Ensuring Equitable Access to Participation in the Electoral Process: A Policy Brief From the American College of Physicians.

During the past 2 decades, voter turnout in U.S. presidential elections has ranged from 51.7% to 66.9% of the eligible population. Low voter turnout rates and inequitable electoral institutions, such as gerrymandered districts, can skew policy decisions toward the preferences of a smaller group and further exclude individuals and communities who have been historically marginalized and excluded from decision-making processes. Voting and health are directly connected through the institution of policies by ballot initiative and the election of officials who incorporate health into their platforms. They are also indirectly connected, as civic participation connects persons to their community and empowers them with agency in decision making. In this position paper, the American College of Physicians seeks to inform physicians, medical students, and other health care professionals on the links between electoral processes and health; encourage civic participation; and offer policy recommendations to support safe and equitable access to electoral participation to advance health equity for both patients and health care professionals.

The Healthy Democracy Kit: design, implementation, uptake, and impact of a novel voter registration toolkit for healthcare settings.

BACKGROUND: Access to voting is increasingly recognized as a social determinant of health. Health equity could be improved if healthcare workers (HCWs) routinely assessed the voter registration status of patients during clinical encounters and helped direct them towards appropriate resources. However, little consensus exists on how to achieve these tasks efficiently and effectively in healthcare settings. Intuitive and scalable tools that minimize workflow disruptions are needed. The Healthy Democracy Kit (HDK) is a novel voter registration toolkit for healthcare settings, featuring a wearable badge and posters that display quick response (QR) and text codes directing patients to an online hub for voter registration and mail-in ballot requests. The objective of this study was to assess national uptake and impact of the HDK prior to the 2020 United States (US) elections. METHODS: Between 19 May and 3 November 2020, HCWs and institutions could order and use HDKs to help direct patients to resources, free of cost. A descriptive analysis was conducted to summarize the characteristics of participating HCWs and institutions as well as the resultant total persons helped prepare to vote. RESULTS: During the study period, 13,192 HCWs (including 7,554 physicians, 2,209 medical students, and 983 nurses) from 2,407 affiliated institutions across the US ordered 24,031 individual HDKs. Representatives from 604 institutions (including 269 academic medical centers, 111 medical schools, and 141 Federally Qualified Health Centers) ordered 960 institutional HDKs. Collectively, HCWs and institutions from all 50 US states and the District of Columbia used HDKs to help initiate 27,317 voter registrations and 17,216 mail-in ballot requests. CONCLUSIONS: A novel voter registration toolkit had widespread organic uptake and enabled HCWs and institutions to successfully conduct point-of-care civic health advocacy during clinical encounters. This methodology holds promise for future implementation of other types of public health initiatives. Further study is needed to assess downstream voting behaviors from healthcare-based voter registration.

Leadership, politics, and communication: challenges of the epidemiology workforce during emergency response.

BACKGROUND: Improving the epidemiological response to emergencies requires an understanding of who the responders are, their role and skills, and the challenges they face during responses. In this paper, we explore the role of the epidemiologist and identify challenges they face during emergency response. METHODS: We conducted a cross-sectional survey to learn more about epidemiologists who respond to public health emergencies. The online survey included open and closed-ended questions on challenges faced while responding, the roles of epidemiology responders, self-rating of skills, and support needed and received. We used purposive sampling to identify participants and a snowballing approach thereafter. We compared data by a number of characteristics, including national or international responder on their last response prior to the survey. We analysed the data using descriptive, content, and exploratory factor analysis. RESULTS: We received 166 responses from individuals with experience in emergency response. The most frequently reported challenge was navigating the political dynamics of a response, which was more common for international responders than national. National responders experienced fewer challenges related to culture, language, and communication. Epidemiology responders reported a lack of response role clarity, limited knowledge sharing, and communication issues during emergency response. Sixty-seven percent of participants reported they needed support to do their job well; males who requested support were statistically more likely to receive it than females who asked. CONCLUSIONS: Our study identified that national responders have additional strengths, such as better understanding of the local political environment, language, and culture, which may in turn support identification of local needs and priorities. Although this research was conducted prior to the COVID-19 pandemic, the results are even more relevant now. This research builds on emerging evidence on how to strengthen public health emergency response and provides a platform to begin a global conversation to address operational issues and the role of the international epidemiology responder.

