California/Milbank Books on Health and the Public – serie

John E. McDonough affords a rare glimpse into the practice of state politics in this insider's account of the fascinating interface between political science and real-life politics. A member of the Massachusetts House of Representatives for thirteen years and a skilled storyteller, McDonough eloquently weaves together stories of politics and policy with engaging theoretical models in a way that illuminates both the theory and the practice. By providing a link between scholarship and the world of experience, he communicates much about the essence of representative democracy. In the process, he demonstrates how politics extend beyond the public sphere into many aspects of life involving diverse values and interests. McDonough describes the nature of conflict, the role of interests, agenda setting, the nature and pace of change, the use of language, and more. Accessible, insightful, and original, his stories touch on a broad range of issues - including health care politics, campaigns, and elections; a street gang called the X-men; the death penalty; and, campaign finance reform, and tenants versus landlords. To the author, politics is everywhere and political dynamics are universal.While the setting for this book is one legislature, the lessons and insights are intended for everyone.

Roughly one in ten adult Americans find their walking slowed by progressive chronic conditions like arthritis, back problems, heart and lung diseases, and diabetes. In this passionate and deeply informed book, Lisa I. Iezzoni describes the personal experiences of and societal responses to adults whose mobility makes it difficult for them to live as they wish--partly because of physical and emotional conditions and partly because of persisting societal and environmental barriers. Basing her conclusions on personal experience, a wealth of survey data, and extensive interviews with dozens of people from a wide social spectrum, Iezzoni explains who has mobility problems and why; how mobility difficulties affect people's physical comfort, attitudes, daily activities, and relationships with family and friends throughout their communities; strategies for improving mobility; and how the health care system addresses mobility difficulties, providing and financing services and assistive technologies. Iezzoni claims that, although strategies exist to improve mobility, many people do not know where to turn for advice.She addresses the need to inform policymakers about areas where changes will better accommodate people with difficulty walking. This straightforward and engaging narrative clearly demonstrates that improving people's ability to move freely and independently will enhance overall health and quality of life, not only for these persons, but also for society as a whole.

This study of the Employee Retirement Income Security Act of 1974 (ERISA) explains in detail how public officials in the executive branch and Congress overcame strong opposition from business and organized labor to pass landmark legislation regulating employer-sponsored retirement and health plans. Before Congress passed ERISA, federal law gave employers and unions great discretion in the design and operation of employee benefit plans. Most importantly, firms and unions could and often did establish pension plans that placed employees at great risk for not receiving any retirement benefits. In the early 1960s, officials in the executive branch proposed a number of regulatory initiatives to protect employees, but business groups and most labor unions objected to the key proposals. Faced with opposition from powerful interest groups, legislative entrepreneurs in Congress, chiefly New York Republican senator Jacob K. Javits, took the case for pension reform directly to voters by publicizing frightening statistics and 'horror stories' about pension plans.This deft and successful effort to mobilize the media and public opinion overwhelmed the business community and organized labor and persuaded Javits' colleagues in Congress to support comprehensive pension reform legislation. The enactment of ERISA in September 1974 recast federal policy for private pension plans by making worker security an overriding objective of federal law.

Just a few generations ago, serious illness, like hazardous weather, arrived with little warning, and people either lived through it or died. In this important, convincing, and long-overdue call for health care reform, Joanne Lynn demonstrates that our current health system, like our concepts of health and disease, developed at a time when life was mostly short, serious illnesses and disabilities were common at every age, and dying was quick. Today, most Americans live a long life, with the disabilities and discomforts of progressive chronic illness appearing only during the final chapters of their life stories. Sick to Death and Not Going to Take It Anymore! maintains that health care and community services are not set up to meet the needs of the large number of people who face a prolonged period of progressive illness and disability before death. Lynn offers what she calls an "owner's manual for the health care system," which lays out facts, concepts, strategies, and action plans for genuine reform and gives the reader new ways to interpret information creatively, imagine innovative possibilities, and take steps to implement them.

