Social Construction and Policy Implementation: Inmate Health as a Public Health Issue*

Objectives. This article develops and tests a concise multi‐stage approach for assessing the impact of social construction on the implementation of public programs designed to benefit negatively constructed groups. The framework suggests that negative constructions lead to policy choices that create problems in the implementation process. These problems prevent the accomplishment of key subobjectives necessary for ultimate program success. Methods. We test the utility of the framework in an analysis of a key public health issue—the spread of HIV/AIDS and tuberculosis in prisons. Despite great strides in the treatment and prevention of these diseases outside prison walls, the incidence and severity of both in the incarcerated population has increased dramatically over the last five years. We hypothesize that the problem of inadequate funding, arising from the negative social construction of this unique target population, is to blame. Results. In an analysis of 50 state correctional systems, we find that states with the most negative constructions of criminals and potential criminals spend dramatically less on inmate health, relative to other states. Conclusions. Our analysis suggests that inadequate funding levels in states with negative constructions of criminals and potential criminals jeopardizes the implementation of prison programs targeted at the prevention and treatment of HIV/AIDS and tuberculosis.     

Ethical Challenges in International HIV Prevention Research

Members of an HIV-prevention research network were asked to describe ethical challenges faced in their work. Major themes included acceptable standards of care for participants, defining research of relevance to host countries, reducing risks related to stigma, designing research that meets local needs without contributing to an inadequate status quo, and ensuring informed consent for complex research with potentially vulnerable participants. The challenges are interrelated and highlight the need for innovative, practical strategies to be incorporated into the planning, design, and conduct of HIV prevention trials. Research in applied ethics to support decision-making about HIV prevention research is needed, along with ethics training, mechanisms to support community-wide benefit from research, and expanded dialog on the ethics surrounding HIV prevention and public health research.     

A triple test for behavioral economics models and public health policy

We propose a triple test to evaluate the usefulness of behavioral economics models for public health policy. Test 1 is whether the model provides reasonably new insights. Test 2 is on whether these have been properly applied to policy settings. Test 3 is whether they are corroborated by evidence. We exemplify by considering the cases of social interactions models, self-control models and, in relation to health message framing, prospect theory. Out of these sets of models, only a correctly applied prospect theory fully passes the tests at present. Specifically, in broad agreement with the evidence, a gain frame has positive implications for welfare encourages disease prevention activity, though this does not apply if the perceived probability of the bad health outcome is large enough. We see our tests as being useful to identify how much health policy weight policy makers should assign to specific behavioral economic models; they are also useful to verify what next steps would be most useful in further research.     

Ethical challenges in international HIV prevention research

Members of an HIV-prevention research network were asked to describe ethical challenges faced in their work. Major themes included acceptable standards of care for participants, defining research of relevance to host countries, reducing risks related to stigma, designing research that meets local needs without contributing to an inadequate status quo, and ensuring informed consent for complex research with potentially vulnerable participants. The challenges are interrelated and highlight the need for innovative, practical strategies to be incorporated into the planning, design, and conduct of HIV prevention trials. Research in applied ethics to support decision-making about HIV prevention research is needed, along with ethics training, mechanisms to support community-wide benefit from research, and expanded dialog on ethics surrounding HIV prevention and public health research.     

Help or hindrance? Social policy and the ‘social determinants of health’

In recent years, public health research has become increasingly focused on issues of social inequality and social disadvantage. This is because social issues, such as poor housing and unemployment, have been found to impact health significantly, and are now referred to as ‘the social determinants of health‘. As a result of this shift, public health is now principally concerned with what are historically considered to be social policy issues. This paper discusses the confluence of public health and social policy; it examines the opportunities and risks posed by this convergence for those working in social policy seeking to reduce poverty and inequality. We argue that, while much can be gained in the two fields by working more closely together, there remain fundamental differences in perspectives and approaches. In order to maximise benefits, these points of difference need to be thought through sooner rather than later.     

