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1.
PLoS Med ; 16(4): e1002788, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31039158

RESUMO

BACKGROUND: Tuberculosis (TB) still represents a major public health problem in Latin America, with low success and high default rates. Poor adherence represents a major threat for TB control and promotes emergence of drug-resistant TB. Expanding social protection programs could have a substantial effect on the global burden of TB; however, there is little evidence to evaluate the outcomes of socioeconomic support interventions. This study evaluated the effect of a conditional cash transfer (CCT) policy on treatment success and default rates in a prospective cohort of socioeconomically disadvantaged patients. METHODS AND FINDINGS: Data were collected on adult patients with first diagnosis of pulmonary TB starting treatment in public healthcare facilities (HCFs) from 16 health departments with high TB burden in Buenos Aires who were followed until treatment completion or abandonment. The main exposure of interest was the registration to receive the CCT. Other covariates, such as sociodemographic and clinical variables and HCFs' characteristics usually associated with treatment adherence and outcomes, were also considered in the analysis. We used hierarchical models, propensity score (PS) matching, and inverse probability weighting (IPW) to estimate treatment effects, adjusting for individual and health system confounders. Of 941 patients with known CCT status, 377 registered for the program showed significantly higher success rates (82% versus 69%) and lower default rates (11% versus 20%). After controlling for individual and system characteristics and modality of treatment, odds ratio (OR) for success was 2.9 (95% CI 2, 4.3, P < 0.001) and default was 0.36 (95% CI 0.23, 0.57, P < 0.001). As this is an observational study evaluating an intervention not randomly assigned, there might be some unmeasured residual confounding. Although it is possible that a small number of patients was not registered into the program because they were deemed not eligible, the majority of patients fulfilled the requirements and were not registered because of different reasons. Since the information on the CCT was collected at the end of the study, we do not know the exact timing for when each patient was registered for the program. CONCLUSIONS: The CCT appears to be a valuable health policy intervention to improve TB treatment outcomes. Incorporating these interventions as established policies may have a considerable effect on the control of TB in similar high-burden areas.


Assuntos
Antituberculosos/uso terapêutico , Política de Saúde , Política Pública , Tuberculose/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/economia , Argentina/epidemiologia , Estudos de Coortes , Feminino , Implementação de Plano de Saúde/economia , Implementação de Plano de Saúde/normas , Implementação de Plano de Saúde/estatística & dados numéricos , Política de Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistemas de Apoio Psicossocial , Política Pública/economia , Remuneração , Fatores Socioeconômicos , Resultado do Tratamento , Tuberculose/economia , Tuberculose/epidemiologia , Populações Vulneráveis/estatística & dados numéricos , Adulto Jovem
3.
Alcohol Alcohol ; 54(2): 123-127, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30801630

RESUMO

AIM: This paper briefly reviews the history of alcohol policy development in Europe leading to the current consensus in the health field on strategic priorities. There is a review of recent policy developments in selected European countries, both EU and non-EU members. METHODS: Narrative review of published journal articles, publications from WHO, and other health organisations and government publications. RESULTS: The implementation of the WHO policy priorities has been variable across Europe. At EU level, there has been a recent pattern of trade considerations taking priority over health and a disinvestment in alcohol research and advocacy. Among EU member states new implementation of WHO strategies have been limited to a few smaller countries and regions. In Russia, there have been considerable falls in mortality following the introduction of controls on price, availability and marketing. CONCLUSION: The implementation of WHO strategy at national level in Europe is highly dependent on the local political circumstances. Where there is concern about alcohol harm and political will, the WHO strategic priorities have been highly influential.In order to build public and political support for prevention, alcohol policy advocates should ensure that there is good data on trends within age, gender, and income groups and develops policies to respond to these trends. The concept of proportionate universalism, where interventions are understood to have a broad population effect but the effect is greater on the groups most in need, may be more useful than the traditional alcohol policy field conceptualisations of whole population and targeted measures.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Prioridades em Saúde/tendências , Formulação de Políticas , Política Pública/tendências , Europa (Continente) , Humanos , Política Pública/economia
4.
Drug Alcohol Rev ; 38(3): 226-233, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30474155

