Public Policy Institute Research Articles

The State of American Federalism 2023–2024: Judicialization of Gridlocked Politics

Abstract Contemporary American federalism, while characterized by nationalized policy battles in the states, is also increasingly defined by the centralization of power in the federal judiciary. In this introductory piece of the 2023–2024 Annual Review issue, we unpack the judicialization of federalism politics. This process, we argue, has been facilitated by national political gridlock, defined by increasing dysfunction in Congress, and the growth of the administrative presidency. In policy conflicts on subjects ranging from education and the environment to abortion and other individual rights, courts have played an increasingly significant role as the arbiter of the federal–state balance of power. As the articles in this Annual Review illustrate, with a few exceptions, judicialization of federalism has often resulted in the devolution of authority to the states, with significant implications for public policy and democratic institutions.

Oikophobia and the crisis of modern Western civilization

The subject of this article is the phenomenon of oikophobia, which in recent decades has attracted the attention of philosophers, political scientists, sociologists and psychologists who tend to interpret it as the origin of many crisis phenomena affecting the modern Western civilization. The term has been used in political contexts to refer critically to political ideologies that are perceived as responsible for repudiating one's own culture, history, traditions and laud others. The simplest way of defining oikophobia is as the opposite extreme of xenophobia. As xenophobia means the fear or hatred of strangers or foreigners, reversely oikophobia means the fear or hatred of home or one's own society or civilization, oikos being the ancient Greek word for home, house, household. The article reveals the essence and content, characteristic manifestations of oikophobia in its narrow and broad meanings, the historical, cultural and intellectual background and sources of its origin and development. The author identifies signs of oikophobia in a number of key political, philosophical and ideological paradigms and concepts. Based on our findings, we suggest that various manifestations of oikophobia, especially those that may provide the ideological basis for mass protest movements, pose a serious challenge to public policy and government institutions not only in Western countries, but also in Russia. Government bodies and non-governmental organizations involved in the process of policy formulation in the spheres of security, information and education should pay attention to the threats and challenges that government institutions in the USA, Great Britain and a number of other Western countries have already dealt with. In our opinion, one of the most relevant areas of interaction between the Russian government and civil society in the field of countering the manifestations of oikophobia should be formulating general criteria for identifying Russophobia, which could be applied not only in the field of scientific research and educational practices, but also in the field of lawmaking and law enforcement.

Social Technologies for Social Inclusion in Traditional Communities in the Amazon

There is a widely recognized consensus in contemporary society and the academic community that education is crucial for a nation's socioeconomic development. This paper presents the research experience, outreach, and curricular internship of the Grupo de Pesquisa Interação, employing the Interaction Method (Action-Research) approach to train professionals for working with riverside communities in the Amazon region. The research employs a comprehensive set of data collection techniques, such as bibliographic and documentary research, semi-structured surveys, interviews with key informants, and both group and individual dynamics with domestic-family groups to encourage participation from local community members and institutions. The results aim to provide community organizations and domestic-family groups with environmentally sustainable innovations and social technologies. Additionally, they offer qualified support to regional public policy institutions for developing affirmative actions geared towards citizenship and social inclusion.

Maintaining essential health services during COVID-19 in Ghana: a qualitative study

IntroductionEvidence suggests that non-pharmaceutical interventions such as lockdown policies, restriction of movement and physical distancing to control the novel COVID-19 contributed to the decline in utilisation of essential health services....

Inter and transdisciplinarity strategies for evaluating and improving water quality monitoring systems: Uruguay as a study case

Developing robust systems for monitoring and evaluating water quality is crucial for assessing ecosystem integrity and the impacts of human activities on nature. It also enables the assessment of water management effectiveness, governance systems, and the design and evaluation of public policies. However, designing such monitoring programs is complex due to multiple constraints like eco-hydrological knowledge, economic resources, human capital availability, and governance dynamics. This study combines quantitative and qualitative analyses (virtual watershed methodologies, empirical modeling, and theoretical frameworks of water governance) to evaluate the robustness of water quality monitoring systems and identify strengthening alternatives (including institutional design and public policy). The inter and transdisciplinary strategy is tested in the evaluation of eutrophication processes in Uruguay. Major spatial patterns of water quality at a national scale were identified, highlighting the influence of land use, soil types, point sources of pollution, and livestock on nitrogen and phosphorus concentrations. Current monitoring efforts and spatial coverage fall short of adequately addressing water management needs, especially in Uruguay's socio-economic context. Based on the weaknesses identified, an increase in the number of stations (and their spatial distribution) is proposed to have a better representation of biogeophysical and socio-economic conditions diversity. The challenge involves an important transformation (i.e. establishing a network system of public institutional nodes at national and regional levels) due to the country's centralism, fragmented water governance system, and scarce economic assets.

Identifying key factors for successful formulation and implementation of healthcare policies on non-communicable diseases: a multinational analysis.