Resilience among older caregivers in rural Namibia: The role of financial status,social support and health

Background: Namibia has one of the highest human immunodeficiency virus (HIV) prevalence rates and one of the highest rates of orphanhood in the world, and older caregivers provide much of the care to Namibians living with HIV and acquired immune deficiency syndrome (AIDS) (UNAIDS, 2014). In this study, the authors explore how financial status, social support, and health were related to the resilience of caregivers caring for people affected by HIV and AIDS in rural northern Namibia, Africa. Method: Data were collected through a structured interview from (N = 147) caregivers from the Zambezi region. Results: Findings from this study show that employment and physical health were significantly associated with increased resilience in older caregivers. Discussion: Our findings point to the need for employment assistance and health services to improve the resilience of caregivers caring for people living with HIV and AIDS. We conclude that there is a need for more vigorous concerted efforts from public and private sector practitioners and policy makers to create more sustained formal employment opportunities and intervention programs aimed at improving the overall health of older HIV caregivers, especially those residing in rural HIV endemic communities in developing countries.     

Conspiracy beliefs about HIV/AIDS and birth control among African Americans: implications for the prevention of HIV, other STIs, and unintended pregnancy

In this article, we examine the potential role that conspiracy beliefs regarding HIV/AIDS (e.g., "HIV is a manmade virus") and birth control (e.g., "The government is trying to limit the Black population by encouraging the use of condoms") play in the prevention of HIV, other STIs, and unintended pregnancies among African Americans in the United States. First, we review prior research indicating that substantial percentages of African Americans endorse conspiracy beliefs about HIV/AIDS and birth control. Next, we present a theoretical framework that suggests how conspiracy beliefs influence sexual behavior and attitudes. We then offer several recommendations for future research. Finally, we discuss the policy and programmatic implications of conspiracy beliefs for the prevention of HIV, other STIs, and unintended pregnancy .     

Users as Citizens: Collective Action and the Local Governance of Welfare

Self-organization amongst users of community care services preceded the consumerist developments of the 1980s and early 1990s, but can be considered to have been "legitimized" by top-down objectives relating to "user involvement". Nevertheless, the objectives and value bases of disabled people's organizations and organizations of users (or survivors) of mental health services have not always been consistent with those of consumerism, and user groups have experienced tensions in determining the extent to which they should respond to official agendas. Drawing on theories of new social movements and of citizenship, this paper considers the developing place of user organizations within systems of local governance. It looks at the way in which groups have sought to assert the legitimacy both of experiential knowledge and of their position as citizens in the face of official responses which have constructed them as self-interested pressure groups. It draws on empirical research investigating local groups of disabled people and of mental health service users conducted in the first part of the 1990s. It discusses the significance of shared identity as a basis for collective action alongside more pragmatic motivations to influence the nature of health and social care services. In the context of appeals to "community" and "partnership" which are starting to replace the discourse of markets and contracts as the key metaphor for both policy-making and service delivery, the article considers likely future roles for groups comprising people often excluded from community.     

Older People and the Health–Social Care Boundary in the UK: Half a Century of Hidden Policy Conflict

The boundary between health and social care services has been an important focus of both social research and policy reform in many western and northern European countries. In the UK there is a history of particularly sharp divisions between the centrally funded NHS and locally run social services. A consequence for older people, especially those with less acute or "intermediate" needs, is that they may be rationed out, ignored, or treated inappropriately on either side of the boundary. This paper seeks to go beyond explanations in terms of financial, administrative and professional divisions by using now-available public records to show how the boundary between health and social care was set in stone in the immediate postwar years and resulted in a constant battle between the two services over the needs they would meet. The first part of the paper examines a largely hidden history of health and social care policy. The second part examines the new NHS Plan and the extent to which it is likely to resolve the problem of the boundary.     