RESUMO

BACKGROUND AND AIMS: Business corporations' use of political donations to garner political influence is especially troubling in relation to products that damage human health. We sought to investigate patterns of donations to Australian political parties from tobacco, alcohol and gambling industry actors and the experiences of key informants. DESIGN AND METHODS: We analysed public data on federal and state donations for 10 years to June 2015. We conducted 28 semi-structured interviews with current and former politicians, ex-political staffers and other key informants, concerning the role played by political donations of tobacco, alcohol and gambling companies in Australian politics. We examined temporal associations in donations data, and thematically analysed interviews. RESULTS: Australian political parties declared donations of A$14 million (US$11 M) from tobacco ($1.9 M), alcohol ($7.7 M), gambling ($2.9 M) and supermarket ($1.7 M) entities, excluding donations below the $12 800 reporting threshold. Donations to the governing party increased substantially during debates about an alcohol tax and gambling law reform. Alcohol industry donations to major parties spiked ahead of elections. Interviewees identified the function of donations in terms of: (i) buying immediate influence; (ii) building long-term relationships; (iii) exploiting a flawed political system; and (iv) the need to look beyond donations, for example, to favour exchange; and the public's right to know about corporate influence on policy-makers. DISCUSSION AND CONCLUSIONS: The alcohol and gambling industries make substantial donations to influence particular decisions in the short term and build relationships over the long term. Banning corporate donations and publicly funding political parties warrant consideration to safeguard the integrity of public policy-making.


Assuntos
Comércio/legislação & jurisprudência , Jogo de Azar/economia , Relações Interprofissionais/ética , Política , Política Pública/legislação & jurisprudência , Indústria do Tabaco/economia , Atitude Frente a Saúde , Austrália , Comércio/economia , Comércio/ética , Jogo de Azar/prevenção & controle , Jogo de Azar/psicologia , Humanos , Manobras Políticas , Saúde Pública , Política Pública/economia , Inquéritos e Questionários , Indústria do Tabaco/legislação & jurisprudência
7.
Health Promot Int ; 34(Supplement_1): i20-i27, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30202924

RESUMO

This article proposes an analysis of the fiscal austerity measures of the Brazilian government and its unfolding in the public health system. It has examined the post-impeachment period of the president of Brazil and the changes of the social policies conduct in opposition to the principle of equity and universality in health with impacts on Brazilian sovereignty. It was a scientific essay on the perspective of the Unified Health System (SUS) and the policy development based on fiscal austerity that is taking place in the Brazilian political scenario, seeking to articulate a diagnosis of the impact of these actions on the structure of the country and the health rights. In this way, we conclude that the SUS is in imminent danger and that austerity policies in Brazil have denied the social gains achieved from previous governments, contributing to the discussion on health systems in the context of the neoliberal economic pressure and its impacts on lifestyles and access to the health services of the Brazilian people.


Assuntos
Recessão Econômica , Programas Nacionais de Saúde/economia , Brasil , Acesso aos Serviços de Saúde/economia , Direitos Humanos , Humanos , Política Pública/economia
8.
PLoS One ; 13(12): e0209383, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30566426

