The human genome as public: Justifications and implications

Since the human genome was decoded, great emphasis has been placed on the unique, personal nature of the genome, along with the benefits that personalized medicine can bring to individuals and the importance of safeguarding genetic privacy. As a result, an equally important aspect of the human genome – its common nature – has been underappreciated and underrepresented in the ethics literature and policy dialogue surrounding genetics and genomics. This article will argue that, just as the personal nature of the genome has been used to reinforce individual rights and justify important privacy protections, so too the common nature of the genome can be employed to support protections of the genome at a population level and policies designed to promote the public's wellbeing. In order for public health officials to have the authority to develop genetics policies for the sake of the public good, the genome must have not only a common, but also a public, dimension. This article contends that DNA carries a public dimension through the use of two conceptual frameworks: the common heritage (CH) framework and the common resource (CR) framework. Both frameworks establish a public interest in the human genome, but the CH framework can be used to justify policies aimed at preserving and protecting the genome, while the CR framework can be employed to justify policies for utilizing the genome for the public benefit. A variety of possible policy implications are discussed, with special attention paid to the use of large‐scale genomics databases for public health research.     

PROVIDER‐INITIATED HIV TESTING AND COUNSELING IN HEALTH FACILITIES – WHAT DOES THIS MEAN FOR THE HEALTH AND HUMAN RIGHTS OF PREGNANT WOMEN?

Since the introduction of drugs to prevent vertical transmission of HIV, the purpose of and approach to HIV testing of pregnant women has increasingly become an area of major controversy. In recent years, many strategies to increase the uptake of HIV testing have focused on offering HIV tests to women in pregnancy-related services. New global guidance issued by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) specifically notes these services as an entry point for provider-initiated HIV testing and counseling (PITC). The guidance constitutes a useful first step towards a framework within which PITC sensitive to health, human rights and ethical concerns can be provided to pregnant women in health facilities. However, a number of issues will require further attention as implementation moves forward. It is incumbent on all those involved in the scale up of PITC to ensure that it promotes long-term connection with relevant health services and does not result simply in increased testing with no concrete benefits being accrued by the women being tested. Within health services, this will require significant attention to informed consent, pre- and post-test counseling, patient confidentiality, referrals and access to appropriate services, as well as reduction of stigma and discrimination. Beyond health services, efforts will be needed to address larger societal, legal, policy and contextual issues. The health and human rights of pregnant women must be a primary consideration in how HIV testing is implemented; they can benefit greatly from PITC but only if it is carried out appropriately.     

GLOBALIZATION, HUMAN RIGHTS, AND THE SOCIAL DETERMINANTS OF HEALTH

Globalization, a process characterized by the growing interdependence of the world's people, impacts health systems and the social determinants of health in ways that are detrimental to health equity. In a world in which there are few countervailing normative and policy approaches to the dominant neoliberal regime underpinning globalization, the human rights paradigm constitutes a widely shared foundation for challenging globalization's effects. The substantive rights enumerated in human rights instruments include the right to the highest attainable level of physical and mental health and others that are relevant to the determinants of health. The rights stipulated in these documents impose extensive legal obligations on states that have ratified these documents and confer health entitlements on their residents. Human rights norms have also inspired civil society efforts to improve access to essential medicines and medical services, particularly for HIV/AIDS. Nevertheless, many factors reduce the potential counterweight human rights might exert, including and specifically the nature of the human rights approach, weak political commitments to promoting and protecting health rights on the part of some states and their lack of institutional and economic resources to do so. Global economic markets and the relative power of global economic institutions are also shrinking national policy space. This article reviews the potential contributions and limitations of human rights to achieving greater equity in shaping the social determinants of health.     