Non-communicable diseases (NCDs) are a major public health concern that accounts for 74% of global deaths each year. The increasing burden of NCDs exhausts public health resources and threatens the achievement of the 2030 agenda for sustainable development. The purpose of this study is to thematically analyze the contributory factors in the health policy process and reforms to strengthen the prevention of NCDs across borders, as well as the milestones achieved through the process of policy-making, change, and implementation. This study informs and draws on the findings of contributory factors in the health policy process for preventing NCDs across borders: United States, England, Sweden, Bangladesh, Singapore, South Korea, and Thailand. Ten experts from the seven countries were recruited purposively for a semi-structured interview (e-Interview) on the NCD policy-making process in their countries, either through health ministries or the authors' network. This descriptive qualitative study design is guided by the "Three I's" framework of public policy (institutions, ideas, and interests). In addition to the information obtained from the interviewee, data were also sourced from relevant documents and homepages suggested by the interviewee, as well as health homepages of the countries. The following themes were generated: (1) environmental policies and social determinants, (2) multistakeholder involvement, (3) interministerial collaboration, (4) independent evidence and review institution, (5) integrated health data, and (6) primary care system. There was a shift from individual-targeted policies to environmental policies and social determinants. Notably, national campaigns were developed through non-governmental organizations (NGOs) for the primary prevention of NCDs. The shift from behavioral modification and treatment to social determinants is important. NCDs are broad and require a multisector and multilevel approach. Establishing an organization or hierarchical body to overlook NCDs could result in increased awareness, focus, and surveillance and enhance the policy process.

Supporting the Health and Well-Being of Caregivers of Persons with Pain Strategies to address stress and improve self-care.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Tonkikh, O., et al. Supporting the Health and Well-Being of Caregivers of Persons with Pain. Am J Nurs 2023; 123 (6): 55-61.

Green Financing for Sustainable Development in Infrastructure Projects in Kenya

Transitioning into a decarbonized economy requires an unprecedented level of new capital investment, particularly in the form of green finance. Market and regulatory trends indicate that there is an increased interest in green and sustainable finance among investors and policymakers. However, capital mobilization for green investments has been constrained by microeconomic obstacles including maturity mismatches between long-term green investments; the typically short-term time horizons of investors and disintegrated financial and environmental policy approaches. It’s against this backdrop that the study intended to assess the green finance trends, green finance instruments and the challenges on green finance adoption.The study adopted desk review also known as Meta-analysis method to extract information concerning green finance trends, instruments and adoption challenges. The study established that to achieve sustainable development goals (SDGs), its necessary to open-up green projects and scale up the financing of investments that provide environmental benefits through innovative financial instruments and new policies such as green bonds, green banks, carbon market instruments, fiscal policy, green central banking, financial technologies and community-based green funds. However, Financial institutions show more interest in fossil fuel projects than green projects because of the low returns and risks associated with green investment compared to brown investment. To reduce the risk of green investment and increase the rate of return to the investors, the creation of green credit guarantee schemes and tax return on revenue generated from the green energy spillover effect is necessary. In conclusion green finance market is well structured in developed economies unlike developing economies due to underdeveloped capital markets, regulatory gaps and unstandardized green taxonomy.Thus the study recommends the development of green finance database and incorporation of green agenda in public policy institutions’ mandates and procurement;Standardization and information disclosure regarding Green investment risks, green taxonomy and commoditization of environmental factors into tradable assets; Raising awareness; Offering tax incentive on green projects; Developing Carbon Capital Markets; Stock Trading of Green finance products; Strengthen the social responsibilities of investors and Technology adoption.

An Interview With Susan Reinhard.

This column addresses how AARP, a consumer organization, is leading a Center for Health Equity through Nursing. The Center is working to support nursing to mitigate the nursing workforce crisis. Susan C. Reinhard is a senior vice president at AARP, directing its Public Policy Institute (PPI), the focal point for public policy research and analysis at the state, federal, and international levels. She leads PPI's family caregiving initiatives and serves as the chief strategist for the Center to Champion Nursing in America, a national resource center created to ensure that America has the highly skilled nurses it needs to provide care in the future. As a previous deputy commissioner of the New Jersey Department of Health and Senior Services, Reinhard led the development of policies and nationally recognized programs for family caregiving, consumer choice, and community-based care options. She is a fellow of the American Academy of Nursing, the Gerontological Society of America, and Salzburg Global. She holds a master's degree in nursing and a PhD in sociology.

POLICY SERIES: ARE WE THERE YET? MEASURING PROGRESS IN ACHIEVING POLICY GOALS FOR FAMILY CAREGIVERS

Abstract The RAISE Family Caregiving Advisory Council, created under the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act (2018) has been tasked to support the Secretary of Health and Human Services in developing a national family caregiving strategy, published in 2022 as its National Strategy to Support Family Caregivers. One key concern identified by advocates and others is the accountability question: how can we hold policymakers at all levels of government accountable for achieving the policy goals articulated in the National Strategy? This symposium discusses that issue by first providing an overview of a key mechanism for state accountability, AARP’s State Scorecard on Long-Term Services and Supports, which identifies support for family caregivers as one of its four dimensions. Susan Reinhard, PhD, Senior Vice President at AARP and Director of its Public Policy Institute, will describe the history, goals, and future of the Scorecard’s family caregiver component. Salom Teshale, PhD, from the National Academy for State Health Policy will describe how states are focusing their energies in current actions supporting family caregivers, while Mike Wittke, MPA, of the National Alliance for Caregiving will discuss how federal actions might be tracked and assessed. Drawing on research supporting the RAISE Advisory Council, Eileen J. Tell, MPH will suggest additional dimensions that could be integrated into the assessment of progress. Rani Snyder, MPA, of the John A. Hartford Foundation will act as discussant.