RESUMO

BACKGROUND: While the rise in opioid analgesic prescribing and overdose deaths was multifactorial, financial relationships between opioid drug manufacturers and physicians may be one important factor. METHODS: Using national data from 2013 to 2015, we conducted a retrospective cohort study linking the Open Payments database and Medicare Part D drug utilization data. We created two cohorts of physicians, those receiving opioid-related payments in 2014 and 2015, but not in 2013, and those receiving opioid-related payments in 2015 but not in 2013 and 2014. Our main outcome measures were expenditures on filled prescriptions, daily doses filled, and expenditures per daily dose. For each cohort, we created a comparison group that did not receive an opioid-related payment in any year and was matched on state, specialty, and baseline opioid expenditures. We used a difference-in-differences analysis with linear generalized estimating equations regression models. RESULTS: We identified 6,322 physicians who received opioid-related payments in 2014 and 2015, but not in 2013; they received a mean total of $251. Relative to comparison group physicians, they had a significantly larger increase in mean opioid expenditures ($6,171; 95% CI: 4,997 to 7,346), daily doses dispensed (1,574; 95%CI: 1,330 to 1,818) and mean expenditures per daily dose ($0.38; 95% CI: 0.29 to 0.47). We identified 8,669 physicians who received opioid-related payments in 2015, but not in 2013 or 2014; they received a mean total of $40. Relative to comparison physicians, they also had a larger increase in mean opioid expenditures ($1,031; 95% CI: 603 to 1,460), daily doses dispensed (557; 95% CI: 417 to 697), and expenditures per daily dose ($0.06; 95% CI: 0.002 to 0.13). CONCLUSIONS: Our findings add to the growing public policy concern that payments from opioid drug manufacturers can influence physician prescribing. Interventions are needed to reduce such promotional activities or to mitigate their influence.


Assuntos
Analgésicos Opioides , Indústria Farmacêutica/economia , Revisão de Uso de Medicamentos/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Custos de Medicamentos/estatística & dados numéricos , Indústria Farmacêutica/ética , Prescrições de Medicamentos/economia , Prescrições de Medicamentos/estatística & dados numéricos , Revisão de Uso de Medicamentos/economia , Doações/ética , Humanos , Medicare Part D/economia , Medicare Part D/estatística & dados numéricos , Padrões de Prática Médica/economia , Padrões de Prática Médica/ética , Política Pública/economia , Estudos Retrospectivos , Estados Unidos
10.
PLoS One ; 13(11): e0206508, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30418983

RESUMO

OBJECTIVE: Dementia has become a global critical issue. It is estimated that the global cost of dementia was 818 billion USD in 2015. The situation in Japan, which is the most aged country in the world, should be critical. However, the societal cost of dementia in Japan has not yet been estimated. This study was designed to estimate cost of dementia from societal perspective. DESIGN: We estimated the cost from societal perspective with prevalence based approach. SETTING, PARTICIPANTS AND MEASURES: Main data sources for the parameters to estimate the costs are the National Data Base, a nationwide representative individual-level database for healthcare utilization, the Survey of Long-Term Care Benefit Expenditures, a nationwide survey based on individual-level secondary data for formal long-term care utilization, and the results of an informal care time survey for informal care cost. We conducted the analyses with 'probabilistic modeling' using the parameters obtained to estimate the costs of dementia. We also projected future costs. RESULTS: The societal costs of dementia in Japan in 2014 were estimated at JPY 14.5 trillion (se 66.0 billion). Of these, the costs for healthcare, long-term care, and informal care are JPY 1.91 trillion (se 4.91 billion), JPY 6.44 trillion (se 63.2 billion), and JPY 6.16 trillion (se 12.5 billion) respectively. The cost per person with dementia appeared to be JPY5.95 million (se 27 thousand). The total costs would reach JPY 24.3 trillion by 2060, which is 1.6 times higher than that in 2014. CONCLUSIONS: The societal cost of dementia in Japan appeared to be considerable. Interventions to mitigate this impact should be considered.


Assuntos
Envelhecimento , Efeitos Psicossociais da Doença , Demência/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Política Pública/economia
11.
PLoS One ; 13(11): e0207598, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30485329

RESUMO

This present research investigates the money demand function of Saudi Arabia using a long period 1968-2016. In addition, the asymmetrical effects of real exchange rate changes have also been explored in the estimated money demand function. Our empirical results suggest that income and inflation have positive and negative effects on money demand respectively. Further, a real appreciation of US dollar has a positive effect but a real depreciation has a negative effect on the money demand. Furthermore, income and price homogeneity hypotheses do not hold for the estimated elasticities. Moreover, the estimated model is found stable with the theoretically expected effects of money demand's determinants. Therefore, we are suggesting money supply as a monetary policy instrument to the economy of Saudi Arabia.