Dynamic health policies for controlling the spread of emerging infections: influenza as an example

The recent appearance and spread of novel infectious pathogens provide motivation for using models as tools to guide public health decision-making. Here we describe a modeling approach for developing dynamic health policies that allow for adaptive decision-making as new data become available during an epidemic. In contrast to static health policies which have generally been selected by comparing the performance of a limited number of pre-determined sequences of interventions within simulation or mathematical models, dynamic health policies produce "real-time" recommendations for the choice of the best current intervention based on the observable state of the epidemic. Using cumulative real-time data for disease spread coupled with current information about resource availability, these policies provide recommendations for interventions that optimally utilize available resources to preserve the overall health of the population. We illustrate the design and implementation of a dynamic health policy for the control of a novel strain of influenza, where we assume that two types of intervention may be available during the epidemic: (1) vaccines and antiviral drugs, and (2) transmission reducing measures, such as social distancing or mask use, that may be turned "on" or "off" repeatedly during the course of epidemic. In this example, the optimal dynamic health policy maximizes the overall population's health during the epidemic by specifying at any point of time, based on observable conditions, (1) the number of individuals to vaccinate if vaccines are available, and (2) whether the transmission-reducing intervention should be either employed or removed.     

The Pacific Islands: a biotechnology resource bank of medicinal plants and traditional intellectual property

Traditional medicines, the mainstay of medical treatment for virtually all minor ailments in many developing countries, have been tapped for the production of new therapeutics in the sustenance of human health and well-being. Vulnerable to the vicissitudes of globalization issues such as intellectual property rights, trade and gender are of relevance in the Pacific region that is a source of some unique traditional healing systems.     

The effect of consumption and production policies on circular economy business models: A machine learning approach

The circular economy (CE) is attracting increasing interest, as it can bring environmental, social, and economic benefits. However, policymakers and scholars appear to concentrate more on the production side of CE, while consumption, and particularly policies that affect consumption have received less attention and their effect is ambiguous. This paper investigates the effect of CE consumption policies on circular economy business models (CEBMs) in firms, but also examines the interplay this type of policies have with CE production policies to have a broader picture of the circular economy policy framework and the relevance of each type of policy on firms. While previous studies assume rational and passive consumer behavior, this paper borrows from a natural resource-based view and stakeholder theory, arguing that consumers have a proactive attitude toward the consumption of environmentally friendly products. Moreover, we use institutional theory as an analytical framework for modeling the effects of a particular policy framework on the CEBM. Our analysis combines classical econometric methods with machine learning approaches, employing data from the EU. The results show that CE policies aimed at promoting consumption have a direct and positive effect on CEBMs. This paper also confirms that a wide portfolio of CE policies on production and consumption has a greater effect on the development of CEBMs, due to the complementarity of CE consumption and production policies. Moreover, we show that in interaction with CE production policies, CE policies on consumption have an even greater effect on CEBMs in firms than would have been anticipated.     

Linking reductionist science and holistic policy using systematic reviews: unpacking environmental policy questions to construct an evidence-based framework

1. There is a mismatch between broad holistic questions typically posed in policy formation and narrow reductionist questions that are susceptible to scientific method. This inhibits the two-way flow of information at the science-policy interface and weakens the impact of applied ecology on environmental policy.
2. We investigate the approaches to building policy in the health services as a model to help establish a framework in applied ecology and environmental management by which reductionist science can underpin decision making at the policy level.
3. A comparison of policy documents in the health and environmental sectors reveals many similarities in identifying approaches and specific interventions that might achieve policy objectives. The difference is that in the health services, information on the effectiveness of potential interventions is far more readily available through the collaborative process of systematic review.
4. Synthesis and applications . Decision makers are increasingly looking to produce policies that are shaped by evidence through evidence-based policy making. The approach that we outline here provides a framework for structuring systematic reviews to deliver the evidence on key policy issues in a way that will see a faster return and provide better use of the systematic review methodology in environmental management.     

