A systematic analysis of influenza vaccine shortage policies.

OBJECTIVES: The aim of this study was to apply SWOT analysis (strengths, weaknesses, opportunities, threats) to a domestic shortage of influenza vaccine, to identify lessons learned, and to generate effective solutions for future public health rationing emergencies. STUDY DESIGN/METHODS: SWOT and TOWS techniques were employed to characterize the vulnerability of the USA to disruptions in the supply of influenza vaccine. A group of five researchers reviewed relevant literature, engaged in group brainstorming, and categorized elements according to the SWOT framework. RESULTS: Three strengths, five weaknesses, five threats and seven opportunities were identified in the areas of vaccine production, purchasing and distribution, and provision. Four future recommendations emerged with respect to government investment, communications, sanctioning of physicians, and incident command. CONCLUSIONS: Application of the SWOT technique is highly relevant to the health policy realm and can assist public health planners in planning for future resource scarcity.

Water privatization and public health in Latin America.

OBJECTIVES: This study had two objectives: (1) to determine what the public health and development literature has found regarding the public health outcomes of water privatization in Latin America and (2) to evaluate whether the benefits of water privatization, if any, outweigh the equity and justice concerns that privatization raises. METHODS: Using a standard set of terms to search several databases, the authors identified and reviewed articles and other materials from public health and development sources that were published between 1995 and 2005 and that evaluated the public health effects of water privatizations in Latin America from 1989 to 2000, based on (1) access to water by the poor and/or (2) improvements in public health. Next, the authors examined the experiences of three cities in Bolivia (Cochabamba, El Alto, and La Paz) in order to illuminate further the challenges of water privatization. Finally, the authors considered the equity and justice issues raised by the privatization of water. RESULTS: The literature review raised persistent concerns regarding access to water by the poor under privatization. The review also suggested that the public sector could deliver public health outcomes comparable to those of the private sector, as measured by access rates and decreasing child mortality rates. In terms of social equity and justice, privatization marked a troubling shift away from the conception of water as a "social good" and toward the conception of water--and water management services--as commodities. CONCLUSIONS: Our results indicated there is no compelling case for privatizing existing public water utilities based on public health grounds. From the perspective of equity and justice, water privatization may encourage a minimalist conception of social responsibility for public health that may hinder the development of public health capacities in the long run.

Water privatization and public health in Latin America

OBJETIVOS: Este estudio tuvo dos objetivos: 1) determinar lo que dicen las fuentes bibliográficas sobre sanidad y desarrollo acerca de las consecuencias que puede tener para la salud pública la privatización del abastecimiento de agua en América Latina y 2) determinar si los beneficios de dicha privatización, de haberlos, son mayores que los problemas que plantea en materia de equidad y justicia. MÉTODOS: Usando ciertas palabras para buscar en varias bases de datos, los autores encontraron y revisaron artículos y otros tipos de materiales obtenidos de fuentes relacionadas con la salud pública y el desarrollo. Se buscaron fuentes publicadas entre 1995 y 2005 donde se evaluaban los efectos para la salud que tuvieron las privatizaciones de los abastecimientos de agua en países de América Latina de 1989 a 2000. Se prestó particular atención a 1) el acceso de los pobres, 2) las mejoras obtenidas en el campo sanitario, o ambas cosas. Posteriormente los autores examinaron las experiencias de tres ciudades de Bolivia (Cochabamba, El Alto y La Paz) a fin de entender mejor los problemas planteados por la privatización. Exploraron, por último, cómo esta repercute en la equidad y la justicia. RESULTADOS: La revisión de las publicaciones reveló inquietud en torno al acceso de los pobres al agua después de la privatización. Puso de manifiesto, además, que el sector público es capaz de lograr resultados equivalentes a los obtenidos por el sector privado, medidos en función de las tasas de acceso y de la reducción de las tasas de mortalidad de niños menores de cinco años. En lo que respecta a la equidad y la justicia, la privatización marca el comienzo de una tendencia alarmante a concebir el agua y su gestión como bienes de consumo y no como "bienes sociales". CONCLUSIONES: Nuestros resultados indican que no hay argumentos convincentes de tipo sanitario que respalden la privatización del abastecimiento de agua. Desde el punto de vista de la equidad y la justicia, dicha privatización podría fomentar una visión minimalista de la responsabilidad social en materia sanitaria que a su vez podría menoscabar las funciones del sector de la salud en el largo plazo.

Public health and the politics of school immunization requirements.

Compulsory vaccination has contributed to the enormous success of US immunization programs. Movements to introduce broad "philosophical/personal beliefs" exemptions administered without adequate public health oversight threaten this success. Health professionals and child welfare advocates must address these developments in order to maintain the effectiveness of the nation's mandatory school vaccination programs. We review recent events regarding mandatory immunization in Arkansas and discuss a proposed nonmedical exemption designed to allow constitutionally permissible, reasonable, health-oriented administrative control over exemptions. The proposal may be useful in political environments that preclude the use of only medical exemptions. Our observations may assist states whose current nonmedical exemption provisions are constitutionally suspect as well as states lacking legally appropriate administrative controls on existing, broad non-medical exemptions.

The Model State Emergency Health Powers Act: planning for and response to bioterrorism and naturally occurring infectious diseases.

The Center for Law and the Public's Health at Georgetown and Johns Hopkins Universities drafted the Model State Emergency Health Powers Act (MSEHPA or Model Act) at the request of the Centers for Disease Control and Prevention. The Model Act provides state actors with the powers they need to detect and contain bioterrorism or a naturally occurring disease outbreak. Legislative bills based on the MSEHPA have been introduced in 34 states. Problems of obsolescence, inconsistency, and inadequacy may render current state laws ineffective or even counterproductive. State laws often date back to the early 20th century and have been built up in layers over the years. They frequently predate the vast changes in the public health sciences and constitutional law. The Model Act is structured to reflect 5 basic public health functions to be facilitated by law: (1) preparedness, comprehensive planning for a public health emergency; (2) surveillance, measures to detect and track public health emergencies; (3) management of property, ensuring adequate availability of vaccines, pharmaceuticals, and hospitals, as well as providing power to abate hazards to the public's health; (4) protection of persons, powers to compel vaccination, testing, treatment, isolation, and quarantine when clearly necessary; and (5) communication, providing clear and authoritative information to the public. The Model Act also contains a modernized, extensive set of principles and requirements to safeguard personal rights. Law can be a tool to improve public health preparedness. A constitutional democracy must balance the common good with respect for personal dignity, toleration of groups, and adherence to principles of justice.