Assuntos
Comércio/economia , Renda/estatística & dados numéricos , Inflação/estatística & dados numéricos , Política Pública/economia , Algoritmos , Comércio/estatística & dados numéricos , Humanos , Renda/tendências , Inflação/tendências , Modelos Econômicos , Arábia Saudita
12.
PLoS One ; 13(9): e0203167, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30222776

RESUMO

The Low Carbon Fuel Standards (LCFS) represents a new policy approach designed to reduce carbon dioxide emissions by applying standards to all stages of motor fuel production. We use the synthetic control and difference-in-differences econometric methods, and Lasso machine learning to analyze the effect of the LCFS on emissions in California's transportation sector. The three different techniques provide robust evidence that the LCFS reduced carbon dioxide emissions in California's transportation sector by around 10%. Furthermore, our calculations show that improved air quality, due to the application of the LCFS, may have benefited California in the magnitude of hundreds of millions of dollars through an increase in worker's productivity.


Assuntos
Dióxido de Carbono/análise , Petróleo/normas , Emissões de Veículos/legislação & jurisprudência , Emissões de Veículos/prevenção & controle , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/normas , Poluição do Ar/análise , Poluição do Ar/legislação & jurisprudência , Poluição do Ar/prevenção & controle , California , Carbono/análise , Simulação por Computador , Humanos , Petróleo/análise , Política Pública/economia , Política Pública/legislação & jurisprudência , Transportes , Emissões de Veículos/análise
13.
BMC Public Health ; 18(Suppl 1): 959, 2018 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-30168392

RESUMO

BACKGROUND: Tobacco use is a major risk factor for non-communicable diseases and policy formulation on tobacco is expected to engrain international guidelines. This paper describes the historical development of tobacco control policies in Nigeria, the use of multi-sectoral action in their formulation and extent to which they align with the World Health Organisation "best buy" interventions. METHODS: We adopted a descriptive case study methodology guided by the Walt and Gilson Policy Analysis Framework. Data collection comprised of document review (N = 18) identified through search of government websites and electronic databases with no date restriction and key informant interviews (N = 44) with stakeholders in public and private sectors. Data was integrated and analyzed using content analysis. Ethical approval was granted by the University of Ibadan and University College Hospital Ethics Review Committee. RESULTS: Although the agenda for development of a national tobacco control policy dates back to the 1950s, a comprehensive Framework Convention for Tobacco Control (FCTC) compliant policy was only developed in 2015, 10 years after Nigeria signed the FCTC. Lack of funding and conflict of interest (of protecting citizens from harmful effect of tobacco viz. a viz. the economic gains from the industry) are the major barriers that slowed the policy process. Current tobacco -related policies developed by the Federal Ministry of Health were formulated through strong multi-sectoral engagement and covering all the four WHO "best buy" interventions. Other policies had limited multi-sectoral engagement and "best buy" strategies. The tobacco industry was involved in the development of the Standards for Tobacco Control of 2014 contrary to the long-standing WHO guideline against engagement of the industry in policy formulation. CONCLUSIONS: Nigeria has a comprehensive national policy for tobacco control which was formulated a decade after ratification of the FCTC due to constraints of funding and conflict of interest. Not all the tobacco control policies in Nigeria engrain the principles of multisectorality and best buy strategies in their formulation. There is an urgent need to address these neglected areas that may hamper tobacco control efforts in Nigeria.


Assuntos
Formulação de Políticas , Política Pública , Setor Público/organização & administração , Uso de Tabaco/prevenção & controle , Conflito de Interesses , Humanos , Nigéria , Política Pública/economia , Indústria do Tabaco , Organização Mundial da Saúde
14.
BMC Public Health ; 18(Suppl 1): 957, 2018 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-30168398