Brazilian public policies for reproductive health: family planning, abortion and prenatal care

This study is an ethical reflection on the formulation and application of public policies regarding reproductive health in Brazil. The Integral Assistance Program for Women's Health (PAISM) can be considered advanced for a country in development. Universal access for family planning is foreseen in the Brazilian legislation, but the services do not offer contraceptive methods for the population in a regular and consistent manner. Abortion is restricted by law to two cases: risk to the woman's life and rape. This reality favors the practice of unsafe abortion, which is the third largest cause of maternal death in Brazil. Legal abortion is regulated by the State and the procedure is performed in public health centers. However, there is resistance on the part of professionals to attend these women. Prenatal care is a priority strategy for promoting the quality of life of these women and of future generations. Nonetheless, it is still difficult for these women to access the prenatal care services and to have the required number of consultations. Moreover, managers and health professionals need to be made aware of the importance of implementing the actions indicated by the public policies in the area of sexual and reproductive health, favoring respect for autonomy in a context of personal freedom.     

Global immunization policies and recommendations: objectives and process

The World Health Organization (WHO) has a dual mandate of providing global policies, standards and norms as well as support for member countries in applying such policies and standards to national programmes with the aim to improve health. The vaccine world is changing and with it the demands and expectations of the global and national policy makers, donors, and other interested parties. Changes pertain to : new vaccines and technologies developments, vaccine safety issues, regulation and approval of vaccines, and increased funding flowing through new financing mechanisms. This places a special responsibility on WHO to respond effectively. WHO has recently reviewed and optimized its policy making structure for vaccines and immunization and adjusted it to the new Global Immunization Vision and Strategy, which broadens the scope of immunization efforts to all age groups and vaccines with emphasis on integration of immunization delivery with other health interventions. This includes an extended consultation process to promptly generate evidence base recommendations, ensuring transparency of the decision making process and added communication efforts. This article presents the objectives and impact of the process set to develop global immunization policies, norms, standards and recommendations. The key advisory committees landscape contributing to this process is described. This includes the Strategic Advisory Group of Experts, the Global Advisory Committee on Vaccine Safety and the Expert Committee on Biological Standardization. The elaboration of WHO vaccine position papers is also described.     

Effect of an abrupt change in sexual and reproductive health policy on teen birth rates in Ecuador, 2008–2017

Several countries have implemented “family-centered” abstinence-only policies for teenagers, as opposed to encouraging utilization and expansion of reproductive health services and education. Little is known, however, about the effects of these more restrictive policies on adolescent birth rates at the national level or their differential effects by race and ethnicity. The extant literature is even scarcer in low- and middle-income countries. We analyze an unexpected policy change in Ecuador that abruptly reversed course and restricted reproductive health services for teenage women in 2014. We use a canton- and time-fixed effects difference-in-differences analysis of Ecuador’s 221 cantons with time-varying controls to analyze the impact of the abrupt policy change on the difference of teen (15−19 years) minus young adult (20−24 years) birth rates. In a difference-in-difference-in-differences analysis, the policy change increases birth rates by 8.5 births per 1000 women in cantons with higher indigenous concentration. Results are robust to changes in the comparison population (young adults vs. women in their late 20 s or in their early 30 s), pre-intervention control periods, population weighting, serial correlation, logarithmic model specification, adjustments for intervention year, definition of indigenous concentration, and potential delays in policy implementation.     

Examining arts education policy development through policy frameworks

ABSTRACT

While policy formation frameworks are commonly used to understand public policy developments, scholars rarely have used them to reflect on arts education policies. Such analysis is important because it can assist both in identifying the genesis of past policies, including who the important actors are, how issues are framed and problematized, and how specific solutions are designed, as well as how to interpret unfolding policies. In this article, I review three prominent policy frameworks: Kingdon's “multiple streams framework,” Sabatier and Jenkins-Smith's “advocacy coalition framework,” and Baumgartner and Jones' “punctuated equilibrium framework.” After reviewing the frameworks, I address the following questions: (a) How would these conceptual frameworks predict arts education policy development to proceed? (b) How would these conceptual frameworks explain constituents and coalitions that affect the arts education policy sphere? (c) How would these conceptual frameworks illuminate precipitating events that drive the policy development process? I apply the frameworks to several instances of arts education policy development, including the formal designation of the arts as a core subjects under the Goals 2000: Educate America Act of 1994 (P.L. 103-227), the development of the 2014 National Core Arts Standards, and music's enumeration in the Every Student Succeeds Act of 2015. Because these three policy issues differ in important ways, they can help to illuminate the breadth of arts education policy.     