The effects of target vulnerabilities on social movement outcomes: Wage campaigns in U.S. cities.

How do target vulnerabilities affect social movement outcomes? Walsh (1986) and Jasper and Poulsen (1993) conceptualize target vulnerabilities as characteristics or practices of organizations that are inconsistent with relevant normative expectations (laws, professional codes, widely-held public expectations, etc.). Organizations' claims to legitimacy, and the access to resources that legitimacy bestows, are based on the presumption of adherence to those normative expectations, so credible threats to that presumption cannot be ignored. We draw on political process theories and the logic of policy change to analyze how target vulnerabilities affect movement outcomes in campaigns for living wages (1994-2003) and for increased minimum wages (2012-2017). For living wage campaigns, we model the effects of political elites' vulnerability to the threat of popular delegitimation and vulnerability to non-participation by municipal workers on the likelihood of city councils 1) holding a vote (access outcome) and 2) adopting a living wage ordinance (advantages outcome). Using sequential regression analyses of these outcomes in 596 U.S. cities, we find that the effects of target vulnerabilities vary across living wage ordinance outcomes: delegitimation vulnerabilities affect the likelihood of access outcomes, whereas adoption advantages are more likely in the presence of non-participation vulnerabilities. We test the generalizability of our model and measures in an analysis of local minimum wage ordinance campaigns. We show that contentious politics at the local level differs from the national-level in ways that render city political elites potentially vulnerable to movement threats of delegitimation and non-participation.

Assessment of training and mentoring for DR-TB care decentralization in Tanzania.

INTRODUCTION: Drug-resistant TB (DR-TB) care shifted from centralized to decentralized care in Tanzania in 2015. This study explored whether DR-TB training and mentoring supported healthcare workers' (HCWs) DR-TB care performance. METHODS: This mixed study assessed HCWs' DR-TB care knowledge, the training quality, and the mentoring around 454 HCWs who were trained across 55 DR-TB sites between January 2016 and December 2017. Pre- and post-training tests, end-of-training evaluation, supervisor's interviews, DR-TB team self-assessment and team focus group discussion were conducted among trained HCWs. Interim and final treatment results of the national central site and the decentralized sites were compared. RESULTS: HCW's knowledge increased for 15-20% between pre-training and post-training. HCWs and supervisors perceived mentoring as most appropriate to further develop their DR-TB competencies. Culture negativity after 6 months of treatment was similar for the decentralized sites compared to the national central site, 81% vs 79%, respectively, whereas decentralized sites had less loss to follow-up (0% versus 3%) and fewer deaths (3% versus 12%). Delays in laboratory results, stigma, and HCWs shortage were reported the main challenges of decentralized care. CONCLUSIONS: Training and mentoring to provide DR-TB care at decentralized sites in Tanzania improved HCWs' knowledge and skills in DR-TB care and supported observed good interim and final patient treatment outcomes despite health system challenges.

Politics, patients, and the role of the pharmacist: Addressing social and political issues that affect health care.

Pharmacists are well-respected health care practitioners tasked with providing optimal patient care while operating under an assigned code of ethics. Pharmacists know their responsibility regarding improving patients' health in the examination room, pharmacy, and hospital, but several factors influence the well-being of a patient that are not directly related to their therapy regimens. A patient's actions regarding political and social issues can have an indirect effect on their health and the health of others. As health professionals, are pharmacists duty-bound to alert patients to the impact of public policies on the health care system and their individual health? In addition, should pharmacists be able to assess when interventions are necessary and provide this education? As a profession, pharmacy must work toward creating guidance to help practitioners identify and address these issues with patients and encourage positive outcomes for individual patients and communities as a whole. Political and social issues will continue to become intertwined in the patient-practitioner relationship, and tools must be created to best navigate these delicate topics.

Law, Regulation or Just Damned Politics: The Under-utilisation and Undervaluing of the World's Largest Health Workforce.