The social consequences of the AIDS epidemic: a challenge for the social sciences

The Social Science Research Council is analyzing the social consequences of the AIDS epidemic from the viewpoint of developing society's coping mechanisms and policies. Since neither drugs nor vaccines for AIDS are available, the National Academy of Sciences and the Institute of Medicine have urged that social service research be directed at the areas of education and policy and also at discrimination against AIDS patients and high-risk minorities, such as homosexuals and intravenous drug users. Education is essential in order to effect behavioral changes among these groups as well as to forestall panic among the public. The AIDS epidemic comes at a time when public health emphasis was shifting from communicable disease to chronic degenerative disorders, and problems, such as the possible need for isolation wards are reappearing. Moreover, the total cost of caring for AIDS sufferers is expected to be between 8 and 16 billion pounds sterling by 1991. As AIDS patients become unemployed, they lose their insurance benefits, and the cost of their care reverts to Medicaid and state revenues. Research needs to be done as to the degree to which voluntary health agencies will be able to help. The AIDS epidemic also affects civil rights. Some federal agencies and the armed forces screen applicants for AIDS seropositivity. The army, which traditionally has recruited from inner city minorities, has found that up to 2% of applicants are HIV seropositive, and foreign governments are beginning to object to the stationing of US soldiers in their countries. Answers must be provided for all of these and other social issues if we are to cope with the social effects of the AIDS epidemic.     

Sleepwalking through an Epidemic--Why Social Work should Wake up to the Threat of Hepatitis C

Correspondence to Dr Ian Paylor, Department of Applied Social Science, Cartmel College, Lancaster University LA1 3HY, UK. E-mail: i.paylor1{at}lancaster.ac.uk Summary One of the many consequences of injecting drug use is the potentialrisk to infectious blood-borne viruses. There is evidence thatthe risk of contracting Hepatitis C (HCV) is greater than thatof HIV. Despite repeated warnings from a variety of sourcesand thousands of new infections among drug users each year andrising incidents of ‘'crack’ injecting, successivegovernments have failed to address a public health emergencyof immense proportions - the HCV epidemic. This article exploresthis issue and the implications it has for social work.     

Social Psychological Factors in Lifestyle Change and Their Relevance to Policy

Crises in obesity and changes in the environment illustrate the need to change problematic behaviors and lifestyles in large segments of the population. This article uses social psychological theory and research to understand methods for facilitating lifestyle change. A basic assumption in the social psychological perspective is that the environment and the person interact to determine behavior. Both factors are important for understanding "upstream" and "downstream" approaches to lifestyle change ( McKinlay, 1993 ; Verplanken & Wood, 2006 ) and consideration of one factor without the other may be disastrous. We review evidence from within and outside of the health context to illustrate the upstream and downstream approaches and then describe implications for public policy and intervention. The evidence and recommendations encompass a wide range of behaviors, ranging from speeding and intoxicated driving to eating an unhealthy diet and energy conservation. When armed with the relevant social psychological theory and evidence, lifestyle change campaigns are likely to be successful.     

Taking Rights Structurally: Disability, Rights and Social Worker Responses to Direct Payments

Correspondence to: Tim Stainton, School of Social Work and Family Studies, University of British Columbia, 2080 West Mall, Vancouver, BC, Canada, V6T 1Z2. E-mail: timst{at}interchange.ubc.ca Summary This article examines the link between a justice and rightsdiscourse and disability policy and practice. Specifically,it considers social worker responses to direct payments, a policywhich has been linked to a discourse of social justice and rights.The article initially considers the nature of justice and rights,arguing that these can plausibly be seen to be grounded in theidea of autonomy and that a rights or justice based social policyand practice must be grounded in the protection, enhancementand development of the capacity for autonomous action. The articlethen presents partial findings of a research project, whichsampled social workers' views and attitudes towards direct paymentsin three local authorities. The findings suggest that socialworkers are aware of the link between direct payments and autonomyand are generally very supportive of the move to a rights basedapproach to policy and practice as evidenced by programmes suchas direct payments. The paper also concludes that structuralconstraints limit social workers' ability to fully functionfrom a rights based approach to disability.     

Food Safety and Consumers: Constructions of Choice and Risk

This paper argues that food safety did not arise as a "new" obsession at the end of the twentieth century, but has been an intermittent object of public and policy concern over the last two hundred years in the UK. However, the nature of food policy has shifted over that period, from an orientation towards protecting a largely ignorant public from fraud, through controlling the risks potentially arising from negligence in food–handling, to informing rational consumers to enable them to "choose" the right foods. Most recently, the public have had a nominally more active role in food policy, as citizens consulted on the content of the policy agenda. Drawing on histories of food policy in the UK and social science research on consumers, this paper explores the links between the changing risks and publics addressed by British food policy.     

