Reconceptualizing Cannabis

Inflammatory rhetoric and increasingly punitive drug policies dominated marijuana politics in the past. Today, as 36 have legalized cannabis in some form and 17 states have legalized recreational marijuana, the federal government continues to perpetuate policies of the past. The following analysis investigates rhetoric and policies that led to the War on Drugs as well as their outcomes, the dramatic shift in public opinion as states began to legalize marijuana, and the successes and failures of state cannabis programs to identify gaps within the MORE Act, the ideal policy, and politically viable incremental change. State programs are incapable of addressing issues regarding data collection, research, and equity. The MORE Act passed by the House of Representatives in December 2020 presents a semi-comprehensive federal reform option. The ideal cannabis reform, however, should address guidelines for federal regulators, barriers to employment and entrepreneurship, incentivize state cannabis legalization and expedited expungements, expand research and data collection, and provide a framework for federal communications. Despite the act’s shortcomings, it remains politically infeasible in today’s polarized climate. Immediate incremental cannabis reform should take the form of action by the Attorney General and Congressional action expanding cannabis research supply and funding, requiring public health data collection, rescheduling marijuana, and authorizing doctors to write prescriptions for medical marijuana

Prev Chronic Dis

In 2014, the Centers for Disease Control and Prevention (CDC) commissioned the Urban Indian Health Institute (UIHI) to coordinate a multifaceted national evaluation plan for Good Health and Wellness in Indian Country (GHWIC), CDC's largest investment in chronic disease prevention for American Indians and Alaska Natives (AI/ANs). GHWIC is a collaborative agreement among UIHI, CDC, tribal organizations, and individual tribes. In collaboration, UIHI and CDC drew upon an indigenous framework, prioritizing strength-based approaches for documenting program activities, to develop a 3-tiered evaluation model. The model incorporated locally tailored metrics, adherence to tribal protocols, and cultural priorities. Ultimately, federal requirements and data collection processes were aligned with tribal strengths and bidirectional learning was promoted. We describe how UIHI worked with tribal recipients, tribal health organizations, Tribal Epidemiology Centers, and CDC to develop and implement the model on the basis of an indigenous framework of mutual trust and respect.31418684PMC6716394663

Wearable Fitness Devices: Personal Health Data Privacy in Washington State

Private entities are increasingly targeting individuals in the United States and around the world to gather personal data for such purposes as product development, market identification, and insurance risk assessment. While credit card records and online browsing histories have long been the medium through which this data is gathered, in more recent years, wearable fitness devices have added a new dimension to data production and collection. These devices are capable of gathering a significant amount of data regarding a person’s physical and physiological characteristics, thereby exposing these data producers to personal privacy infringement. Washington State lawmakers and citizens must be pro-active in orienting themselves to the challenge of protecting personal health data derived from wearable fitness devices, and they must develop a framework of legal safeguards to protect individuals. Wearable fitness devices, as the name implies, are generally on or attached to a person’s body as a bracelet, watch, or token. These products utilize sensors to track, and otherwise monitor a broad range of activities performed by the user and generally transfer collected data to smartphones, computers, or network storage clouds. Most, if not all, of this personal health data is transferred to entities outside the control of the data producer, including the device’s manufacturer or a third party. While such sharing of data is becoming increasingly common—and, some might argue, expected—in our electronics-driven culture, individuals are neither adequately informed regarding the scope of the data collection, transfer, and use, nor are they adequately protected by the law from exploitative behavior by these data users. This Note addresses the nature and consequences of health data infringement by private entities, and the position that Washington State lawmakers should take in protecting against this infringement. Part I of this Note discusses the benefits and problems associated with wearable fitness devices and personal health data. Part II reviews the current federal approach to personal health data protection. Part III presents recommendations for Washington State constitutional amendments and legislative enactments that would protect Washington citizens against infringement of this data privacy. Finally, this Note concludes with a summary of the need for, and possible approaches to, protecting personal health data