This article analyses the outcomes of a three-year campaign to raise the status and profile of nursing - The Nursing Now Campaign. The Campaign aim was to take forward the recommendations of the Triple Impact Report of the United Kingdom All-Party Parliamentary Group (APPG) on Global Health. The Triple Impact Report documented the undervaluing and under-utilisation of nursing which is the largest health workforce globally and which the APPG believed had the greatest potential to have a positive impact upon the United Nations move to universal health coverage. The framework for analysis is that of Shiffman et al which was developed to explain the emergence and effectiveness of global networks, and is used here to examine the effectiveness of the Nursing Now Campaign against its stated aims.

White Coats, White Hoods: The Medical Politics of the Ku Klux Klan in 1920s America.

This article explores the medical politics of the second iteration of the Ku Klux Klan in the United States. As eugenics gained a foothold in America at the turn of the twentieth century, the Klan embraced the latest in scientific racism to lend legitimacy to their cultural, political, and economic goals of white supremacy. Klan physicians in particular held a vested interest in preserving a racialized medical hierarchy and promoting reproductive surveillance in public health. By the 1920s, a symbiotic relationship developed between the organization and the medical profession. The Klan relied on its member physicians to lend professional respectability to the organization and scientific legitimacy to its agenda. In turn, affiliation with the Klan gave physicians an opportunity for career advancement and provided the muscle to intimidate professional and political opponents.

Survival finance and the politics of equal pay.

Wage gaps constitute a major component of workplace inequality. While scholars have explored the causes and consequences of differences in pay, very few question the basic presumption that workers are paid differently in the first place. Drawing on ethnographic research in a worker cooperative with a policy of equal pay, this article analyses how the organization compensated its members in the context of low wages, economic uncertainty, and insufficient social benefits. Over time, I found that members justified small variations that led to wage difference without amending their commitment to pay equity. This was made possible through a system of survival finance, a set of compensation practices that supports the reproduction of both individual members and the organization as a whole. Whereas members understood money wages as market-based incentives for labor, the cooperative enacted its principles of equality and fairness by compensating members with alternative currencies (time) and additional benefits (zero interest rate credit) to help make ends meet. The article concludes by reflecting on the challenges of equalizing pay and its implications for reducing workplace inequality.

How will Brexit affect health services in the UK? An updated evaluation.

All forms of Brexit are bad for health, but some are worse than others. This paper builds on our 2017 analysis using the WHO health system building blocks framework to assess the likely effects of Brexit on the National Health Service (NHS) in the UK. We consider four possible scenarios as follows: a No-Deal Brexit under which the UK leaves the EU on March 29, 2019, without any formal agreement on the terms of withdrawal; a Withdrawal Agreement, as negotiated between the UK and EU and awaiting (possible) formal agreement, which provides a transition period until the end of December, 2020; the Northern Ireland Protocol's backstop coming into effect after the end of that period; or the Political Declaration on the Future Relationship between the UK and EU. Our analysis shows that a No-Deal Brexit is substantially worse for the NHS than a future involving the Withdrawal Agreement, which provides certainty and continuity in legal relations while the Political Declaration on the Future Relationship is negotiated and put into legal form. The Northern Ireland backstop has varying effects, with continuity in some areas, such as health products, but no continuity in others. The Political Declaration on the Future Relationship envisages a relationship that is centred around a free-trade agreement, in which wider health-related issues are largely absent. All forms of Brexit, however, involve negative consequences for the UK's leadership and governance of health, in both Europe and globally, with questions about the ability of parliament and other stakeholders to scrutinise and oversee government actions.

A Short History of Occupational Safety and Health in the United States.

As this short history of occupational safety and health before and after establishment of the Occupational Safety and Health Administration (OSHA) clearly demonstrates, labor has always recognized perils in the workplace, and as a result, workers' safety and health have played an essential part of the battles for shorter hours, higher wages, and better working conditions. OSHA's history is an intimate part of a long struggle over the rights of working people to a safe and healthy workplace. In the early decades, strikes over working conditions multiplied. The New Deal profoundly increased the role of the federal government in the field of occupational safety and health. In the 1960s, unions helped mobilize hundreds of thousands of workers and their unions to push for federal legislation that ultimately resulted in the passage of the Mine Safety and Health Act of 1969 and the Occupational Safety and Health Act of 1970. From the 1970s onward, industry developed a variety of tactics to undercut OSHA. Industry argued over what constituted good science, shifted the debate from health to economic costs, and challenged all statements considered damaging.

