Public Policy Recommendations Research Articles

Paediatric familial hypercholesterolaemia screening in Europe: public policy background and recommendations.

Familial hypercholesterolaemia (FH) is under-recognized and under-treated in Europe leading to significantly higher risk for premature heart disease in those affected. As treatment beginning early in life is highly effective in preventing heart disease and cost-effective in these patients, screening for FH is crucial. It has therefore now been recognized by the European Commission Public Health Best Practice Portal as an effective strategy. Model programmes exist in Europe to identify young individuals with FH, which are based on cascade screening of first-degree relatives of affected individuals, universal screening for high cholesterol, opportunistic screening of high-risk individuals, or a combination of the above approaches. Recommendations presented herein to improve identification of FH emphasize that every country should have an FH screening programme. These programmes should be adapted from existing strategies to best fit the individual country's healthcare system, governments should provide financial support for these programmes and related care, and further research to optimize care and implementations should be conducted.

Two Paths, One Destination: A Demographic Portrait of Physicians Sanctioned by the Federal Government

There is scarce information about the institutional mechanisms creating the demographic portrait of sanctioned doctors published in the U.S. Office of Inspector General's (OIG) List of Excluded Individuals and Entities (LEIE). The current study examines the demographic characteristics of 1,289 physicians who appeared in the LEIE during a five-year period from 2008 to 2013. The results of a multivariate logistic regression found that sex, country of medical school training, and medical specialty were associated with being excluded by the OIG for a quality of care matter. Findings suggest the demographic portrait of doctors in the LEIE reflects the interplay between the doctors’ behaviors and the actions of various agencies. A demographic portrait of physician violators, if one considers the mechanisms generating the list, can be useful for public policy recommendations and action.

Managing New Technology When Effective Control is Lost: Facing Hard Choices With CRISPR

ABSTRACTThis paper seeks to expand our appreciation of the gene editing tool, clustered regularly interspaced short palindromic repeats‐associated protein 9 (CRISPR‐Cas9), its function, its benefits and risks, and the challenges of regulating its use. I frame CRISPR's emergence and its current use in the context of 150 years of formal exploration of heredity and genetics. I describe CRISPR's structure and explain how it functions as a useful engineering tool. The contemporary international and domestic regulatory environment governing human genetic interventions is reviewed and shown to be increasingly ineffective in its ability to restrain, guide, and optimize the emerging use of CRISPR. Several reasons for this lack of consensus are discussed. In conclusion, I suggest a number of public policy recommendations that might allow us to simultaneously embrace our most important moral values and manage the inevitable power CRISPR will come to have in our lives.

The institutional design of CUSMA: Improvement or reversal vis-à-vis NAFTA?

In this article we comparatively analyze the institutional design of the 2020 Canada-United States-Mexico Agreement (CUSMA) vis-à-vis the 1994 North American Free Trade Agreement (NAFTA). In the modernization of NAFTA into CUSMA, three strategies were employed: updating, upgrading, and adjusting the institutional design. We explore whether the implementation of these strategies provide a better governance of free trade and investment in the region compared to NAFTA. To do so, we conduct an in-depth evaluation of both agreements. Our central argument is that there were both progress and reversals in several areas: for example, the strength and powers of dispute settlement mechanisms, an improvement in the implementation of the working groups, changes in the flexibility or rigidity of its architecture depending on the sector analyzed, among many others. The article is comprised of three sections, each of them dealing with one of the three strategies under scrutiny. Finally, based on the central findings, we provide some public policy recommendations to strengthen the governance of free trade and investment in North America through the CUSMA.

Impact of COVID19-related non-pharmacologic interventions on healthcare utilization for other virally-triggered respiratory illnesses