The potential power of social policy programmes: income redistribution,economic resources and health

Lundberg O, Fritzell J, Åberg Yngwe M, Kölegård ML. The potential power of social policy programmes: income redistribution, economic resources and health Int J Soc Welfare 2010: ??: ??–??© 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare. This Supplement includes a number of articles dealing with the role of social policy schemes for public health across the life course. As a key social determinant of health, poverty and its consequences have historically been at the forefront of the public health discussion. But also in rich countries today, economic resources are likely to be important for health and survival, both on an individual and an aggregate level. This introductory article serves as a background for the more specific analyses that follow. The focus is on why income and income inequality could have an effect on individual and population health. We discuss relationships between the individual and population levels and between income and health, and some of the possible mechanisms involved. We also present arguments for why welfare state institutions may matter.     

The nature of child protection practices: an Irish case study

Child protection social work in Ireland has been expanding at a significant pace over the past decade, particularly since the implementation of the 1991 Child Care Act and the emergence of a number of child abuse 'scandals' since the early 1990s. One health board area in Ireland, itself subject to one of the most controversial child abuse inquiries, commissioned a research study into the nature of child protection practices in the area. The aim of the research was to evaluate the overall child protection system and to consider what impact, if any, new practice guidelines and procedures, implemented in the aftermath of the inquiry, had made on the service. This paper considers some of the key findings from the research and considers these in the context of the overall Irish child protection system. Three particular aspects of the research are focused on: the use of procedures and guidelines, the nature of interagency cooperation and the position of social workers within this, and the overall nature and direction of the child care system.     

Ethics and research assessing the relative roles of genes and the environment

Research on the interaction of genes and the environment is revealing that many human diseases have both genetic and environmental components. Even traditional "environmental" diseases, such as infections, appear to interact with genetic components in the human host. Environmental genetics research will inevitably increase understanding of individual susceptibilities to toxic exposures in the environment and harmful side effects of medications; therefore, it has great promise for improving the prevention and treatment of human diseases. However, realizing the benefits of this research requires careful attention to ethical issues that are particularly relevant in this context. This article reviews some of the most pressing issues related to research design and methods, as well as from the application of research results (e.g., workplace genetic screening and legal toxic torts, personal medical responsibility, and the relationship between genetics and public health measures).     

Do-It-Yourself Social Policy: Searching for a New Paradigm?

One of the most significant trends of recent decades has been the growing importance of do-it-yourself social policy: i.e. individuals constructing their own welfare mix both within the public sector and in private markets. This paper argues that this challenges the traditional top-down bias of social policy studies and requires a shift of focus within the discipline. The implications for normative theory, research strategy and policy analysis are explored. Some of the arguments for and against choice as a guiding principle are sketched out; some existing research on benefit take-up and choice in education and health is reviewed and the case for moving away from the economist's simple model of rationality is put forward. Finally, we argue, there should be more emphasis in social policy on developing a better understanding of the way in which individuals take their decisions, the context of public policy within which they act and the interaction between the two.     

From Snapshots to Videotape: New Directions in Research on Gender Differences

This article identifies five answers to the question of whether there are sex differences in abilities and personality traits: the "sociobiology" argument, the "differently situated" argument, the "contingent" argument, the "no differences" argument, and the "disadvantage, not difference" argument. The multiplicity of arguments about sex differences derives from contrasting research paradigms in psychology. The individual differences model, stemming from the early days of scientific psychology, assumes a radical individualism in which mental abilities are made up of stable and unalterable individual characteristics that are not influenced by social factors; these characteristics are easily captured by quick, one-time, "snapshot" research methods. In contrast, the social psychological model considers the individual to be embedded in and influenced by the social situation. This article points out shortcomings of both models for the study of sex differences, and advocates instead a multi-level approach that considers both micro- and macro-level factors in shaping the behavior of both females and males. Videotape as a metaphor suggests new ways of thinking about research on women's lives.