RESUMO

BACKGROUND: Harmful use of alcohol is one of the most common risk factors for Non-Communicable Diseases and other health conditions such as injuries. World Health Organization has identified highly cost-effective interventions for reduction of alcohol consumption at population level, known as "best buy" interventions, which include tax increases, bans on alcohol advertising and restricted access to retailed alcohol. This paper describes the extent of inclusion of alcohol related "best buy" interventions in national policies and also describes the application of multi-sectoral action in the development of alcohol policies in Malawi. METHODS: The study was part of a multi-country research project on Analysis of Non-Communicable Disease Preventive Policies in Africa, which applied a qualitative case study design. Data were collected from thirty-two key informants through interviews. A review of twelve national policy documents that relate to control of harmful use of alcohol was also conducted. Transcripts were coded according to a predefined protocol followed by thematic content analysis. RESULTS: Only three of the twelve national policy documents related to alcohol included at least one "best buy" intervention. Multi-Sectoral Action was only evident in the development process of the latest alcohol policy document, the National Alcohol Policy. Facilitators for multi-sectoral action for alcohol policy formulation included: structured leadership and collaboration, shared concern over the burden of harmful use of alcohol, advocacy efforts by local non-governmental organisations and availability of some dedicated funding. Perceived barriers included financial constraints, high personnel turnover in different government departments, role confusion between sectors and some interference from the alcohol industry. CONCLUSIONS: Malawi's national legislations and policies have inadequate inclusion of the "best buy" interventions for control of harmful use of alcohol. Effective development and implementation of alcohol policies require structured organisation and collaboration of multi-sectoral actors. Sustainable financing mechanisms for the policy development and implementation processes should be considered; and the influence of the alcohol industry should be mitigated.


Assuntos
Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Consumo de Bebidas Alcoólicas/prevenção & controle , Formulação de Políticas , Política Pública , Humanos , Malaui , Política Pública/economia , Setor Público/organização & administração , Pesquisa Qualitativa , Organização Mundial da Saúde
15.
Environ Sci Pollut Res Int ; 25(30): 30647-30658, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30178404

RESUMO

As the average noise level and number of noise sources have increased, governments have taken various measures to make soundscapes sustainable. Wise policy decisions require information about the monetary value of noise-control policies. This study elicited people's willingness to pay (WTP) for noise policies, separating traffic noise from residential noise to compare the value of controlling different types of noise. The contingent valuation method was used for the empirical analysis, with data from South Korea. The results show that the monthly mean WTP of respondents was KRW 3392.3 for residential noise reduction and KRW 3507.1 for transport noise reduction; thus, the WTP for the latter is slightly higher than that for the former. Moreover, about 80% of people are unwilling to pay for a noise policy at all, and that high ratio of people with zero WTP must be taken into consideration in the process of policy formulation and implementation. Respondents' experiential and psychological factors were found to be more important than their demographics in explaining their WTP for a noise policy. Potential policy implications based on the analysis results are provided.


Assuntos
Monitoramento Ambiental/economia , Monitoramento Ambiental/legislação & jurisprudência , Ruído/efeitos adversos , Política Pública/economia , Adulto , Monitoramento Ambiental/normas , Humanos , República da Coreia
16.
J Stud Alcohol Drugs ; 79(4): 514-522, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30079865

RESUMO

OBJECTIVE: Evidence on the comparative cost-effectiveness of alcohol control strategies is a relevant input into public policy and resource allocation. At the global level, this evidence has been used to identify so-called best buys for noncommunicable disease prevention and control. This article uses global evidence on alcohol use exposures and risk relations, as well as on intervention costs and impacts, to re-examine the comparative cost-effectiveness of a range of alcohol control strategies. METHOD: A "generalized" approach to cost-effectiveness analysis was adopted. A new modeling tool (OneHealth) was used to estimate the population-level effects of interventions. Interventions that reduce the harmful use of alcohol included brief psychosocial interventions, excise taxes, and the enactment as well as enforcement of restrictions on alcohol marketing, availability, and drink-driving laws. Costs were estimated in international dollars for the year 2010 and effects expressed in healthy life years gained. Analysis was carried out for 16 countries spanning low-, middle-, and high-income settings. RESULTS: Increasing excise taxes has a low cost (

Assuntos
Consumo de Bebidas Alcoólicas/economia , Consumo de Bebidas Alcoólicas/prevenção & controle , Análise Custo-Benefício/economia , Saúde Global/economia , Política Pública/economia , Consumo de Bebidas Alcoólicas/epidemiologia , Condução de Veículo , Concentração Alcoólica no Sangue , Feminino , Saúde Global/tendências , Humanos , Masculino , Marketing/economia , Marketing/tendências , Política Pública/tendências , Impostos/economia
17.
J Aging Soc Policy ; 30(3-4): 337-356, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29634409