基于生态系统服务和农户福祉的生态补偿效果评估研究进展

生态补偿是以经济手段为主调节相关者利益关系的制度安排,最终实现区域生态系统服务和居民福祉"双赢"。尽管我国在生态补偿效果评估方面已开展了大量的研究,但更多关注的是生态系统服务功能的提升,忽略了生态补偿对社区居民福祉的影响及其反馈关系,影响了生态补偿政策的成效和可持续性。围绕生态补偿效果评估中涉及到的主要内容和关键的科学问题,对相关研究进行了归纳总结,认为:生态补偿、农户福祉、生态系统服务三者之间的耦合关系是生态补偿效果评估研究的重要科学问题;生态系统服务、农户生计、成本效益是评估生态补偿效果的3个核心指标;综合自然、人文两个因素统一的生态补偿评估与调控模型与方法体系,是亟待研究探索的重要方向。     

Regional implementation of alternative entry control policies and their role in fisheries management

Abstract

This paper reviews and examines the development of the concept of entry control policies in fisheries management. With renewed expectations for U. S. fisheries surrounding the recent enactment of legislation that extends jurisdiction over living resources within 200 mi, optimal management of an open‐access resource becomes an increasingly important public policy problem. The paper reviews alternative entry control schemes and criteria in order to evaluate their effectiveness and suggests ways in which limited entry could be implemented incrementally. It is argued that the appropriate combination of alternative limited‐entry mechanisms should take into account regional variables that affect the feasibility of entry controls for each particular fishery. It is also postulated that exploitation of an open‐access resource such as a fishery implies certain types of political behavior and outcomes that are analogous to economic behavior and outcomes in a common‐property resource environment. These characteristics of an openaccess resource, along with physical characteristics, tend to inhibit severely the rate of development of clearly defined property rights that would enhance the overall efficiency of the resource industry. The rate of development of property rights in an open‐access resource is a function of the cost of defining and enforcing these rights. The paper urges further identification and analysis of these “transactions costs,” which are largely a function of the political environment.     

Social Responsibility and the State's Duty to provide Healthcare: An Islamic Ethico‐Legal Perspective

The United Nations Educational, Scientific and Cultural Organization's (UNESCO) Declaration on Bioethics and Human Rights asserts that governments are morally obliged to promote health and to provide access to quality healthcare, essential medicines and adequate nutrition and water to all members of society. According to UNESCO, this obligation is grounded in a moral commitment to promoting fundamental human rights and emerges from the principle of social responsibility. Yet in an era of ethical pluralism and contentions over the universality of human rights conventions, the extent to which the UNESCO Declaration can motivate behaviors and policies rests, at least in part, upon accepting the moral arguments it makes. In this essay I reflect on a state's moral obligation to provide healthcare from the perspective of Islamic moral theology and law. I examine how Islamic ethico‐legal conceptual analogues for human rights and communal responsibility, ?uqūq al‐’ibād and far? al‐kifāyah and other related constructs might be used to advance a moral argument for healthcare provision by the state. Moving from theory to application, I next illustrate how notions of human rights and social responsibility were used by Muslim stakeholders to buttress moral arguments to support American healthcare reform. In this way, the paper advance discourses on a universal bioethics and common morality by bringing into view the concordances and discordances between Islamic ethico‐legal constructs and moral arguments advanced by transnational health policy advocates. It also provides insight into applied Islamic bioethics by demonstrating how Islamic ethico‐legal values might inform the discursive outputs of Muslim organizations.     

Evidence-informed policy formulation and implementation: a comparative case study of two national policies for improving health and social care in Sweden

Background

Evidence has come to play a central role in health policymaking. However, policymakers tend to use other types of information besides research evidence. Most prior studies on evidence-informed policy have focused on the policy formulation phase without a systematic analysis of its implementation. It has been suggested that in order to fully understand the policy process, the analysis should include both policy formulation and implementation. The purpose of the study was to explore and compare two policies aiming to improve health and social care in Sweden and to empirically test a new conceptual model for evidence-informed policy formulation and implementation.

