A value-critical policy analysis of the nursing home reform act: a focus on care of African American and Latino residents.

Improving nursing home care has been a central legislative focus since the 1980s; The major response effort to address these reports of poor-quality care was first met with a federal rule in 1987, the Nursing Home Reform Act (NHRA). Since enactment of the NHRA in 1987, and despite an increasing utilization of nursing home care by aging minorities, the standardization of care practice, or quality indicators (e.g., structural, process, and outcome measures), within long-term nursing home care have remained relatively unchanged. This paper reports a value-critical policy analysis of the most recent final action rule, effective on November 28 of 2016 by the Centers for Medicare and Medicaid Services (CMS) with a particular focus on its impact on African-American and Latino older adults. This paper presents results of two policy analyses. Taken together, this merged analysis focuses on an overview of the problem, the groups most affected by the problem, current program goals and objectives, forms of benefits and services, and a current state of the social problem. Following the analysis, we present changes and improvements to be made, as well as proposals for reform and recommendations for policy changes.

Ethical and Legal Considerations for the Inclusion of Underserved and Underrepresented Immigrant Populations in Precision Health and Genomic Research in the United States.

There has been growing recognition of the importance of diversity and inclusion of underrepresented minority populations, including immigrants, in genomic research and precision medicine. Achieving diversity has been difficult and has led some scholars to question whether the law is a help or a threat to the inclusion of underserved and underrepresented immigrant populations. In this commentary, I provide an overview of some of the many relevant legal issues affecting the inclusion of immigrants in genomic research and precision health initiatives, such as the All of UsSM Research Program. Development of research recruitment, retention, and data collection plans without also considering the legal and sociopolitical context within which such efforts are to be carried out is risky. Advancing health policy with a goal of eliminating health disparities (or, at a minimum, ensuring that health disparities are not exacerbated by genomic or precision health technologies) requires us to acknowledge the negative effects that immigration policy and criminal justice policy have on the involvement of immigrants in such research and on their health directly. I conclude that it is not a question of whether the law is a help or a threat but, rather, whether we collectively will prioritize authentic diversity and inclusion policies and also insist on compliance with the laws intended to ensure the human right of every individual - regardless of immigration status or national origin - to share in the advancement of science.

Improvements in Outcomes for Ethnic Minorities During the Share 35 Era Are Not Due to Decreased Rates of Early Graft Loss.

OBJECTIVES: Our aim was to investigate the effects of the Share 35 policy on outcomes in ethnic minorities and recipients who experienced early graft failure. MATERIALS AND METHODS: We analyzed donor and recipient data from the United Network for Organ Sharing database before (June 6, 2011 to June 18, 2013) and after (June 18, 2013 to June 30, 2015) implementation of Share 35. Graft and patient survival outcomes were compared. RESULTS: There were significant differences in 1- and 2-year graft and patient survival rates between ethnicities pre-Share 35 (P = .03, P < .001, P = .01, P < .001, respectively). There were no significant differences in 1- and 2-year graft and patient survival between ethnicities post-Share 35 (P = .268, P = .09, P = .343, P = .087, respectively). There were no differences in early graft failure rates pre- and post-Share 35 at 7 days (2.1% vs 2.0; P = .71) and 30 days (4.0% vs 3.8%; P = .47) after transplant, with a decreased early graft failure rate shown at 90 days after transplant (6.8% vs 5.8%; P = .003). When analyzed separately, the low Model for End-Stage Liver Disease (score of < 35) and the high Model for End-Stage Liver Disease recipients (score of ≥ 35) both exhibited reduced early graft failure rates post-Share 35 (6.1% vs 5.3% and 10.8% vs 7.8%, respectively; P < .05). CONCLUIONS: Share 35 was associated with a short-term reduction in ethnic disparities. Most ethnic groups experienced improved survival in the Share 35 era. Share 35 was not associated with an increase in early graft failure and is an efficacious policy with regard to short-term outcomes.

Is Aboriginal nutrition a priority for local government? A policy analysis.

OBJECTIVE: The present study aimed to explore how Australian local governments prioritise the health and well-being of Aboriginal populations and the extent to which nutrition is addressed by local government health policy. DESIGN: In the state of Victoria, Australia, all seventy-nine local governments' public health policy documents were retrieved. Inclusion of Aboriginal health and nutrition in policy documents was analysed using quantitative content analysis. Representation of Aboriginal nutrition 'problems' and 'solutions' was examined using qualitative framing analysis. The socio-ecological framework was used to classify the types of Aboriginal nutrition issues and strategies within policy documents. SETTING: Victoria, Australia. SUBJECTS: Local governments' public health policy documents (n 79). RESULTS: A small proportion (14 %, n 11) of local governments addressed Aboriginal health and well-being in terms of nutrition. Where strategies aimed at nutrition existed, they mostly focused on individual factors rather than the broader macroenvironment. CONCLUSIONS: A limited number of Victorian local governments address nutrition as a health issue for their Aboriginal populations in policy documents. Nutrition needs to be addressed as a community and social responsibility rather than merely an individual 'behaviour'. Partnerships are required to ensure Aboriginal people lead government policy development.

Health Justice: A Framework (and Call to Action) for the Elimination of Health Inequity and Social Injustice.