THE LTSS STATE SCORECARD NATIONAL ADVISORY PANEL

Abstract Reaching consensus across the field is an important endeavor for a project like the LTSS State Scorecard. Since the Scorecard’s inception in 2008, the AARP Public Policy Institute has engaged a broad range of experts, known as the Scorecard National Advisory Panel (NAP). The NAP is drawn from a broad range of expert stakeholders across private and nonprofit organizations, state agencies, researchers, and the federal government. The NAP has informed virtually all aspects of the Scorecard, including indicator selection, scoring methodology, and the framing and messaging of Scorecard findings. This portion of the symposium will feature remarks and analysis from a long-standing NAP member and expert in the field of long-term services and supports.

AARP PUBLIC POLICY INSTITUTE PRESENTS THE LONG-TERM SERVICES AND SUPPORTS STATE SCORECARD, 2023

Abstract This symposium will present and explore in-depth the 2023 Long-Term Services and Supports (LTSS) State Scorecard. With funding from The SCAN Foundation, The Commonwealth Fund, and The John A. Hartford Foundation, this Scorecard is the fifth edition from the AARP Public Policy Institute. The Scorecard ranks states across five key dimensions that comprise a framework for high-performing LTSS system performance: affordability and access, choice of setting and provider, quality and safety, support for family caregivers, and community and integration. In this symposium, speakers will discuss the Scorecard’s history, its most recent findings, and the implications of the COVID-19 pandemic for state LTSS system performance. In addition, the Scorecard explores LTSS equity, and we will discuss how policymakers, practitioners, the private sector, and other actors can further realize equitable systems of supports.

Mental Models, Decision-Making, Bargaining Power, and Institutional Change

Institutions not only impact on the behavior of individuals, but they are affected by the behavior of individuals and the mental models or practical theories that drive human action. I argue that it is important to better incorporate mental models and competing mental models into the modelling of institutional change. This needs to be coupled with integrating the role of power relationships to better explain for institutional change and related to this, economic development. Power relationships affect not only the development of mental models, which ones are developed and articulated, they also influence which ones receive public approbation or disapprobation, and which are used to drive or justify institutional design and public policy. I argue that given the particular bundle of power relationships and mental models one can predict an array of institutional designs consistent with an array of levels of economic development and wellbeing, ranging from highly efficient and dynamic to inefficient and laggard. In contrast with traditional economics, no unique set of institutions are inevitable and efficient regimes need not and often do not drive out the inefficient ones. And, in contrast with transaction cost institutional modelling, transaction costs’ role is outranking here by the importance of bargaining power, mental model availability and model literacy.

Managing Older Adults' Chronic Pain: Higher-Risk Interventions How to help caregivers promote safe pain management.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Arnstein, P., et al. Managing Older Adults' Chronic Pain: Higher-Risk Interventions. Am J Nurs 2023; 123 (4): 56-61.

The elusive search engine: How search engine use is reflected in survey reports

AbstractThe overall aim of this article is to contribute to a research‐based understanding of the increasing invisibility of web search engines in society and to discussions about the potential impact of this invisibility. It examines how search engine use and online search activities are represented in national and regional reports on internet habits and experience published by public foundations and policy institutes. The elusiveness of search engines is understood through a theoretical perspective from infrastructure theory. National survey reports on internet habits and experience from the United States, UK, and Sweden from 2015 to 2021 are analyzed. The article shows how difficult it is to gain insights into how people search online and the role search engines play in everyday life. The nature of the survey report, which is often used to inform national policy, risks exacerbating the invisibility of search engines: what cannot be measured cannot be discussed at the policy level. This invisibility can lead to insufficient attention being paid to search engines, including their uses and effects, in legislation, in school education, and in the general formation of public knowledge about search engines in society.

Supporting the Health and Well-Being of Caregivers of Persons with Pain.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

Assessing Pain in Older Adults: Caregivers play a key role in recognizing and documenting pain at home.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Horgas, A.L., et al. Assessing Pain in Older Adults. Am J Nurs 2022; 122 (12): 42-48.

Managing Older Adults' Chronic Pain: Higher-Risk Interventions.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

Interrupting Biases in the Experience and Management of Pain Nurses can help address challenges faced by racially and ethnically diverse patients and caregivers.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. The articles in this new installment of the series provide practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Booker, S.Q., et al. Interrupting Biases in the Experience and Management of Pain. Am J Nurs 2022; 122(9): 48-54.

Promoting Safe Mobility Strategies for partnering with caregivers to maximize older adults' functional ability.

This article is the fifth in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Olson,L.M., et al. Promote Safe Mobility. Am J Nurs 2022; 122(7): 46-52.