Patient management is the central clinical task of medical care. Until the 1970s, there was no generally accepted method of ensuring a scientific, critical approach to clinical decision making. And while traditional clinical authority was under attack, there was increasing concern about the way in which doctors made decisions about patient care. In this book, Jeanne Daly traces the origins, essential features, and achievements of evidence-based medicine and clinical epidemiology over the past few decades. Drawing largely on interviews with key players, she offers unique insights into the ways that practitioners of evidence-based medicine set out to generate scientific knowledge about patient care and how, in the process, they reshaped the way medicine is practiced and administered.

The American culture of death changed radically in the 1970s. For terminal illnesses, hidden decisions by physicians were rejected in favor of rational self-control by patients asserting their 'right to die' - initially by refusing medical treatment and more recently by physician-assisted suicide. This new claim rested on two seemingly irrefutable propositions: first, that death can be a positive good for individuals whose suffering has become intolerable; and second, that death is an inevitable and therefore morally neutral biological event. "Death Is That Man Taking Names" suggests, however, that a contrary attitude persists in our culture - that death is inherently evil, not just in practical but also in moral terms. The new ethos of rational self-control cannot refute but can only unsuccessfully try to suppress this contrary attitude. The inevitable failure of this suppressive effort provokes ambivalence and clouds rational judgment in many people's minds and paradoxically leads to inflictions of terrible suffering on terminally ill people.Judicial reforms in the 1970s of abortion and capital punishment were driven by similarly high valuations of rationality and public decision-making - rejecting physician control over abortion in favor of individual self-control by pregnant women and subjecting unsupervised jury decisions for capital punishment to supposed rationally guided supervision by judges. These reforms also attempt to suppress persistently ambivalent attitudes toward death, and are therefore prone to inflicting unjustified suffering on pregnant women and death-sentenced prisoners. In this profound and subtle account of psychological and social forces underlying American cultural attitudes toward death, Robert A. Burt maintains that unacknowledged ambivalence is likely to undermine the beneficent goals of post-1970s reforms and harm the very people these changes were intended to help.

The general practitioner was once America's doctor. The GP delivered babies, removed gallbladders, and sat by the bedsides of the dying. But as the twentieth century progressed, the pattern of medical care in the United States changed dramatically. By the 1960s, the GP was almost extinct. The later part of the twentieth century, however, saw a rebirth of the idea of the GP in the form of primary care practitioners. In this engrossing collection of oral histories and provocative essays about the past and future of generalism in health care, Fitzhugh Mullan - a pediatrician, writer, and historian - argues that primary care is a fascinating, important, and still endangered calling. In conveying the personal voices of primary care practitioners, Mullan sheds light on the political and economic contradictions that confront American medicine. Mullan interviewed dozens of primary care practitioners - family physicians, internists, pediatricians, nurse practitioners, and physician assistants - asking them about their lives and their work.He explains how, during the last forty years, the primary care movement has emerged built on the principles of 'big doctoring' - coordinated, comprehensive care over time. This book is essential reading for understanding core issues of the current health care dilemma. As our country struggles with managed care, market reforms, and cost containment strategies in medicine, "Big Doctoring in America" provides an engrossing and illuminating look at those in the trenches of the profession.

The idea that we have an unlimited moral imperative to pursue medical research is deeply rooted in American society and medicine. In this provocative work, Daniel Callahan exposes the ways in which such a seemingly high and humane ideal can be corrupted and distorted into a harmful practice. Medical research, with its power to attract money and political support, and its promise of cures for a wide range of medical burdens, has good and bad sides - which are often indistinguishable. In "What Price Better Health?", Callahan teases out the distinctions and differences, revealing the difficulties that result when the research imperative is suffused with excessive zeal, adulterated by the profit motive, or used to justify cutting moral corners. Exploring the National Institutes of Health's annual budget, the inflated estimates of health care cost savings that result from research, the high prices charged by drug companies, the use and misuse of human subjects for medical testing, and the controversies surrounding human cloning and stem cell research, Callahan clarifies the fine line between doing good and doing harm in the name of medical progress.His work shows that medical research must be understood in light of other social and economic needs and how even the research imperative, dedicated to the highest human good, has its limits.