Background: Acute and chronic respiratory illnesses are a leading cause of morbidity and mortality in Canada. While non-pharmacological interventions (NPIs) such as masking and physical distancing have effectively stemmed the spread of COVID19, the efficacy of NPIs in preventing other virally-triggered respiratory illnesses (VRIs) is less well understood. As the world moves into what may be the endemic phase of the COVID19 pandemic, better evidence is needed to inform rapidly-evolving public policy recommendations on the role of NPIs in infection control.
 Methods: This study assessed the impact of NPI implementation on VRI-related healthcare utilization during the COVID19 pandemic. Following ethics approval from the Conjoined Health Research Ethics Board of Alberta (CHREB), long-term retrospective tableau data was extracted from the Alberta Health Services (AHS) data analytics enterprise data warehouse. International classification of disease (ICD-10) codes were used to identify patients who presented to an acute care facility in Alberta during the pandemic (Mar 2020-2021) and pre-pandemic (Feb 2015-2020) periods with a primary complaint of asthma, community-acquired pneumonia, influenza, or chronic obstructive pulmonary disease (COPD). Heart failure (HF) and acute appendicitis (AA) served as controls. The study team consisted of a medical student, an undergraduate student, a principal investigator from the Department of Emergency Medicine at the University of Calgary, members of the AHS provincial research data services team, and collaborating faculty members.
 Evaluation Methods: The final study dataset comprised 585,809 ED visits and 175,456 hospitalizations. The primary outcome of interest was the change in ED visits and hospitalizations between the pandemic and pre-pandemic period for VRIs and controls. This was evaluated using quasi-experimental interrupted time-series analyses. A secondary outcome of interest was the cost-reduction associated with NPI implementation, for which multivariable regression models were constructed. These evaluation methods aimed to identify whether NPI implementation can (i) improve patient outcomes by preventing VRI-related ED visits and hospitalizations (ii) alleviate the strain on an already-constrained healthcare system by reducing VRI-associated healthcare spending.
 Results: Triage acuity and comorbidity index scores were similar between the two periods. While a substantial decrease in healthcare utilization was observed in the early months of the pandemic for both VRIs and controls, a rapid rebound towards pre-pandemic caseloads was observed only for controls, while VRI-related health utilization remained consistently low. Overall, there was a 43-62% and 41-84% decrease in weekly ED visits and hospitalizations for individual VRIs during the pandemic period (all P<0.001). ED visits and hospitalizations for HF declined by a small magnitude of 6% (P=0.002) and 8% (P<0.001), respectively. In contrast, an 11% increase in ED visits (P<0.001) and 3% increase in hospitalizations (P=0.046) was observed for AA. The decrease in VRI-related healthcare utilization resulted in $121 million in cost reduction. Surprisingly, even after accounting for COVID19, there was a significant decrease of 19,391 ED visits and 1,524 hospitalizations for respiratory illnesses during the pandemic period (P<0.001).
 Advice and Lessons Learned:
 
 NPI implementation was followed by a substantial decrease in healthcare utilization for VRIs. This resulted in substantial decrease in healthcare utilization costs and likely prevented significant patient morbidity and mortality.
 The greater magnitude decrease for VRIs than controls as well as the fact that acuity/comorbidity scores did not increase indicates that the observed decrease I healthcare utilization was primary driven by NPI implementation rather than an avoidance of healthcare settings due to fears of nosocomial COVID19 acquisition.
 NPIs appear to be an effective method of reducing the perennial burden of common respiratory illnesses. These findings provide a strong foundation for public policy recommendations on NPI use and establish the rationale for randomized studies on NPI use for preventing VRIs.

Overwhelmed by Learning in Lockdown: Effects of Covid-19-enforced Homeschooling on Parents’ Wellbeing

With the closure of schools due to the Covid-19-pandemic, parents of schoolchildren had to quickly adapt their daily schedules by taking over responsibilities of homeschooling for their children, while arranging their own schedule. This study first identifies the parents who are most challenged by having to ensure homeschooling responsibilities and then assesses how homeschooling affects different dimensions of parents’ wellbeing. Analyzing data from a large general population-representative panel survey in Switzerland, we compare subjective wellbeing before the Covid-19-outbreak to wellbeing at the end of the semi-lockdown. Almost one fifth of parents report being sometimes overwhelmed by homeschooling obligations for their children. Women, mid-aged and lower-educated individuals as well as those with young children and a lower income are particularly overwhelmed. Being sometimes overwhelmed by homeschooling does not cause changes in life satisfaction, stress and negative affect. Yet, it leads to a decrease in positive affect. We derive recommendations for educational and public health policies.

Analysis of the Influence of the Covid-19 Pandemic on Economic Growth Convergence at the District/City Level in East Java: What Is the Right Public Policy?

Indonesia has experienced relatively significant and stable economic growth in the last decade. However, Indonesia, a developing country, is still vulnerable to income disparities between regions or regions. It is due to the unequal distribution of natural resources, population, and development concentration. This study aims to examine the effect of the COVID-19 pandemic on the convergence of economic growth in East Java Province. In this study, per capita Gross Regional Domestic Product (GRDP) data or secondary data with panel type is used which is accessed from the annual report of the Central Statistics Agency in each district or city in East Java for the period 2010 to 2020. By using the -convergence analysis technique and -convergence and considering the spatial dependence between regions, the researchers found no substantial evidence of the occurrence of regional income convergence in East Java. There has been a divergence in regional income before and after the pandemic. But with a more significant divergence coefficient before the pandemic, it means that the existence of a pandemic has reduced the level of divergence even though the catch-up effect is negligible on economic growth. In general, this means a decrease in income inequality due to the pandemic, as rich regions are affected more than poor regions. So that public policy recommendations are needed, especially after the pandemic, through recovery that focuses on improving the economic sector in the affected affluent areas such as Surabaya and others.