RESUMO

Economic risk exposure through increased labor market volatility and growing caregiving responsibilities has risen for older Americans. At the same time, key protections such as unemployment insurance and Social Security have declined, while other protections-particularly in the private market-are limited or nonexistent. Social policy can lower the chance of risk exposure and the associated costs, especially with respect to unemployment and caregiving. In virtually all instances, however, the Trump administration has already moved to weaken existing protections. And it has offered either no proposals or very limited proposals to increase protections in the private sector As a result, an aging population will increasingly face rising economic risks on their own.


Assuntos
Política Pública/economia , Aposentadoria/economia , Desemprego , Demografia , Humanos , Investimentos em Saúde/economia , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos
18.
Nutr Clin Pract ; 33(3): 316-324, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29603389

RESUMO

Home parenteral nutrition (HPN) has been considered a lifesaving intervention since the late 1960s for patients with gastrointestinal (GI) failure and other conditions that affect the GI tract who are well enough to be at home. Payment for this therapy under federal programs requires significant documentation and complex processes to qualify. Medicare parenteral nutrition policy, qualification processes and challenges, and advocacy supported by the American Society for Parenteral and Enteral Nutrition are reviewed with the goal of increasing clinician awareness of the complexity surrounding Medicare HPN reimbursement.


Assuntos
Reembolso de Seguro de Saúde/economia , Nutrição Parenteral no Domicílio/economia , Política Pública/economia , Sociedades Médicas , Centros Comunitários de Saúde , Nutrição Enteral/economia , Humanos , Medicare/economia , Estados Unidos
19.
Int Rev Psychiatry ; 30(1): 110-115, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29537885

RESUMO

Children with Autism Spectrum Disorder (ASD) are admitted to inpatient psychiatric units at markedly high rates. As health insurance companies and government healthcare systems and regulators seek more evidence for healthcare outcomes, it is important to learn more about the effectiveness of psychiatric inpatient admissions for children with ASD to best inform decisions on provision and access to this level of care. Evidence for models of inpatient treatment for youth with ASD is presented, and key characteristics and consensus recommendations for care are discussed.


Assuntos
Transtorno do Espectro Autista/terapia , Hospitalização , Seguro Saúde , Unidade Hospitalar de Psiquiatria , Política Pública , Criança , Hospitalização/economia , Hospitalização/legislação & jurisprudência , Hospitalização/estatística & dados numéricos , Humanos , Seguro Saúde/economia , Seguro Saúde/legislação & jurisprudência , Seguro Saúde/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/economia , Unidade Hospitalar de Psiquiatria/legislação & jurisprudência , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Política Pública/economia , Política Pública/legislação & jurisprudência , Estados Unidos
20.
J Public Health Policy ; 39(2): 156-169, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29358695

RESUMO

Despite strong evidence confirming vaccination is safe and effective, some parents choose not to vaccinate their children. In 2016, the Australian Government introduced legislation strengthening links between vaccination compliance and some government payments. We interviewed thirty-one non-vaccinating parents about the impacts of this policy. Data analysis produced three key themes: 'questioning policy integrity', 'minimising impact' and 'holding my ground'. Affected parents offset reduced income by removing children from early childhood learning, reducing work commitments, moving residence to reduce living costs and accessing informal childcare arrangements. Parents reported a greater commitment to their decision not to vaccinate and an increased desire to maintain control over health choices for their children including an unprecedented willingness to become involved in protest action. Our study identifies why financial penalties have not been an effective policy measure for this sample of non-vaccinating parents, an understanding which may assist in the development of future legislation.


Assuntos
Governo , Pais/psicologia , Política Pública/economia , Recusa de Vacinação , Vacinação/legislação & jurisprudência , Austrália , Criança , Pré-Escolar , Humanos , Lactente , Pesquisa Qualitativa
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