The parliamentary political agenda: a tool for policy analysis of diabetes priorities in Spain.

OBJECTIVE: To analyze the political agenda on diabetes in Spain under democracy by considering the frequency and content of initiatives in the Spanish parliament. METHODS: A systematic search of parliamentary interventions (1979-2010) reported on the Spanish Congress of Deputies' web page was carried out using the key word "diabetes". A descriptive study of the frequency of interventions was performed, followed by a content analysis, according to the priorities of the World Health Organization (WHO), the International Diabetes Federation and the Spanish Diabetes Federation. Other study variables were the year of presentation, legislature, type of initiative and whether a political decision was taken (yes/no). RESULTS: There were 59 interventions: 22% were related to the first international initiatives and 44.1% took place in the last two legislatures in response to the WHO's program Diabetes Action Now. A total of 32.2% of the initiatives addressed educational and social programs, while 23.7% addressed access to resources and health services. Most initiatives (74.6%) consisted of parliamentary questions to the government, which only required a response. Of the 15 initiatives requiring a decision to be taken, only eight were approved. CONCLUSIONS: Spanish legislators aim to comply with international standards. Nevertheless, political decision-making has sometimes been slow. Importantly, most of the political responsibilities related to health have been transferred to the autonomous regions. The updated National Diabetes Strategy in Spain will need to strengthen public health policies according to established international priorities. Monitoring parliamentary interventions has proven to be a valid tool for evaluating patterns of political debate and decisions on diabetes.

Images of welfare in law and society: the British welfare state in comparative perspective.

Designed by Beveridge and built by Attlee's post-war Labour government, the welfare state was created during the 1940s. Britain has been seen ­ in domestic debates and internationally ­ as a world first: the place where both the idea and the practice of the welfare state were invented. I draw together comparative welfare state analysis with law and society scholarship (previously largely developed in isolation from one another) ­ as well as using British political cartoons as a source ­ to develop a revisionist historical critique of this conventional wisdom. First, the British welfare state has always been comparatively parsimonious. Second, the idea of the welfare state seems to have its origins outside the United Kingdom and this terminology was adopted relatively late and with some ambivalence in public debate and scholarly analysis. Third, a large body of socio-legal scholarship shows that robust 'welfare rights' were never embedded in the British 'welfare state'.

What adult worker model? A critical look at recent social policy reform in Europe from a gender and family perspective.

Analyses regularly feature claims that European welfare states are in the process of creating an adult worker model. The theoretical and empirical basis of this argument is examined here by looking first at the conceptual foundations of the adult worker model formulation and then at the extent to which social policy reform in western Europe fits with the argument. It is suggested that the adult worker formulation is under-specified. A framework incorporating four dimensions­the treatment of individuals vis-à-vis their family role and status for the purposes of social rights, the treatment of care, the treatment of the family as a social institution, and the extent to which gender inequality is problematized­is developed and then applied. The empirical analysis reveals a strong move towards individualization as social policy promotes and valorizes individual agency and self-sufficiency and shifts some childcare from the family. Yet evidence is also found of continued (albeit changed) familism. Rather than an unequivocal move to an individualized worker model then, a dual earner, gender-specialized, family arrangement is being promoted. The latter is the middle way between the old dependencies and the new "independence." This makes for complexity and even ambiguity in policy, a manifestation of which is that reform within countries involves concurrent moves in several directions.

Poppies for medicine in Afghanistan: lessons from India and Turkey.

This study examines India and Turkey as case studies relevant to the Senlis Council's 'poppies for medicine' proposal. The proposal is that Afghan farmers are licensed to produce opium for medical and scientific purposes. Here it is posited that the Senlis proposal neglects at least three key lessons from the Turkish and Indian experiences. First, not enough weight has been given to diversion from licit markets, as experienced in India. Second, both India and Turkey had significantly more efficient state institutions with authority over the licensed growing areas. Third, the proposal appears to overlook the fact that Turkey's successful transition was largely due to the use of the poppy straw method of opium production. It is concluded that, while innovative and creative policy proposals such as that of the Senlis proposal are required if Afghanistan is to move beyond its present problems, 'poppies for medicine' does not withstand evidence-based scrutiny.

Accounting for the contribution of vitamin B to Canada's WWII effort.

Canada began to fortify its flour and bread with vitamin B when it entered the Second World War. The decision was informed by the biology of vitamin B and therefore I suggest that the complexity of this political maneuver can best be understood by considering the specificity of the biochemistry of vitamin B. In this paper I will show that the specific biology of vitamin B allowed the Canadian government the possibility of a healthier population under wartime conditions but also allowed the government a variety of means by which to develop and organize food processing practices to this end.

Contested visions of American democracy: citizenship, public housing, and the international arena.