This first comprehensive history of the social and political aspects of vaccination in the United States tells the story of how vaccination became a widely accepted public health measure over the course of the twentieth century. One hundred years ago, just a handful of vaccines existed, and only one, for smallpox, was widely used. Today more than two dozen vaccines are in use, fourteen of which are universally recommended for children. State of Immunity examines the strategies that health officials have used--ranging from advertising and public relations campaigns to laws requiring children to be immunized before they can attend school--to gain public acceptance of vaccines. Like any medical intervention, vaccination carries a small risk of adverse reactions. But unlike other procedures, it is performed on healthy people, most commonly children, and has been mandated by law. Vaccination thus poses unique ethical, political, and legal questions.James Colgrove considers how individual liberty should be balanced against the need to protect the common welfare, how experts should act in the face of incomplete or inconsistent scientific information, and how the public should be involved in these decisions. A well-researched, intelligent, and balanced look at a timely topic, this book explores these issues through a vivid historical narrative that offers new insights into the past, present, and future of vaccination.

A contemporary history of a critical period, "Are We Ready?" analyzes the impact of 9/11, the anthrax attacks that followed, and preparations for a possible smallpox attack on the nation's public health infrastructure. David Rosner and Gerald Markowitz interviewed local, state, and federal officials to determine the immediate reactions of key participants in these events. The authors explore the extent to which these emergencies permanently altered the political, cultural, and organizational life of the country and consider whether the nation is now better prepared to withstand another potentially devastating attack. This well-reasoned and well-researched book presents compelling evidence that few with hands-on experience with disease and emergency preparedness believe that an adequate response to terrorism - whether biological, chemical, or radiological - is possible without a strong and vibrant infrastructure to provide everyday services as well as emergency responses."Are We Ready?" begins with an examination of the experiences of local New York officials who were the first responders to 9/11 and follows them as events unfolded and as state and national authorities arrived.It goes on to analyze how various states dealt with changing federal funding for a variety of public health services. Using oral histories of CDC and other federal officials, the book then focuses on the federal reaction to 9/11 and anthrax. What emerges is a picture of dedicated public servants who were overcome by the emotions of the moment yet who were able to react in ways that significantly reduced the public anxiety and public health threat.Despite the extraordinary opportunity to revitalize and reinvigorate the nation's public health infrastructure, the growing federal and state budget deficits, the refocusing of national attention on the war in Iraq, and the passage of time all combined to undermine many of the needed reforms to the nation's public health defenses. Copub: Milbank Memorial Fund.

Disease and Democracy is the first comparative analysis of how Western democratic nations have coped with AIDS. Peter Baldwin's exploration of divergent approaches to the epidemic in the United States and several European nations is a springboard for a wide-ranging and sophisticated historical analysis of public health practices and policies. In addition to his comprehensive presentation of information on approaches to AIDS, Baldwin's authoritative book provides a new perspective on our most enduring political dilemma: how to reconcile individual liberty with the safety of the community. Baldwin finds that Western democratic nations have adopted much more varied approaches to AIDS than is commonly recognized. He situates the range of responses to AIDS within the span of past attempts to control contagious disease and discovers the crucial role that history has played in developing these various approaches. Baldwin finds that the various tactics adopted to fight AIDS have sprung largely from those adopted against the classic epidemic diseases of the nineteenth century--especially cholera--and that they reflect the long institutional memories embodied in public health institutions.

Savvy, comprehensive, and authoritative, this book, written by a physician with more than thirty years' experience caring for elderly patients, assesses the current state and the future prospects of Medicare, perhaps the most influential health-insurance program of our time. Christine K. Cassel draws upon the latest developments in science and medicine in a sweeping analysis of Medicare's social, demographic, institutional, political, and policy contexts. Writing in accessible language, using case studies to illustrate how policies translate to everyday lives, and applying lessons from the practice of geriatric medicine, Cassel makes a powerful argument for reforming and modernizing Medicare. She offers a new vision of what healthy aging could be and delineates what is needed to realize this vision, including changes in the medical sector, in the policy arena, and in our cultural beliefs about aging. Cassel sheds light on a wide range of issues pertaining to Medicare, including debates about coverage and the looming deficit in the Medicare trust fund. Perhaps, the most controversial issue she addresses is the challenge of rationing some kinds of care.Anchoring her discussion of Medicare in the idea that care for the elderly represents a social contract between government and its citizens, Cassel describes both the principles and potential of a progressive approach to geriatric medicine. She further argues that with this approach, we can also address the chronic problems of our larger health-care system and provide all Americans, no matter what their age, with high-quality and affordable medical care.