Every aspect of society is dependent upon the health of its members. Health is essential to an individual's well-being, quality of life, and ability to participate in society. Yet the healthcare industry, even at its optimal level of functioning, cannot improve the health of the population without addressing the root causes of poor health. The health of approximately 46.7 million individuals, most of whom are low-income and racial minorities, is threatened by economic, societal, cultural, environmental, and social conditions. Poor health in any population group affects everyone, leading to higher crime rates, negative economic impacts, decreased residential home values, increased healthcare costs, and other devastating consequences. Despite this fact, efforts to improve health among low-income and minority communities are impeded by inequitable social structures, stereotypes, legal systems, and regulatory schemes that are not designed to take into account the social determinants of health in decision making models and legal interpretation. As a result, a large segment of the population is continually denied the opportunity to live long, productive lives and to exercise their rights under democratic principles. Health, equity, and justice make up the keystone of a functional, thriving society. These principles are unsatisfied when they do not apply equally to all members of society. This Article describes the social and legal roots of poor health and how health inequity, social injustice, and poverty are inextricably linked. For example, it provides an in depth overview of the social determinants of health, including poverty, institutional discrimination and segregation, implicit bias, residential environmental hazards, adverse childhood experiences, and food insecurity. It then discusses how the law is a determinant of health due to court systems that do not evaluate individual circumstances, the enactment of laws that perpetuate poor health, and the lack of primary prevention laws. It demonstrates how addressing these issues requires true adherence to equality principles and making justice and freedom of opportunity accessible to everyone. Finally, it recommends the creation of "health justice," a new jurisprudential and legislative framework for the achievement and delivery of health equity and social justice.

Sexual minorities, human rights and public health strategies in Africa.

Remarkable progress has been made towards the recognition of sexual minority rights in Africa. At the same time, a marked increase in attacks, rhetorical abuse, and restrictive legislation against sexual minorities or 'homosexuality' makes activism for sexual rights a risky endeavour in many African countries. Campaigns for sexual rights and 'coming out' are frequently perceived as a form of Western cultural imperialism, leading to an exportation of Western gay identities and provoking a patriotic defensiveness. Cultures of quiet acceptance of same-sex relationships or secretive bisexuality are meanwhile also problematic given the high rate of HIV prevalence on much of the continent. This article examines specific initiatives that are using subtle, somewhat covert means to negotiate a path between rights activism and secretive bisexuality. It argues that strategies primarily focused on health concerns that simultaneously yet discreetly promote sexual rights are having some success in challenging prevalent homophobic or 'silencing' cultures and discourses.

Culturally competent care pedagogy: what works?

BACKGROUND: In its 2002 publication Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, the Institute of Medicine reported American racial and ethnic minorities receive lower-quality health care than white Americans. Because caregiver bias may contribute to disparate health care, the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education have issued specific directives to address culturally competent care education. QUESTIONS/PURPOSES: We discuss the general approaches to culturally competent care education, the tools used in evaluating such endeavors, and the impact of such endeavors on caregivers and/or the outcomes of therapeutic interventions from three perspectives: (1) Where are we now? (2) Where do we need to go? (3) How do we get there? METHODS: We summarized information from (1) articles identified in a PubMed search of relevant terms and (2) the authors' experience in delivering, evaluating, and promoting culturally competent care education. WHERE ARE WE NOW?: Considerable variation exists in approaches to culturally competent care education; specific guidelines and valid evaluation methods are lacking; and while existing education programs may promote changes in providers' knowledge and attitudes, there is little empirical evidence that such efforts reduce indicators of disparate care. WHERE DO WE NEED TO GO?: We must develop evidence-based educational strategies that produce changes in caregiver attitudes and behaviors and, ultimately, reduction in healthcare disparities. HOW DO WE GET THERE?: We must have ongoing dialog about, development in, and focused research on specific educational and evaluation methodologies, while simultaneously addressing the economic, political, practical, and social barriers to the delivery of culturally competent care education.

Projections of the ethnic minority populations of the United Kingdom 2006-2056.

The ethnic minority populations in the UK are growing substantially through immigration, a youthful age structure, and in some cases relatively high fertility. Their diverse demographic and socioeconomic characteristics have attracted considerable academic and policy attention, especially insofar as those distinctive characteristics have persisted in the generations born in the UK. No official projections of the UK ethnic populations have been published since 1979. This article provides projections to 2056 and beyond of 12 ethnic groups. Given overall net immigration and vital rates as assumed in the office for National Statistics 2008-based Principal Projection, and the ethnic characteristics estimated here, the ethnic minority populations (including the Other White) would increase from 13 percent of the UK population in 2006 to 28 percent by 2031 and 44 percent by 2056, and to about half the 0-4 age group in 2056. Alternative projections assume various lower levels of immigration. Possible implications of projected changes are discussed.

A Decade Later: assessing successes and challenges in Manitoba's Provincial Immigrant Nominee Program.

During the past decade, Manitoba's Provincial Nominee Program (MPNP) has increased immigration to the province and dispersed immigrants more widely within Manitoba. At the same time, the rapid growth of the program and the decentralized way in which it has been implemented have contributed to some challenges. This ten-year analysis of the MPNP finds that many places in Manitoba are experiencing settlement service gaps, and that immigrants and communities are taking on much of the burden for MPNP application and settlement. In addition, the analysis demonstrates that the fragmented way in which the MPNP has been marketed and implemented (i.e., by relying on particular employers, consultants, and ethnocultural organizations) has resulted in a sort of ethnocultural inequality where certain groups are ushered into the province-often to perform particular occupations-while others are bypassed.

Legislating separation and solidarity in plural societies: the Chinese in Indonesia and Malaysia.

The Chinese minority plays a dominant role in the economies of Indonesia and Malaysia, a fact that evokes indigenous resentment. However, Indonesia and Malaysia dealt differently with the issue. Malaysia legislated the Malays into the economy and protected Chinese citizenship, making them an integral part of a multicultural state. By contrast, New Order Indonesia adopted policies of economic manipulation, forced assimilation, and unequal citizenship. Only when the New Order regime fell did Chinese integration begin. The policy trajectories of Indonesia and Malaysia offer important lessons for plural states.