Federal, State, and Local Mental Health Policy Interventions in Response to the Pediatric Mental Health Crisis following the COVID-19 Pandemic.

The state of pediatric mental health in the United States has been declining prior to the coronavirus disease 2019 pandemic and was also acutely exacerbated by it as well. Federal, state, and local governments have increasingly prioritized pediatric mental health by investing critical resources through the implementation of policies at all levels of government to reverse this disturbing trend. Despite these investments, there remains a need to improve access to critical pediatric mental health prevention and interventions. When all stakeholders are actively and authentically engaged in the creation and implementation of policy, there is the greatest potential for widespread impact.

The Medicines Center and pharmaceutical care during the civil-military dictatorship (1970-1974). / A Central de Medicamentos e a assistência farmacêutica na ditadura civil-militar (1970-1974).

The present article analyzes the formation of the first pharmaceutical care policies implemented by the Brazilian Federal Government between 1968 and 1974, during the civil-military dictatorship. It examines a set of measures adopted by the Costa e Silva and Médici governments to contain a continuous rise in the prices of raw materials and pharmaceutical specialties, with this context being essential to the creation of the Medicines Center (CEME) in 1971. The core argument of the article is that CEME represented, at the federal level, the consolidation of a policy carried out at the National Institute of Social Security (Instituto Nacional da Previdência Social - INPS) between 1968 and 1970, based on the production of inputs and medicines in public laboratories. Ended in 1970, this policy was resumed the following year with broad participation of military personnel and laboratories of the Armed Forces. The originality of this article lies in its explanation of how such support influenced the establishment of CEME in its early years. Until 1974, military members were the majority in the Board of Directors of CEME, with some of the agency's early missions being the supplier for Civil-Social Actions of the Armed Forces.

O artigo analisa a formação das primeiras políticas de assistência farmacêutica executadas pelo Governo Federal brasileiro entre 1968 e 1974, durante a ditadura civil-militar. Examina um conjunto de medidas adotadas pelos governos Costa e Silva e Médici para conter uma contínua elevação nos preços de matérias-primas e especialidades farmacêuticas, sendo este contexto fundamental para a criação da Central de Medicamentos (CEME), em 1971. O argumento central do artigo é o de que a CEME representou a consolidação, em âmbito federal, de uma política realizada no Instituto Nacional da Previdência Social (INPS) entre 1968 e 1970, baseada na produção de insumos e medicamentos em laboratórios públicos. Encerrada em 1970, esta política foi retomada no ano seguinte com ampla participação de militares e laboratórios das Forças Armadas, sendo a originalidade deste artigo explicar como tal apoio influiu na montagem da CEME em seus primeiros anos. Até 1974, os membros militares eram majoritários na Comissão Diretora da CEME, sendo algumas das primeiras missões da autarquia o abastecimento de Ações Cívico-Sociais das Forças Armadas.

Fiscal austerity and municipal health spending: an interrupted time series study.

OBJECTIVE: To analyze the impact of the fiscal austerity policy (PAF) on health spending in Brazilian municipalities, considering population size and source of funds. METHODS: The interrupted time series method was used to analyze the effect of the PAF on total expenditure, resources transferred by the Federal Government, and own/state per capita resources allocated to health in the municipalities. The time series analyzed covered the period from 2010 to 2019, every six months. The first semester of 2015 was adopted as the start date of the intervention. The municipalities were grouped into small (up to 100,000 inhabitants), medium (101,000 to 400,000 inhabitants), and large (over 400,000 inhabitants). The data was obtained from the Sistema de Informações sobre Orçamentos Públicos em Saúde (Information System on Public Health Budget). RESULTS: The results for the national average of municipalities show that the PAF had a negative impact on the level of total expenditure and own/state resources allocated to health in the first half of 2015, without causing statically significant changes in the trends of any of the indicators analyzed in the period after 2015. Small municipalities saw a drop in total expenditure, while large municipalities saw a drop in own/state resources, and medium-sized municipalities saw a drop in both variables. There was no statistically significant drop in the volume of funds transferred by the Federal Government in the immediate aftermath of the implementation of the PAF in any of the municipal groups analyzed. In the medium-term, the PAF only had a negative impact on the large municipalities, which saw significant reductions in the trends of own/state resources and those transferred by the Union for health. CONCLUSION: In general, the impact of the PAF on health financing in municipalities was immediate and based on the decrease in own/state resources allocated to health. In large municipalities, however, the impact lasted from 2015 to 2019, mainly affecting health expenditure from federal funds.

How Might Corporations' and Nonhuman Animals' Personhood Compare Under the Fifth and Fourteenth Amendments?

The Fourteenth Amendment to the US Constitution prohibits states from depriving any person "equal protection of the laws," and the Constitution's Fifth Amendment has been interpreted as applying this prohibition to the federal government. This article considers whether constitutional equal protection should apply to some nonhuman animals in light of corporations having gained such protection and concludes that expanding equal protection personhood to nonhuman animals is improbable in the present legal landscape.

A Federated Registration System for Artificial Intelligence in Health.

This Viewpoint discusses a suggested framework of local registries to record and track all health artificial intelligence technologies used in clinical care, with the goal of providing transparency on these technologies and helping speed adoption while also protecting patient well-being.

Mainstreaming nature in US federal policy.

Integrated policy changes must be cross-sectoral, appropriate, strategic, and evidence-based.

Examining the Contextual Factors Influencing Intersectoral Action for the SDGs: Insights From Canadian Federal Policy Leaders.

