U.S. policy on health inequities: the interplay of politics and research

What is the relationship between scientific research and government action in addressing health inequalities in the United States? What factors increase the impact of scientific research on public policy? To answer these questions, we focus on racial and ethnic disparities in health status and health care in the United States. We first review the history of the disparities issue to elucidate how the continual and persistent interplay between political action and scientific research drives government policy. We then analyze two recent government-sponsored reports about racial and ethnic disparities to understand the strategic consequences of issue framing. We draw lessons about how disparities research can have a greater impact on public policy.     

Reframing the racial disparities issue for state governments

Although racial and ethnic disparities in health have been on the federal government's agenda since 1985, no policy reforms have significantly reduced disparities. The question arises whether states can effectively address this issue without waiting for solutions from the national government. The purpose of this article is to propose ways of reframing the disparities issue that might give state policy makers more leverage and might strengthen political will to address the issue. I suggest a moral frame based on a concept of distributive justice in which medical care must be distributed according to need. I explain the rationales for such a frame and consider its strategic advantages and disadvantages. In the last section, I suggest some policies based on this framing that are within the power of state legislatures.     

IsTeen Court effective for repeat offenders? A test of the restorative justice approach

Teen Courts are an effective judicial alternative for many youth offenders. The majority of youth courts deal solely with first-time offenders. However, repeat offenders are at a greater risk for future crime. Is Teen Court effective with more experienced offenders? In this study, the authors examine the outcomes of 26 Whatcom County Teen Court offenders with at least one prior conviction. The sentence completion rate was higher and the recidivism was lower for the Teen Court offenders when compared with a sample of first-time Court Diversion offenders. This objective evidence of program success is augmented by an offender's perspective on his or her court experience. These perspectives as well as the continued voluntary involvement with Teen Court are discussed in relation to empowerment theory.     

Refocusing on women: a new direction for policy and research on intimate partner violence

A key question facing researchers of intimate partner violence is how the real-life contexts of victims' lives should affect state policy. The bulk of recently adopted and much touted criminal justice reforms have taken the form of relatively inflexible, one-size-fits-all mandatory responses focused on counseling, restraining, and punishing batterers. Even the protection order system relies far more heavily on batterer treatment programs than on victim support to prevent future violence. Together, these reforms have largely sacrificed the contextualized, woman-centered focus from which the antidomestic violence movement originated. Recently, however, a small body of research has emerged indicating that responding flexibly to victims' needs and providing them with advocacy and broad social support could be a more successful strategy for keeping women safe. These data highlight the importance of expanding victim-centered resources and reincorporating a particularized perspective into current policy and practice. Development of this literature should guide future reform efforts.     

National Association of Medical Examiners position paper on the certification of cocaine-related deaths

The National Association of Medical Examiners Committee on Cocaine-related Deaths recommends that the following guidelines be applied in the process of documenting, interpreting, and certifying potential cocaine-related fatalities. The committee cautions that the investigation of any drug-related death requires a complete investigation of the circumstances of death, the death scene, and past medical history. It is also necessary to have the results of the forensic toxicological analysis and those of a complete forensic autopsy examination prior to formulating an opinion as to the cause and manner of death. Cocaine should be considered the underlying cause of the death when 1 or more of the following is true: (1). the circumstances surrounding the death can be associated with an acute cocaine exposure and there are no supervening causes of death; (2). the immediate cause of death is directly due to a readily identifiable mechanism or disease such as a gunshot wound or a stroke, yet the acute use of cocaine was the direct underlying cause of the trauma or the disease process; and (3). chronic cocaine use leads to a disease that results in an ultimately fatal pathologic process leading to organ injury and death. The committee further cautions that reported drug levels may not directly relate to the toxic or lethal effects of the drug upon the patient. These guidelines are intended for use by practicing medical examiners and physicians who certify drug deaths, as well as providing education tools for students.