphasis on milestones, and the development of clinical specialists to prepare a well-trained workforce. Background General practitioners developed educational reforms through graduate medical education that resulted in primary care as it is known today. Graduate medical education has refined its assessment of students to include milestones for the purpose of describing the progression of clinical competence with identifiable behaviors. The development of future clinical specialists in primary care will also involve competence in public health. Recommendation(s) Practicing clinicians and educators should begin to critically explore the congruencies between the primary care attributes and athletic training practice. It is important to conceptualize traditional models of care within the frameworks of primary care and public health, given that athletic training practice routinely engages patients at personal, community, and environmental levels. The athletic training skill mix should be purposefully presented within interprofessional health care teams in primary care so that stakeholders can appropriately integrate athletic trainers (ATs) at the point of first contact. It is plausible that continued structural changes in the traditional practice settings will be required to facilitate integration of ATs into primary care. Conclusion(s) The impact of ATs in ambulatory settings and primary care possesses a foundation in the current literature. The ATs are uniquely suited to create a symbiotic pattern of care integrating both primary care and public health for improved outcomes.

scholarly journals Queensland Family Cohort: a study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044463
Author(s):  
Danielle Borg ◽  
Kym Rae ◽  
Corrine Fiveash ◽  
Johanna Schagen ◽  
Janelle James-McAlpine ◽  
...  
Keyword(s):  
Mental Health ◽  
Family Environment ◽  
Biological Samples ◽  
Local Governments ◽  
Financial Stability ◽  
Federal State ◽  
Physical And Mental Health ◽  
Future Health ◽  
The Impact

IntroductionThe perinatal–postnatal family environment is associated with childhood outcomes including impacts on physical and mental health and educational attainment. Family longitudinal cohort studies collect in-depth data that can capture the influence of an era on family lifestyle, mental health, chronic disease, education and financial stability to enable identification of gaps in society and provide the evidence for changes in government in policy and practice.Methods and analysisThe Queensland Family Cohort (QFC) is a prospective, observational, longitudinal study that will recruit 12 500 pregnant families across the state of Queensland (QLD), Australia and intends to follow-up families and children for three decades. To identify the immediate and future health requirements of the QLD population; pregnant participants and their partners will be enrolled by 24 weeks of gestation and followed up at 24, 28 and 36 weeks of gestation, during delivery, on-ward, 6 weeks postpartum and then every 12 months where questionnaires, biological samples and physical measures will be collected from parents and children. To examine the impact of environmental exposures on families, data related to environmental pollution, household pollution and employment exposures will be linked to pregnancy and health outcomes. Where feasible, data linkage of state and federal government databases will be used to follow the participants long term. Biological samples will be stored long term for future discoveries of biomarkers of health and disease.Ethics and disseminationEthical approval has been obtained from the Mater Research Ethics (HREC/16/MHS/113). Findings will be reported to (1) QFC participating families; (2) funding bodies, institutes and hospitals supporting the QFC; (3) federal, state and local governments to inform policy; (4) presented at local, national and international conferences and (5) disseminated by peer-review publications.

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