Reducing cancer disparities through community engagement in policy development: the role of cancer councils.

Cancer is the second leading cause of death in the U.S and a source of large racial and ethnic disparities in population health. Policy development is a powerful but sometimes overlooked public health tool for reducing cancer burden and disparities. Along with other partners in the public health system, community-based organizations such as local cancer councils can play valuable roles in developing policies that are responsive to community needs and in mobilizing resources to support policy adoption and implementation. This paper examines the current and potential roles played by local cancer councils to reduce cancer burden and disparities. Responsive public health systems require vehicles for communities to engage in policy development. Cancer councils provide promising models of engagement. Untapped opportunities exist for enhancing policy development through cancer councils, such as expanding targets of engagement to include private-sector stakeholders and expanding methods of engagement utilizing the Affordable Care Act's Prevention and Public Health Fund.

The Swedish State Health Technology Board (SBU) report on treatment of alcohol and drug misuse: an economist's view.

The Swedish State Health Technology Board (SBU) has published a Report on the treatment of alcohol and drug misuse (SBU, 2001). This article is a brief Commentary on the economic issues raised in Chapter 9 of the Report, in particular, the question of 'how cost-effective are the different treatment alternatives?' An outline is given of how the authors approached the economic work, with particular reference to a standard checklist approach to judging the quality of published economic appraisals. A paucity of such appraisals was retrieved and detailed review of just 16 papers was undertaken. The authors are critical of the lack of quality of economic work in the substance misuse area and their main points are summarized here. The main conclusion drawn is that no economic judgements can be made about alternative treatment approaches, and more study and research are needed in this area. Chapter 9 is, on balance, a good attempt at a critical review of the economic appraisal literature. Unfortunately the main Report provides a series of summary judgements on the effectiveness or otherwise of alternative treatments, which, while recognizing the need for further cost-effectiveness work, essentially ignores the conclusion drawn in the economics chapter. This is likely to do a disservice to the cause of appropriate resource allocation in the substance misuse area.

Implementing public competition in Swedish county councils: a case study.

Earlier presentations of the theoretical framework for public competition (Saltman and von Otter, 1987) and of the comparative advantage of public competition as against a mixed market model (Saltman and von Otter, 1989a) suggest the importance of concrete arrangements to introduce a public competition approach at the operating level. This paper explores the administrative infra-structure required to implement public competition within the Swedish county-council-based health care system.