Journal of public health policy
-
J Public Health Policy · Jan 2000
Rural economic development vs. tobacco control? Tensions underlying the use of tobacco settlement funds.
Some public health advocates in tobacco states, having reconsidered the impacts of the federal tobacco price-support program, have negotiated common tobacco regulatory policy stances with tobacco grower representatives. This paper describes the impact of this rapprochement on the state-level negotiations of Master Settlement Agreement funds. ⋯ Among three competing philosophies of economic development for TDCs, none are well evaluated, and two potentially create endless demands on Settlement resources. Public health policy advocates are urged to participate in negotiations on TDC economic development and to forcefully advocate for adequate tobacco control resources.
-
J Public Health Policy · Jan 2000
The ethics of medical marijuana: government restrictions vs. medical necessity.
Marijuana is listed by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no currently accepted medical use. However, on March 17, 1999, 11 independent scientists appointed by the Institute of Medicine reported that medical marijuana was effective in controlling some forms of pain, alleviating nausea and vomiting due to chemotherapy, treating wasting due to AIDS, and combating muscle spasms associated with multiple sclerosis. There was also no evidence that using marijuana would increase illicit drug use or that it was a "gateway" drug. ⋯ After reviewing the pertinent scientific data and applying the principle of double effect, there is a proportionate reason for allowing physicians to prescribe marijuana. Seriously ill patients have the right to effective therapies. To deny patients access to such a therapy is to deny them dignity and respect as persons.
-
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.
-
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.
-
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.