Challenges, Extent of Involvement, and the Impact of Nurses' Involvement in Politics and Policy Making in in Last Two Decades: An Integrative Review.

PURPOSE: To determine nurses' challenges, extent of involvement, and the impact of involvement in politics and policy making. ORGANIZING CONSTRUCT: Nurses in politics and health policy making. METHODS: Literature was searched in PubMed, Scopus, Google Scholar, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), OVID, and Open Grey using phrases comprising the following key words: "nurses", "policy making", "politics", "health policy", "nurses involvement in policy making/politics/health policy", "nurses challenges in policy making/politics/policy", and "impact of nursing policy making/politics/health policy"; 22 articles published from January 2000 to May 2019 were included. FINDINGS: The major challenges included intra- and interprofessional power dynamics, marginalization of nurses in policy making, and nursing profession-specific challenges. The extent of involvement was inadequate, and nurses mainly worked as policy implementers rather than as policy developers. Those nurses who participated in policy development focused on health promotion to build healthy communities and to empower nurses and the nursing profession. CONCLUSIONS: Nurses' involvement in policy making has not improved over time. Nursing institutions and regulatory bodies should prepare and encourage nurses to work as policymakers rather than implementers and advocate for the rightful place of nurses at policy-making forums. CLINICAL RELEVANCE: Preparation for health system policy making starts in the clinical settings. Educational institutions and nurse leaders should adequately prepare nurses for policy making, and nurses should participate in policy making at the organization, system, and national levels.

Ideological Sorting of Physicians in Both Geography and the Workplace.

CONTEXT: The distribution of physicians across geography and employers has important implications for the delivery of medical services. This study examines how the political beliefs of physicians influence their decisions about where to live and work. METHODS: Physician relocation and employment patterns are analyzed with a panel constructed from the National Provider Identifier directory. Data on political donations are used to measure the political preferences of physicians. FINDINGS: The "ideological fit" between a physician and his or her community is a key predictor of both relocation and employment decisions. A Democratic physician in a predominantly Republican area is twice as likely to relocate as a Republican counterpart living there; the reverse is also true for Republicans living in Democratic areas. Physicians who do not share the political orientation of their colleagues are more likely to change workplaces within the same geographic area. CONCLUSIONS: Physicians are actively sorting along political lines. Younger physicians have trended sharply to the left and are increasingly drawn to urban areas with physician surpluses and away from rural areas suffering from physician shortages. The findings also help explain why physician shortages are more prevalent among left-leaning specialties such as psychiatry.

Determining if nurses are involved in political action or politics: A scoping literature review.

BACKGROUND: There is much current as well as long-standing concern that nurses need to be more involved in and also more adept at politics and political action for the advancement of the profession, and for the health and wellbeing of the public. OBJECTIVES: An historical scoping literature review was carried out to identify if, as well as why, when, and how nurses become involved in government or meso-level political action or politics, and what is or has been gained through this involvement. DESIGN: Scoping literature review. SETTINGS (INCLUDING GEOGRAPHICAL LOCATION): Worldwide published literature. PARTICIPANT: Nil. METHODS: Research and non-research articles on the topic were identified in a decade-by-decade search of the CINAHL database, all relevant ones were retained, and the per-decade findings in them were compared over time. RESULTS: Only 25 research reports, published 1988-2019, were identified. These studies were conducted in a few, mostly developed, countries. They provide a varied picture of nurse or nursing association involvement in political action and policy circles. In contrast, the opinion and theory articles demonstrate increased nurse and nursing association involvement in, as well as rising skill in political action and public policy engagement, although primarily in the United States and Canada. CONCLUSIONS: Research and case reports are needed now in all countries to correct the view that nurses and nursing associations are apolitical, and to gain information on how and why nurses and nursing associations become politically active and also determine what is gained through this activity.

[Men without a past? (Honorary) Presidents of the German Neurological Society and their NS past]. / Männer ohne Vergangenheit? (Ehren-)Vorsitzende der DGN nach 1957 und ihre NS-Belastung.