BACKGROUND: The interdependent and intersecting nature of the Sustainable Development Goals (SDGs) require collaboration across government sectors, and it is likely that departments with few past interactions will find themselves engaged in joint missions on SDG projects. Intersectoral action (IA) is becoming a common framework for different sectors to work together. Understanding the factors in the environment external to policy teams enacting IA is crucial for making progress on the SDGs. METHODS: Interviews [n=17] with senior public servants leading SDG work in nine departments in the federal government of Canada were conducted to elicit information about issues affecting how departments engage in IA for the SDGs. Transcripts were coded based on a set of factors identified in a background review of 20 documents related to Canada's progress on SDGs. Iterative group thematic analysis by the authors illuminated a set of domestic and global contextual factors affecting IA processes for the SDGs. RESULTS: The mechanisms for successful IA were identified as facilitative governance, leadership by a central coordinating office, supportive staff, flexible and clear reporting structures, adequate resources, and targeted skills development focused on collaboration and cross-sector learning. Factors that affect IA positively include alignment of the SDG agenda with domestic and global political priorities, and the co-occurrence of social issues such as Indigenous rights and gender equity that raise awareness of and support for related SDGs. Factors that affect IA negatively include competing conceptual frameworks for approaching shared priorities, lack of capacity for "big picture" thinking among bureaucratic staff, and global disruptions that shift national priorities away from the SDGs. CONCLUSION: IA is becoming a normal way of working on problems that cross otherwise separate government accountabilities. The success of these collaborations can be impacted by contextual factors beyond any one department's control.

Navigating the Labyrinth of Pregnancy-Related Coverage for Undocumented Immigrants: An Assessment of Current State and Federal Policies.

Insurance coverage for prenatal care, labor and delivery care, and postpartum care for undocumented immigrants consists of a patchwork of state and federal policies, which varies widely by state. According to federal law, states must provide coverage for labor and delivery through Emergency Medicaid. Various states have additional prenatal and postpartum coverage for undocumented immigrants through policy mechanisms such as the Children's Health Insurance Program's "unborn child" option, expansion of Medicaid, and independent state-level mechanisms. Using a search of state Medicaid and federal government websites, we found that 27 states and the District of Columbia provide additional coverage for prenatal care, postpartum care, or both, while 23 states do not. Twelve states include any postpartum coverage; 7 provide coverage for 12 months postpartum. Although information regarding coverage is available publicly online, there exist many barriers to access, such as lack of transparency, lack of availability of information in multiple languages, and incorrect information. More inclusive and easily accessible policies are needed as the first step toward improving maternal health among undocumented immigrants, a population trapped in a complicated web of immigration policy and a maternal health crisis. (Am J Public Health. 2024;114(10):1051-1060. https://doi.org/10.2105/AJPH.2024.307750).

The Biden Administration's Push to Lower Drug Prices Through March-In Rights.

This Viewpoint explores a 2023 Biden administration proposal for US agencies to use their march-in rights and the impact this proposed framework could have on drug prices.

Upholding Tribal Sovereignty in Federal, State, and Local Emergency Vaccine Distribution Plans.

Cross jurisdictional collaboration efforts and emergency vaccine plans that are consistent with Tribal sovereignty are essential to public health emergency preparedness. The widespread adoption of clearly written federal, state, and local vaccine plans that address fundamental assumptions in vaccine distribution to Tribal nations is imperative for future pandemic response.

United States Federal Policies Contributing to Health and Health Care Inequities in Puerto Rico.

Puerto Rico, a territory of the United States since 1898, has recently experienced an increasing frequency and intensity of natural disasters and public health emergencies. In 2022, Hurricane Fiona became the latest storm to attract media attention and cast a light on Puerto Rico's deteriorating conditions, including infrastructural failings, health care provider shortages, and high levels of chronic illness. Although recent events have been uniquely devastating, decades of inequitable US federal policy practices have fueled the persistence of health inequities in the territory. Here we demonstrate how existing health and health care inequities in Puerto Rico have been exacerbated by compounding disasters but are rooted in the differential treatment of the territory under US federal policies. Specifically, we focus on the unequal US Federal Emergency Management Agency response to disasters in the territory, the lack of parity in federal Medicaid funding for Puerto Rico, and Puerto Rico's limited political power as a territory of the United States. We also provide empirically supported policy recommendations aimed at reducing health and health care inequities in the often-forgotten US territory of Puerto Rico. (Am J Public Health. 2024;114(S6):S478-S484. https://doi.org/10.2105/AJPH.2024.307585) [Formula: see text].

Use of research evidence in U.S. federal policymaking: A reflexive report on intra-stage mixed methods.

The policymaking process is largely opaque, especially regarding the actual writing of the policy. To attempt to better understand this complex process, we utilized mixed methods in our evaluation of an intervention. However, the process of mixing methods can be messy, and thus may require recalibration during the evaluation itself. Yet, in comparison to reporting results, relatively little attention is paid to the effects of mixing methods on the evaluation process. In this article, we take a reflexive approach to reporting a mixed methods evaluation of an intervention on the use of research evidence in U.S. federal policymaking. We focus on the research process in a qualitative coding team, and the effects of mixing methods on that process. Additionally, we report in general terms how to interpret multinomial logistic regressions, an underused analysis type applicable to many evaluations. Thus, this reflexive piece contributes (1) findings from evaluation of the intervention on the policymaking process, (2) an example of mixing methods leading to unexpected findings and future directions, (3) a report about the evaluation process itself, and (4) a tutorial for those new to multinomial logistic regressions.