Wearable Fitness Devices: Personal Health Data Privacy in Washington State

Private entities are increasingly targeting individuals in the United States and around the world to gather personal data for such purposes as product development, market identification, and insurance risk assessment. While credit card records and online browsing histories have long been the medium through which this data is gathered, in more recent years, wearable fitness devices have added a new dimension to data production and collection. These devices are capable of gathering a significant amount of data regarding a person’s physical and physiological characteristics, thereby exposing these data producers to personal privacy infringement. Washington State lawmakers and citizens must be pro-active in orienting themselves to the challenge of protecting personal health data derived from wearable fitness devices, and they must develop a framework of legal safeguards to protect individuals. Wearable fitness devices, as the name implies, are generally on or attached to a person’s body as a bracelet, watch, or token. These products utilize sensors to track, and otherwise monitor a broad range of activities performed by the user and generally transfer collected data to smartphones, computers, or network storage clouds. Most, if not all, of this personal health data is transferred to entities outside the control of the data producer, including the device’s manufacturer or a third party. While such sharing of data is becoming increasingly common—and, some might argue, expected—in our electronics-driven culture, individuals are neither adequately informed regarding the scope of the data collection, transfer, and use, nor are they adequately protected by the law from exploitative behavior by these data users. This Note addresses the nature and consequences of health data infringement by private entities, and the position that Washington State lawmakers should take in protecting against this infringement. Part I of this Note discusses the benefits and problems associated with wearable fitness devices and personal health data. Part II reviews the current federal approach to personal health data protection. Part III presents recommendations for Washington State constitutional amendments and legislative enactments that would protect Washington citizens against infringement of this data privacy. Finally, this Note concludes with a summary of the need for, and possible approaches to, protecting personal health data

Ensuring disability inclusive healthcare in Nepal: A qualitative case study in Sindhupalchok District

Persons with disabilities often face barriers to accessing healthcare services. Since the ratification of the UN Convention on the Rights of Persons with Disabilities (UNCRPD), Nepal has shown its commitment to disability inclusion in healthcare with several legal and implementational initiatives. The purpose of this qualitative case study was to explore the current situation, experienced challenges, and opportunities of disability-inclusive healthcare at community level in a district of Nepal and to identify the barriers to inclusive healthcare from the perspective of persons with disabilities and the health coordinators of the municipalities. The study applies a qualitative case study design for data collection, analysis, and interpretation. In-depth interviews were conducted with 10 persons with disabilities and with 12 health coordinators in the Sindhupalchok District (one from each municipality) and data collection was supplemented by observations made in four health facilities and by the analysis of plans and policies of the municipalities. Findings reveal that though the challenges of transportation, communication, and inaccessible health facilities persist, the healthcare systems at the local level of Sindhupalchok district are gradually adapting to the needs of persons with disabilities. Moreover, the practice of federalism in the government offers opportunities to mainstream disability in the health sector. However according to the informants, de-prioritization of disability may potentially accompany federalism. It was observed that the formulation of numerous plans and policies at the national and local levels has provided a promising framework for ensuring disability-inclusive healthcare services. Nonetheless, the achievement of this would require federal government's support, guidance, and allocation of resources.M.Phil. in Global Health - ThesisINTH395AMAMD-GLO

The design and implementation policy of the National Health Insurance Scheme in Oyo State, Nigeria

Given the general poor state of health care and the devastating effect of user fee, the National Health Insurance Scheme (NHIS) was instituted as a health financing policy with the main purpose to ensure universal access for all Nigerians. However, since NHIS became operational in 2005, only members of scheme are able to access health care both in the public and in private sectors, representing about 3% of Nigerian population. The thesis therefore examines the design and implementation policy of NHIS in Oyo state, Nigeria. Key design issues conceptual framework guides the analysis of data. The framework identifies three health interrelated financing functions namely revenue collection, risk pooling and purchasing. Data was collected from the NHIS officials, employees of the Health Maintenance Organisations (HMOs) and the Health Care Providers (HCPs) using key informant interview. In addition, in-depth interview and semi structure questionnaire were used to gather data from the enrolees and the nonenrolees. Empirical findings show that NHIS is fragmented given the existence of several programmes. In addition, there is no risk pooling neither redistribution of funds in the scheme. Revenue generated through contributions from the enrolees was not sufficient to fund health care services received by the beneficiaries because of the small percentage of the Nigerian population that the scheme covers. Further findings indicate that enrolled federal civil servants have not commenced monthly contribution to the NHIS. They pay 10% as co-pay in every consultation while federal government as an employer subsidised by 90%. Majority (76.8%) of the respondents agreed that they were financially protected from catastrophic spending. However, the overall benefit package was rated moderate because of exclusion of some priority and essential health care needs. Although above half (57%) of the respondents concurred that HMOs are accessible, in the overall, (47.6%) of the respondents were not satisfied with their services. In the case of the HCPs, majority (61.9%) of the respondents claimed that there is no excessive waiting time for consultation. Furthermore, (64.3%) rated their interpersonal relationship with the HCPs to be good. However, more than half of the respondents (54%) disagreed on availability of prescribed drugs in NHIS accredited health facilities. For the nonenrolees, findings show that most of the respondents (72.9%) were willing to enrol, but significant proportion (47.5%) indicated financial constraint as impediment to enrolment.SociologyD. Phil. (Sociology