This paper aims at reconstructing the biographies of six German neurologists during and after the "Third Reich". Between 1957 and 1976, five of them were presidents of the German Neurological Society (DGN), the sixth was appointed honorary president in 1981. They all joined the National Socialist German Workers' Party (NSDAP) or Storm Troopers (SA) as young doctors between the ages 20 and 35 years. According to the current state of research they thus have to be classified as formally incriminated, yet none of them developed significant (health) political activities, with the slight exception of Eberhard Bay (1908-1989), who once acted as expert witness in an Hereditary Health Court trial. Gustav Döhring (1909-1963), NSDAP member since 1937, Pette student and co-founder of the DGN, was secretary of the Society for many years and editor of a commemorative publication. Johannes Hirschmann (1910-1991), also a party comrade since 1937, served as an army and military hospital doctor from 1939 to 1945. Richard Jung (1911-1986) had joined the SA in 1934. This entailed his immediate dismissal after the war from the University of Freiburg but benefitting from the support by the dean he could pursue his career not long thereafter. Robert Charles Behrend (1919-1996) became a party member at the age of 20 years and with his time in office in 1975-1976 he was the last of the post-war presidents of the DGN connected to National Socialism in Germany. Older than these five was honorary chairman Gustav Bodechtel (1899-1983) a member of the SA, NSDAP and other Nazi organizations. He was dismissed in 1946 but reinstated just 1 week later due to the interventions by the Medical Academy Düsseldorf and the Mayor of the City. New findings on these personalities are exclusively based on archival research. This underlines the necessity of resorting to sources previously neglected when investigating biographies of twentieth century neurologists.

Conference Report on First Certificate Course in Health Professions Educationat College of Medicine, University of Kerbala, Iraq.(September 2019).

The current status of medical education in Iraq requires complete transformation to conform to the latest trends of modern education. Presently it is compromised due to the influence of political factors, finances, weakness or fragility of planning and security. It has to be re-shaped for the future of medical education to produce good and efficient medical professionals. It is necessary to reform and revise the curriculum as accreditation in accordance with international medical universities. The initial requirement is faculty development in areas including but not limited to, curriculum development, teaching and learning improvement, research capacity building, and leadership development. The capacity building of faculty at College of Medicine, University of Kerbala (CMUCK) has been initiated in collaboration with Medics International at a local and the government level. Medics International conducted the current Course on Certificate in Health Professions Education (CHPE) programme in September, 2019 to facilitate the faculty to revise their curriculum and improve their current educational practices. Further steps will be taken to develop the faculty for Masters in Medical Education (MME), PhD, and fellowship programmes. To face the on-going challenges in the medical and health care system, continous efforts are required for faculty education. Medics International has volunteered to begin a series of Webinars through its global faculty to reach out to the Iraqi Board followed by engagement of the Arab Board covering 18 countries.

The Patient as Obligation - The Binary Failure of "Privilege" vs. "Right" Part 2 - My Privilege - From The Great Equation to An American Sickness to Mac and Cheese for All to An American Idea.

"Privilege" vs. "Right" in healthcare is a failed political binary because it has divided the nation. The "my privilege" end of this false choice has been damaging, shifting the burden to the patient and away from the physician. It is medicine's historic privilege to care for any human but obligation has waned being plagued by opportunism. Also, what we have a right to or are privileged to receive is undefined. Past premises for the privilege are untrue, based on Health = medical care. Present assessments of the privilege are unfair, deeming American medicine a sickness. Future solutions for the privilege are untenable, if "equality" is the goal. The framework for healthcare's obligation-to-give already surrounds us, emerging from the American Revolution with its idea of individual dignity as to priority, checks and balances as to protection and Federalism as to improvement. American medicine has followed this idea albeit misused and unfulfilled. The null hypothesis of this debate must be fairly tested - that American medicine is the worst form of healthcare delivery - except for all the rest. Both Big Business and Big Politics in healthcare have become ends unto themselves and therefore neither can solve the privilege question nor bear the weight of our obligation-to-give. The patient-as-obligation must be our aim.