This essay reexamines the history of public housing and the controversy it generated from the Great Depression to the Cold War. By recasting that history in the global arena, it demonstrates that the debate over public housing versus homeownership was also a debate over the meaning of American citizenship and democracy, pointing up starkly divergent notions about what was and was not American. Through an examination of national conflicts and neglected local struggles, this article further shows that the fight over public housing was far more meaningful and volatile than traditionally assumed. Both critics and advocates of public housing drew from international experiences and imagery in positioning the home as a constitutive feature of citizenship in American democracy. Fears of Bolshevism, fascism, and communism served to internationalize issues of race, space, and housing and together shaped the decision of whether a decent home was an American right or privilege.

The Breast and Cervical Cancer Prevention and Treatment Act in Georgia: effects on time to Medicaid enrollment.

BACKGROUND: Implementation of the Breast and Cervical Cancer Prevention and Treatment Act of 2000 (BCCPTA) allowed states to extend Medicaid to any woman aged <65 without insurance screened and found to need treatment either for breast or cervical cancer or for a precancerous cervical condition through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) or in Georgia, other provider sites. METHODS: The authors used linked Georgia Comprehensive Cancer Registry (GCCR) and Medicaid data to test the: 1) likelihood of Medicaid enrollment in a given month and 2) time-to-enrollment (months) for those eventually enrolling. The authors used difference-in-differences analysis to estimate the effects of BCCPTA for breast or cervical cancer cases relative to a control group of women with other cancers. The authors controlled for sociodemographics, stage at diagnosis, year of diagnosis, and county level factors related to insurance levels in the area. RESULTS: Compared with the control cancer group, the hazard ratio of Medicaid enrollment for women with breast and cervical cancers increased post- vs pre-BCCPTA implementation. The estimated effect of this increase was that out of every 1000 women with breast cancer, BCCPTA led to 1.7 more (from 2.8 to 4.5 per month) enrolling in Medicaid. The results for women with local or later stages of cervical cancer indicated that of 1000 women with these cancers, the number enrolling in a given month increased by 3.4 due to BCCPTA. Results on time-to-enrollment indicated that the time between cancer diagnosis and enrollment was shortened by 7 to 8 months. CONCLUSIONS: The Georgia Medicaid program, in response to national legislation, increased the probability of women enrolling in Medicaid earlier and in turn, likely increased their cancer treatment options.

Linking traditional knowledge and environmental practice in Ontario.

Beginning in the late 1980s with the release of Our Common Future by the World Commission on Environment and Development, followed by the development of international accords such as the 1992 Convention on Biological Diversity, international pressure to resolve Indigenous rights issues has been steadily mounting. Successive Canadian governments have been striving increasingly to recognize and incorporate Aboriginal traditional knowledge into resource management planning. Following more than a decade of such efforts, the question of how to achieve such incorporation appropriately remains inadequately answered. This essay contributes to the resolution of this issue by first clarifying some key differences between Aboriginal and non-Aboriginal definitions of "traditional knowledge." Then, three Ontario case studies are briefly described that highlight the most and least successful aspects of previous undertakings. Among the lessons learned are the need to value traditional knowledge on a par with Western science while recognizing the particular capabilities of each system, and the requirement that Aboriginal peoples and their knowledge participate on a mutually respectful basis.

Editorial: a view from beneath: community health insurance in Africa.

This paper presents an overview of the development of Community Health Insurance (CHI) in sub-Saharan Africa. In 2003, nearly 600 CHI initiatives were registered in a dozen countries of francophone West Africa alone. At regional level, coordination networks have been created in Africa with the aim to support and monitor the developments of this innovative model of health care financing. At national level, governments are preparing the necessary legal frameworks for CHI implementation. CHI is increasingly seen as a strategy to meet other development goals than only health. It constitutes an interesting model to finance health care, to pool financial resources in a fair way and to empower health care users. The CHI movement however still faces many challenges. The relevance of more professional inputs in the management of CHI and the need for careful subsidy of CHI schemes are increasingly recognized. There is also need to optimize the relationship of CHI with the other actors in the health system and to scale-up CHI so as to gain in effectiveness and efficiency. The boom in the number of schemes in Africa during the last years is an indicator of the increasing attractiveness of the model. In practice however, enrolment rates per scheme remain low or are only slowly increasing. Context-specific research is needed on the reasons that prevent people from enrolling in larger numbers. On that basis, relevant action to be taken locally can be identified.

Shifting the focus from cost to value: a government perspective.

OBJECTIVE: To examine the federal government.s current health care initiatives in the Centers for Medicare and Medicaid Services (CMS) to improve quality of care and cost-effectiveness around the prescription drug benefit. SUMMARY: The government has a unique perspective on quality and outcome. Pharmacists need a working knowledge of 3 areas: (1) Medicare Part D, (2) medication therapy management efforts, and (3) demonstration projects. All of these will make demands on health care providers but should result in better outcomes data and patient care. All of these areas also have value components, and all have strategic implications as 2006 moves into 2007. CONCLUSION: CMS does not consider managing cost and providing value to be mutually exclusive and is attempting to move America.s health care toward a value-based program.