School meals as a resource for low-income families in three European countries: a comparative case approach

ABSTRACT In the context of successive global crises and rising household food insecurity in wealthy European countries there is renewed attention to the role of school meals as a welfare intervention. However, little is known about the extent to which school meals are a resource for low-income families living in different contexts. Drawing on a mixed methods study of food in low-income families in three European countries, this paper adopts a realist ontological stance and an embedded case study approach to address this question. The research concerns low-income families with children aged 11–15 years in the aftermath of the 2008 financial crisis in the UK, Portugal and Norway. Based on a comparative, multi-layered analysis of macro-, meso- and micro-level contexts, we argue that publicly funded, nutritious school meals protect children from the direct effects of poverty on their food security, whilst underfunded and weakly regulated school food provision compounds children’s experiences of disadvantage and exclusion. The paper concludes with recommendations for public policies that conceptualise school meals as a collective resource, like education, to which young people as bearers of the right to food are entitled.

Research on the Mechanism of Digital Inclusive Finance to Empower Rural Revitalization

Vigorously developing digital inclusive finance can effectively alleviate the problem of "three rural areas" and serve rural revitalization. The article first sorts out the literature of domestic and foreign scholars in digital inclusive finance and rural development in recent years, and then from the perspective of digital inclusive finance empowering rural revitalization, it is studied from the two aspects of direct action mechanism and indirect action mechanism, so it proposes to improve the digital inclusive financial system and mechanism, pay attention to the construction of rural civilization, and improve public governance capabilities Policy recommendations.

Applying Social Capital Theory on Conservation Policies of Protected Areas: A Case Study of Penang, Malaysia

Environmental conservation efforts internationally and in Malaysia are focused on the establishment, maintenance and conservation of Protected Areas. The phenomenon of Protected Areas is justified by both biological considerations and social considerations. Biological considerations are commonly articulated. This research attempts to balance the narrative by focusing on social considerations, specific on the component of social capital, as derived from Social Capital Theory. Social capital is not commonly employed in the discourse on conservation policies of Protected Areas. However, social capital is postulated to have a tangible influence, as witnessed by its successful application in other contexts such as housing policy and social development. To explore the applicability of social capital towards Protected Areas, a case study of Penang in Malaysia is utilized. Document analysis and field observations are adopted as the research methodology and the data is analyzed thematically. The findings indicate that social capital has a tangible effect on the conservation policies of Protected Areas. Subsequently, public policy recommendations are proposed in light of the findings.

Digital divide and sustainable development of Ukrainian regions

Digital inequality of the regions is considered one of the topical issues of sustainable development provision in less developed countries. It can be defined as a gap between the geographical areas regarding the access opportunities to ICT and the Internet use for different activities. The goal of the study is to identify the link between the regional digital divide and the level of economic development in Ukraine and generalize international practices of digitalization promotion in lagging regions. Methodologically, various statistical methods (analytical grouping, variation, and correlation analysis) were used. The most appropriate and available data for assessing the digital divide referred to the State Statistical Service of Ukraine’s survey on Internet users in Ukrainian regions. The study revealed an overall shrink in the variation coefficient of the share of Internet users (from 36.4% in 2010 to 10.2% in 2019). However, the variation coefficients for the share of interacting with public authorities, reading online, and e-mailing persons remain significant.Furthermore, analytical grouping of regions suggested that the level of industrial sector development influenced the penetration of digital technologies into public life vastly, though several unaccounted factors also existed. Finally, the paper examined international practices of managing the digital divide. As a result, recommendations for public policy (e.g., the implementation of training programs for late adults and elderly, improved digital maintenance and digitalization programs for schools, price equalization for digital technologies, equal Internet provision in different regions, and investments in services digitalization) were developed.

Signalling security: An observational and game theory approach to inter-pedestrian psychology

Whereas the mental health and personal safety of pedestrians have been the subject of both debates in the public sphere and discourses in social sciences, the interpersonal dynamic of citizens on foot remains so far unexplored. This paper takes a game-theoretical approach to the psychology, behaviour, and welfare of pedestrians, who experience different levels of mutualised anxiety and confidence in spontaneous encounters with strangers on the road. Through a combined method of survey, modelling, and theory, it proposes an equilibrium-analysis of inter-pedestrian signalling, as well as a set of public policy recommendations aimed to reduce unnecessary frictions, improve information transparency, and therefore promote public safety.

Resident-Owned Resilience: Can Cooperative Land Ownership Enable Transformative Climate Adaptation for Manufactured Housing Communities?