Basic Sanitation and Health - Challenges and Perspectives in Brazil and Brazilian Federal District

Basic sanitation has been considered an important environmental determinant of health. Mainly related to the services of drinking water availability, solid waste management, sanitation problems are aggravated by the unplanned growth of urban centers, affecting an important part of the total disease burden in the world. The Sanitation Ranking prepared by the Trata Brazil Institute (2020) was used as the basis for the studies presented here taking into account the data from the SNIS (National Sanitation Information System – Ministry of Regional Development, Brazil), which were consulted for the 100 largest Brazilian municipalities, in terms of inhabitants, in the year 2018. 27 out of the 100 largest municipalities in Brazil have 100% total water service, that is, they have universal water service. Only one municipality has 100% sewage collection (Piracicaba –SP). 14 municipalities have a sewage collection rate greater than or equal to 98%. The average indicator of sewage treatment in the municipalities is 56.07%, that is very worrying. According to SNIS 2018, the national average for the treatment of generated sewage is 46.3%; that is, the average of the 100 largest municipalities in the study is higher than the national average. However, in both cases, the indicator is at a very low level, pointing to an area whose challenges to be overcome are great. The Brazilian capital’ city (Brasilia, Federal District of Brazil) in the sanitation is ranked 27th among Brazilian capitals based on data from the National Sanitation Information System (2018). The new Basic Sanitation Legal Framework, signed on July 15, 2020 has as its main objective to universalize and qualify the provision of services in the sector. The Federal Government’s goal is to achieve universal access by 2033, ensuring that 99% of the Brazilian population has access to drinking water and 90% to sewage collection and treatment. The expectation is that the universalization of water and sewage services will reduce annual health costs by up to 290 million USD

Ongoing and Emerging Issues in Privacy and Security in a Post COVID-19 Era: An Environmental Scan

