Journal of public health policy
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J Public Health Policy · Jan 1999
ReviewLimitations of occupational air contaminant standards, as exemplified by the neurotoxin N-hexane.
Available industry guidelines and federal standards have failed to fully protect workers from chemical toxicity: none exist for most chemicals, many are biased toward what can easily be achieved, and many were developed long after health consequences became evident. Limitations of occupational air contaminant standards in the United States are well illustrated by standard-setting for the neurotoxin n-hexane. In the 1940s, the American Conference of Governmental Industrial Hygienists (ACGIH) first promulgated industrial guidelines known as "threshold limit values" (TLVs), including an 8-hour time-weighted average of 500 ppm for inspired n-hexane. ⋯ Court of Appeals in 1992. As a result, the current OSHA PEL for n-hexane remains at the 500 ppm level adopted in 1971, which even then was too high based upon available scientific evidence. New information over this long period, including that obtained from industrial outbreaks of disease due to chemical exposures, has not been incorporated into revised federal standards.
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J Public Health Policy · Jan 1999
"I didn't know the gun was loaded": an examination of two safety devices that can reduce the risk of unintentional firearm injuries.
Some handguns contain built-in safety devices intended to prevent injuries caused by erroneously believing that a handgun is loaded. A loaded chamber indicator indicates the presence of ammunition in the gun; a magazine safety prevents the gun from being fired when the ammunition magazine is removed, even if one round remains in the firing chamber. In our patent search these devices date back to the turn of the century. ⋯ S. adults, 34.8% of poll respondents (incorrectly) thought that a firearm with its ammunition magazine removed could not be shot, or said that they did not know. Some of the 1100 unintentional gun deaths in the U. S. each year might be prevented if the prevalence of these and other safety devices is increased through legislation, litigation, or voluntary manufacturer action.
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J Public Health Policy · Jan 1999
Federalist flirtations: the politics and execution of health services decentralization for the uninsured population in Mexico, 1985-1995.
Around the world health services delivery systems are undergoing decentralization, responding to pressure to increase equity, efficiency, participation, intersectoral collaboration and accountability. This study examines the Mexican health decentralization efforts of the past decade to discern the motivations for the reform, the context for its implementation, the politics of its downfall, and the reform's impact at subnational levels of government. Sparked by economic crisis and pressure from international creditors for fiscal reform; demands for greater democracy, equity, and quality; and technocratic impulses to rationalize health services delivery, the decentralization reform could not overcome the authoritarian centralism of the federal government and its corporatist clients. In the end, even in the most technically capable states, the reform was unable to overcome political obstacles to decentralizing fiscal power, redistributing resources in an equitable fashion, and eliminating the inefficiencies of separate but unequal health systems for social security recipients and the uninsured population.
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Beginning with a reminder of the main features and effects of the profound changes to the NHS made by the Conservative government in 1990, this account then reviews the incoming Labour government's proposals as set out in the White Paper "The New NHS." An analysis, based on the formal response of the NHS Consultants' Association to the White Paper, welcomes many of the new initiatives but shows how the Conservative "Internal Market" is being modified, not removed, and the proposals fall short of restoring the public service ethos. In conclusion, the arguments and strategy being employed by the Association are described.