Methods

Two concurrent national policies were studied during the entire policy process using a longitudinal, comparative case study approach. Data was collected through interviews, observations, and documents. A Conceptual Model for Evidence-Informed Policy Formulation and Implementation was developed based on prior frameworks for evidence-informed policymaking and policy dissemination and implementation. The conceptual model was used to organize and analyze the data.

Results

The policies differed regarding the use of evidence in the policy formulation and the extent to which the policy formulation and implementation phases overlapped. Similarities between the cases were an emphasis on capacity assessment, modified activities based on the assessment, and a highly active implementation approach relying on networks of stakeholders. The Conceptual Model for Evidence-Informed Policy Formulation and Implementation was empirically useful to organize the data.

Conclusions

The policy actors’ roles and functions were found to have a great influence on the choices of strategies and collaborators in all policy phases. The Conceptual Model for Evidence-Informed Policy Formulation and Implementation was found to be useful. However, it provided insufficient guidance for analyzing actors involved in the policy process, capacity-building strategies, and overlapping policy phases. A revised version of the model that includes these aspects is suggested.

     

生态系统综合评价的内容与方法

生态系统综合评价是系统分析生态系统的生产及服务能力,对生态系统进行健康诊断,做出综合的生态分析和经济分析,评价其当前状态,并预测生态系统今后的发展趋势,为生态系统管理提供科学依据。从总体上讲,综合评价更强调生态系统一系列产品与服务功能之间的权衡,具有很强的实践意义。许多学者对不同的生态系统服务功能进行了经济价值评估,但缺乏对生态系统的产品、服务、健康与管理之间关系的进一步探讨。对生态系统服务功能评价、健康评价的生态管理与预测进行了系统论述,目的是提出生态系统综合评价的框架,指导生态系统评价行动及生态系统管理。     

Life-cycle based government policies a survey

This paper examines how different Life-Cycle Assessment (LCA) approaches, from full LCA’s to more qualitative LCA’s, are being used internationally in the development of government policies. Examples from 14 countries are provided for recent initiatives in various forms of policy which were developed to move national environmental policies toward the more life-cycle based programs. They indicate that a broader frame of reference is beginning to be used by those who write such policies. Discussion is also provided on the barriers that slow the adoption of life-cycle approaches in the development of government policies.     

Prescribing at the hospital-general practice interface. I: Hospital outpatient dispensing policies in England.

OBJECTIVE--To describe the outpatient dispensing policies of major acute hospitals in England. DESIGN--Postal questionnaire survey in November 1990. SETTING--All (278) major acute hospitals in England with more than 250 beds, excluding maternity, paediatric, or psychiatric hospitals; nine hospitals declined. PARTICIPANTS--Hospital chief pharmacists. MAIN OUTCOME MEASURES--Current dispensing policy and exceptions to it; when the policy was formed; and who was involved in its formation. RESULTS--Completed questionnaires were received from 200 (72%) of the hospitals approached. The quantities of drugs dispensed to outpatients ranged from zero in 12 hospitals to unlimited amounts in nine; nearly half (92) dispensed a 14 days'' supply of drugs. The greater the restriction on outpatient dispensing, the more recently the policy had been introduced (chi 2 for trend = 7.15; df = 1; p less than 0.01). Permissible exceptions to the policy included the consultant''s specific request (134 hospitals), difficulty in obtaining drugs in the community (102), urgent need for start of treatment (49), and certain types of patients (41) or drugs or their regimens (104). Groups who were neither represented on the hospital committee concerned with policy formation nor consulted before policy changes included regional health authorities in 122 hospitals, district health authorities in 101 hospitals, and general practitioners in 32 hospitals. CONCLUSIONS--Outpatient dispensing policies varied considerably among the hospitals surveyed, but they seemed to be moving towards greater restrictions on the supply of drugs given to outpatients.