This book studies the experience of twelve countries that have broken through the limits that low incomes so often impose on human survival: China, Costa Rica, Cuba, Jamaica, Japan, Korea, Mexico, Oman, Panama, the former Soviet Union, Sri Lanka, and Venezuela. Most made impressive gains in life expectancy in the decades after 1920, and by 1960 nearly matched the rich countries in survival. James C. Riley finds that all of these countries enjoyed significant social growth, all invested in public health, and all gained the people's participation in the effort to improve their own lives and health. This innovative analysis suggests an alternative model of growth in which the measure of a nation's success is not its per capita income but the life expectancy of its population.

This is the first history of public health surveillance in the United States to span more than a century of conflict and controversy. The practice of reporting the names of those with disease to health authorities inevitably poses questions about the interplay between the imperative to control threats to the public's health and legal and ethical concerns about privacy. Authors Amy L. Fairchild, Ronald Bayer, and James Colgrove situate the tension inherent in public health surveillance in a broad social and political context and show how the changing meaning and significance of privacy have marked the politics and practice of surveillance since the end of the nineteenth century.

America's market-based health care system, unique among the nations of the world, is in large part the product of an obscure, yet profound, revolution that overthrew the medical monopoly in the late 1970s. In this lucid, balanced account, Carl F. Ameringer tells how this revolution came into being when the U.S. Supreme Court and Congress prompted the antitrust agencies of the federal government - the Federal Trade Commission and the Justice Department - to change the rules of the health care system. Ameringer: lays out the key events that led up to this regime change; explores its broader social, political, and economic contexts; examines the views of both its proponents and opponents; and, considers its current trajectory.

Essential reading for those who work in global health, this practical handbook focuses on what might be the most important lesson of the last fifty years: that collaboration is the best way to make health resources count for disadvantaged people around the world. Designed as a learning resource to catalyze fresh thinking, "Real Collaboration" draws from case studies of teams struggling to combat smallpox, river blindness, polio, and other health threats. In honest appraisals, participants share their missteps as well as their successes. Based on these stories, as well as on analyses of many other enterprises, this accessible, engaging book distills the critical factors that can increase the likelihood of success for those who are launching or managing a new partnership. It features a solutions-oriented approach and covers leadership skills, management approaches and lessons from experienced project teams. The information is clearly presented in graphics, sidebars, checklists, and other useful features include the supplementary teaching aids that contain a DVD and additional online resources.

Essential reading for those who work in global health, this practical handbook focuses on what might be the most important lesson of the last fifty years: that collaboration is the best way to make health resources count for disadvantaged people around the world. Designed as a learning resource to catalyze fresh thinking, "Real Collaboration" draws from case studies of teams struggling to combat smallpox, river blindness, polio, and other health threats. In honest appraisals, participants share their missteps as well as their successes. Based on these stories, as well as on analyses of many other enterprises, this accessible, engaging book distills the critical factors that can increase the likelihood of success for those who are launching or managing a new partnership. It features a solutions-oriented approach and covers leadership skills, management approaches and lessons from experienced project teams. The information is clearly presented in graphics, sidebars, checklists, and other useful features include the supplementary teaching aids that contain a DVD and additional online resources.

A story of courage and risk-taking, "House on Fire" tells how smallpox, a disease that killed, blinded, and scarred millions over centuries of human history, was completely eradicated in a spectacular triumph of medicine and public health. Part autobiography, part mystery, the story is told by a man who was one of the architects of a radical vaccination scheme that became a key strategy in ending the horrible disease when it was finally contained in India. In "House on Fire", William H. Foege describes his own experiences in public health and details the remarkable program that involved people from countries around the world in pursuit of a single objective - eliminating smallpox forever. Rich with the details of everyday life, as well as a few adventures, "House on Fire" gives an intimate sense of what it is like to work on the ground in some of the world's most impoverished countries - and tells what it is like to contribute to programs that really do change the world.