Residents of manufactured housing communities (MHCs) are disproportionately vulnerable to both hazards and displacement. The cooperative ownership model of resident-owned communities (ROCs) pioneered by ROC USA helps MHC residents resist displacement, but little research assesses how cooperative tenure impacts hazard vulnerability. To fill this gap, we conduct a spatial analysis of 234 ROC USA sites; analyze the co-op conversion process; and interview ROC USA staff, technical assistance providers, and resident co-op leaders. Although ROC USA communities, like other MHCs, face elevated exposure and sensitivity to hazards, we find that ROC USA’s model supports communities’ adaptive capacity by increasing access to financial resources, bridging formal and informal knowledge and skills, and improving social and institutional capacity. This networked cooperative model represents a scalable form of transformative adaptation by enabling low-income communities to address the underlying causes of uneven hazard vulnerabilities that are intensifying under climate change. We close with public policy and programmatic recommendations to enhance and expand this model.

The temporal dependence of public policy evaluation: the case of local government amalgamation

ABSTRACT Amalgamation has been a cornerstone of many local government reform programmes internationally. However, there has been a lack of consensus in the academic literature surrounding the outcomes associated with amalgamation. One potential explanation for this is the difference in the length of time over which the evaluation takes place. In order to determine if the impacts of boundary reform are indeed temporally dependent on nature, we collected and analysed a 17-year panel of empirical data from a large-scale amalgamation programme in 2008. Our results indicate that the outcomes arising from the program do indeed display variation over time, with initial savings being negated by increased costs in the medium-term and ultimately an insignificant impact over the long term. The public policy implications and recommendations suggested by our analysis have important implications for the design and evaluation of future local government boundary reform programmes.

In Science We Trust?

In the prepandemic world of 2017, a Pew Research Center survey demonstrated that the overall public confidence in scientists was positive (1). Then, along came COVID-19. During the pandemic, scientific discoveries and resulting public policy recommendations have been just as likely to be scrutinized by content experts as it is by family members on Facebook, resulting in a cacophony of opinions. The politicization of science has led to an overall sense of public mistrust, and the debate over vaccinations demonstrates an erosion of the trust in clinical trials, which are the methodologic cornerstones of advancing medicine and improving patient outcomes.

The Metal Art Industry in Tumang, Cepogo, Boyolali: Preservation and Development Recommendation Policy

Nowadays, the craftsman is considered a profession that does not need higher education requirements; thus, it creates a wider gap in the craftsmen's regeneration. Tumang's younger generation prefers to work as resellers instead of becoming craftsmen. This study aims to provide policy recommendations that support the preservation of the Tumang Copper Craft Art as traditional Indonesian knowledge. The research uses a qualitative method with a participatory action research approach. It focuses on group discussions with copper artisans and sellers in Tumang on collecting data on the field's challenges and interviews with policymakers to obtain appropriate policy recommendations. The results show that supporting the regeneration process is necessary. The request of public policy needs to be linked to formal education in schools through the Education and Culture Office and efforts to increase the capacity of artisans through the Community and Village Empowerment Service. Moreover, to ensure that the recommendation to support the preservation and development of the Copper Craft Art can be implemented, a public policy recommendation with legality is in the form of a Regent's Regulation because it may cover both education and community empowerment in Tumang.

Managing the risk of COVID-19 via vaccine passports: Modeling economic and policy implications.

The increasing use of vaccine passports (VPs) to certify immunity from the prevailing coronavirus has created positive and negative aspects that have shaken the workings of markets. The VPs are, however, not universally used and not required by all businesses and governments at this point. Given the newness associated with VPs and the ongoing uncertainty of the pandemic, full implications of VPs have not been considered. This paper provides some formal insights into the implications of the use of VPs, borrowing from the established economic theory. Recommendations for public policy are provided.

Validation of International Classification of Diseases criteria to identify severe influenza hospitalizations.

In this cohort study of hospitalized patients with linked medical record data, we developed International Classification of Diseases (ICD) criteria that accurately identified laboratory‐confirmed, severe influenza hospitalizations (positive predictive value [PPV] 80%, 95% confidence interval [CI] 71–87%), which we validated through medical record documentation. These criteria identify patients with clinically important influenza illness outcomes to inform evaluation of preventive and therapeutic interventions and public health policy recommendations.

Exploring influences on social entrepreneurial intentions among Indian students: the function of gender role orientation

Societies are changing, including attitudes toward gender roles. This research uniquely considers the influence of individual's gender role orientation (i.e., expressive and instrumental traits) on social entrepreneurial intentions (SEI) among Indian students at the nascent stage of learning about social entrepreneurship. Quantitative analysis results support and challenge previous research on SEI antecedents and suggest that measuring gender role orientation, rather than differences between men and women will enhance our understanding of the millennial and Gen Z aspirations to do well while doing good. Recommendations for public policy and business education are offered to strengthen previous findings that associate strong entrepreneurial ecosystems with economic and social growth.

Public Policy Recommendations and Strategic Business Rationale for Accelerated Adoption of Battery Energy Storage Systems (Bess) in India

Public Policy Recommendations and Strategic Business Rationale for Accelerated Adoption of Battery Energy Storage Systems (Bess) in India