Politiques publiques et santé:les dilemmes de I‘évaluation prospective

Sommaire: Depuis le milieu des années 1990, plusieurs gouvernements ont affirmé leur volonté de tenir compte des impacts de leurs actions sur la santé des populations. En juin 2002, le gouvernement du Québec met en vigueur l'article 54 de la Loi sur la santé publique (L.R.Q. chapitre S‐22, 2001). Cet article atteste de l'obligation pour les ministères de tenir dorénavant compte des impacts sociaux, environnementaux et économiques de leurs actions sur la santé. La mise en Oeuvre de cet article suppose l'intégration d'un processus d'évaluation prospective des politiques publiques dans l'appareil gouvernemental, remet en question le fonctionnement vertical des administrations publiques et souligne l'importance d'une gestion stratégique des connaissances dans un monde sans frontières. Dans ce contexte, quatre dilemmes sont soulevés. Les deux premiers dilemmes sont d'ordre interministériel. Ils concernent les relations qu'entretiennent les ministéres entre eux et avec les organismes centraux. Les deux autres dilemmes s'intéressent à la dimension intra organisationnelle, c'est‐à‐dire la maniére dont chaque ministère réagit face aux demandes d'évaluations prospectives de ses politiques ou programmes et répond aux exigences dc l'article 54. Des méthodes qui devraient permettre aux administrations publiques de remédier à ces différents dilemmes sont également présentées. Abstract: Since the mid‐1990s, several governments have declared their commitment to ensuring that the impact of their actions on the health of the population is taken into account. In June 2002 the Quebec provincial government implemented article 54 of the Public Health Act (R.S.Q., chapter 2.2, 2001). This article stipulates the obligation on the part of the government departments to take into account the social, environmental, and economic impacts of their actions on public health in the future. The implementation of this article means integrating a process for the prospective assessment of the government's public policies, and re‐examining the vertical model of operation of public administrations; it also underlines the importance of strategic knowledge management in a world without borders. Four dilemmas are raised within this context. The first two dilemmas are interdepartmental in nature, and involve the relationships the government departments have with each other and with the central agencies. The other two dilemmas fall within the intra‐organizational sphere ‐ that is, the way in which each government department reacts to the demands for the prospective assessment of its public policies or programs, and how each department responds to the requirements of article 54. Processes that should allow the public administrations to solve these various dilemmas are also presented.     

Inaccessible and Unknowable: Accretion and Uncertainty in Modern Criminal Law

Between May 1997 and August 2006 over 3,000 new crimes and offences entered the statute book expanding the criminal law exponentially and insinuating criminal liability into areas of everyday life previously untouched. This unremitting intensification of the criminal law where often quite random and unrelated provisions are embedded in huge, generic and virtually annual Criminal Justice Acts has made the law inaccessible and unknowable to the public, and uncertain to those charged with interpreting and applying it. This article examines the phenomenon of accretion in the criminal law within the last decade drawing on historico-legal contexts, jurisprudential theory (particularly the Rule of Law), and contemporary illustrations. It argues that uncontrolled legislative accretion and a bloated statute book may introduce dangerous levels of uncertainty into the law not only undermining its integrity but eroding the essential mutual respect between government and the governed which legitimises the authority of the criminal law. The political hothouse of spin-cycle government has sought to rely on the creation of new law as the panacea to all ills blurring the democratic boundary between citizen and government.

Receipt of preventive dental care among special-needs children enrolled in Medicaid: a crisis in need of attention

Although not widely recognized, tooth decay is the most common childhood chronic disease among children ages five to seventeen. Despite higher rates of dental caries and greater needs, low-income minority children enrolled in Medicaid are more likely to go untreated relative to their higher income counterparts. No research has examined this issue for children with special needs. We analyzed Medicaid enrollment and claims data for special-needs children enrolled in the District of Columbia Medicaid program to evaluate receipt of recommended preventive dental care. Use of preventive dental care is abysmally low and has declined over time. Enrollment in managed care rather than fee for service improves the likelihood that special-needs children receive recommended preventive dental services, whereas residing farther from the Metro is an impediment to receipt of dental care.     

Modus operandi and situational aspects in adolescent sexual offenses against children: a further examination

The relationship between situational factors and the modus operandi of 103 adolescents involved in sexual offenses against children (12 years old or younger) is analyzed. Situational factors taken into account in this study are the location of the crime, the offender-victim relationship, and the presence of deviant sexual fantasies involving the victim prior to the offense. Modus operandi strategies were measured on the basis of participants' responses to Kaufman's Modus Operandi Questionnaire. Results indicate that modus operandi strategies are influenced by situational factors and that the offender's home, when no one else is home, is likely to be the place and the situation for adolescent offenders to adopt manipulative strategies. Suggestions are made regarding future modus operandi studies.     

Modeling the Deviant Y in Criminology: An Examination of the Assumptions of Censored Normal Regression and Potential Alternatives

Many dependent variables of criminological interest have censored distributions. Investigations that use such variables increasingly have turned to the Tobit model, a censored regression technique that is specified based on a latent dependent variable. When used under suitable circumstances, this model provides appropriate estimates. This paper discusses key assumptions of the Tobit model. It then highlights the risk of violating these assumptions and reviews alternative flexible parametric and semiparametric modeling techniques, currently used sparingly in criminology, which researchers may find helpful when assumptions regarding the error terms are untenable. By using an empirical example focused on sentencing outcomes and comparing estimates across analytic methods, this study illustrates the potential utility of simultaneously estimating the Tobit model along with some alternatives.

Conditional Rights,Benefit Reform,and Drug Users: Reducing Dependency?

United Kingdom government policy to increase social security claimants' entry to the labour market through conditions attached to unemployed, sickness and incapacity benefits now includes additional measures to activate particular groups such as lone parents and drug users. The latter are a prime target because of their high level of dependency on benefits and because social security rules are seen as having the potential to modify the behaviour of individuals with a lifestyle regarded as being at odds with the moral obligations of citizenship and incompatible with the government's realization of its wider economic and social goals. There are strict procedures for the identification of drug‐user claimants, enabling additional conditions to be attached to their benefit rights. This article discusses the general trend in benefit reform towards increased conditionality and evaluates the reforms affecting drug users, considering human rights and other implications. It concludes by reflecting on the status of conditional rights to social security as social rights.