Since the 1950s, the American pharmaceutical industry has been heavily criticized for its profit levels, the high cost of prescription drugs, drug safety problems, and more, yet it has, together with the medical profession, staunchly and successfully opposed regulation. "Pills, Power, and Policy" offers a lucid history of how the American drug industry and key sectors of the medical profession came to be allies against pharmaceutical reform. It details the political strategies they have used to influence public opinion, shape legislative reform, and define the regulatory environment of prescription drugs. Untangling the complex relationships between drug companies, physicians, and academic researchers, the book provides essential historical context for understanding how corporate interests came to dominate American health care policy after World War II.

Since the 1950s, the American pharmaceutical industry has been heavily criticized for its profit levels, the high cost of prescription drugs, drug safety problems, and more, yet it has, together with the medical profession, staunchly and successfully opposed regulation. "Pills, Power, and Policy" offers a lucid history of how the American drug industry and key sectors of the medical profession came to be allies against pharmaceutical reform. It details the political strategies they have used to influence public opinion, shape legislative reform, and define the regulatory environment of prescription drugs. Untangling the complex relationships between drug companies, physicians, and academic researchers, the book provides essential historical context for understanding how corporate interests came to dominate American health care policy after World War II.

A story of courage and risk-taking, "House on Fire" tells how smallpox, a disease that killed, blinded, and scarred millions over centuries of human history, was completely eradicated in a spectacular triumph of medicine and public health. Part autobiography, part mystery, the story is told by a man who was one of the architects of a radical vaccination scheme that became a key strategy in ending the horrible disease when it was finally contained in India. In "House on Fire", William H. Foege describes his own experiences in public health and details the remarkable program that involved people from countries around the world in pursuit of a single objective - eliminating smallpox forever. Rich with the details of everyday life, as well as a few adventures, "House on Fire" gives an intimate sense of what it is like to work on the ground in some of the world's most impoverished countries - and tells what it is like to contribute to programs that really do change the world.

This indispensable guide to the Affordable Care Act, our new national health care law, lends an insider's deep understanding of policy to a lively and absorbing account of the extraordinary--and extraordinarily ambitious--legislative effort to reform the nation's health care system. Dr. John E. McDonough, DPH, a health policy expert who served as an advisor to the late Senator Edward Kennedy, provides a vivid picture of the intense effort required to bring this legislation into law. McDonough clearly explains the ACA's inner workings, revealing the rich landscape of the issues, policies, and controversies embedded in the law yet unknown to most Americans. In his account of these historic events, McDonough takes us through the process from the 2008 presidential campaign to the moment in 2010 when President Obama signed the bill into law. At a time when the nation is taking a second look at the ACA, Inside National Health Reform provides the essential information for Americans to make informed judgments about this landmark law.

"Deceit and Denial" details the attempts by the chemical and lead industries to deceive Americans about the dangers that their deadly products present to workers, the public, and consumers. Gerald Markowitz and David Rosner pursued evidence steadily and relentlessly, interviewed the important players, investigated untapped sources, and uncovered a bruising story of cynical and cruel disregard for health and human rights. This resulting expose is full of startling revelations, provocative arguments, and disturbing conclusions - all based on remarkable research and information gleaned from secret industry documents. This book reveals for the first time the public relations campaign that the lead industry undertook to convince Americans to use its deadly product to paint walls, toys, furniture, and other objects in America's homes, despite a wealth of information that children were at risk for serious brain damage and death from ingesting this poison. This book highlights the immediate dangers ordinary citizens face because of the relentless failure of industrial polluters to warn, inform, and protect their workers and neighbors.It offers a historical analysis of how corporate control over scientific research has undermined the process of proving the links between toxic chemicals and disease. The authors also describe the wisdom, courage, and determination of workers and community members who continue to voice their concerns in spite of vicious opposition. Readable, ground-breaking, and revelatory, "Deceit and Denial" provides crucial answers to questions of dangerous environmental degradation, escalating corporate greed, and governmental disregard for its citizens' safety and health. After eleven years, Markowitz and Rosner update their work with a new epilogue that outlines the attempts these industries have made to undermine and create doubt about the accuracy of the information in this book.