The National Committee on Vital and Health Statistics (NCVHS) Subcommittee on Privacy, Confidentiality and Security (PCS) requested this environmental scan to better understand recent developments in privacy, confidentiality and security issues in the health, healthcare, and public health sectors.1 Accordingly, this environmental scan was developed to guide PCS and NCVHS in identifying new major projects to pursue.1 This report is primarily focused on developments occurring during or after 2018.Information privacy, confidentiality, and security continue to be issues of national importance. In the last four years, there have been substantial developments in law, legal theory, data analytics, privacy preserving technologies, efforts to promote novel and socially beneficial data applications, and public disclosures of concerning data applications. The National Committee on Vital and Health Statistics (NCVHS) Subcommittee on Privacy, Confidentiality and Security (PCS) requested this environmental scan to better understand recent developments in privacy, confidentiality and security issues in the health, healthcare, and public health sectors. Accordingly, this environmental scan was developed to guide PCS and NCVHS in identifying new major projects to pursue. This report is primarily focused on developments occurring during or after 2018. PROPOSED AND ENACTED STATE AND FEDERAL PRIVACY LEGISLATION Nationally, there are intensive efforts to address privacy and security risks in state and federal legislation. At the state level, momentum for new comprehensive privacy legislation is “at an all-time high.” Since 2018, five states have adopted new comprehensive privacy laws: California, Colorado, Connecticut, Virginia, and Utah. Four additional states—Michigan, New Jersey, Ohio, and Pennsylvania—have active comprehensive privacy bills under active consideration. Also noteworthy is the Uniform Law Commission’s Uniform Personal Data Protection Act, which introduces several innovative privacy provisions. These innovations include a factor-based approach to defining allowable data uses and incorporating a voluntary consensus standard approach to enable the law to adapt to evolutions to data practices over time. In comparison to state activity, few new federal privacy laws have been adopted. However, dozens of bills have been introduced, and at least one has broad support. The 21st Century Cures Act’s regulations defining exceptions to the Act’s prohibition of “information blocking” is a notable exception to relative federal inactivity. Nevertheless, Congress has been busy exploring new federal privacy legislation with over 50 federal privacy bills introduced during the 117th Congress. Of these, the American Data Privacy & Protection Act (ADPPA) is considered the most significant and promising federal comprehensive privacy effort in the past decade. However, there are still significant political challenges to overcome before the ADPPA can become law. NEW PRIVACY AND SECURITY RISKS AND PROMISING POLICIES, PRACTICES AND TECHNOLOGIES This environmental scan explores two significant new risks to privacy and security: artificial intelligence and law enforcement use of private data. Artificial intelligence has evolved in a largely unregulated space. This has created significant alarm due to the growing reliance on these tools across sectors. Risks associated with artificial intelligence cross social, health, economic, and political dimensions. Notably, artificial intelligence processes can be opaque, making it difficult for consumers to understand risks or difficult for processors to evaluate the unintended effects of their algorithms. In particular, group harms can be pronounced in artificial intelligence applications. Additionally, multiple high-profile stories have alarmed the public and lawmakers about the scope of law enforcement use of data. These include the use of commercial DNA databases to identify criminal suspects from the DNA of their distant relatives, the criminalization of once legal health procedures (e.g., after the Dobbs v. Jackson Supreme Court decision, which overturned a long recognized federal constitutional right to abortion,) as well as law enforcement using commercial surveillance tools to achieve “mass surveillance on a budget.” Despite these challenges, there are many innovations in privacy policies, practices, and technologies. This report describes four primary approaches to contemporary privacy legislation: (1) the consumer protection model, e.g., notice and consent, (2) the data protection approach, similar to the European Union’s General Data Protection Regulation (GDPR), (3) the antitrust approach, i.e., focusing oversight on dominant entities, and (4) the information fiduciary approach, i.e., imposing legal duties of confidentiality, care, and loyalty on data controllers. Similarly, this report describes different approaches to privacy enforcement. Each alternative can be consequential for the effectiveness of a given regulatory framework. These enforcement options include, (1) delegating enforcement authority to a preexisting or newly created agency, (2) enforcement through an individual right of action, (3) deputizing intermediaries to enforce standards and discipline, (4) increasing standards and associated penalties according to the scale of the activity or the size and sophistication of the regulated entity, (5) profit disgorgement, and (6) personal liability for corporate executives. POTENTIAL PROBLEMS IN GOVERNANCE OF HEALTH INFORMATION The U.S. privacy framework is often derided as a patchwork of laws. This patchwork is both overly complex and under protective. The U.S. legal privacy framework is under protective when its sector-by-sector and jurisdiction-by-jurisdiction approach leaves personal information un(der)-regulated (e.g., commercial data). This sectoral approach leads to uneven protections that can be confusing to consumers (e.g., health information stored in a hospital versus health information stored in a fitness-tracking app). The U.S. privacy framework is also overly complex because of inconsistency between jurisdictional approaches. This variability complicates compliance. This is one reason why industry has embraced calls for a national comprehensive privacy law. Notably, the U.S. privacy framework might also be considered overprotective where it restricts popular and socially beneficial data uses. For example, a 2020 national survey of U.S. adults measured privacy preferences, and it identified instances where socially beneficial and popular data uses might be impeded by existing privacy restrictions. This environmental scan also identifies and explores important and contentious issues in legislative debates. These include (1) defining and regulating sensitive data, (2) preemption of state laws, (3) treatment of existing federal laws, (4) authorizing an individual right of action, and (5) the impact of privacy legislation on healthcare and public health data practices. In addition, developments in data science, world events, and privacy scholarship necessitate discussion of four additional issues. First, artificial intelligence’s anticipated risks and benefits warrant regulatory attention, but it presents a challenging regulatory target. Second, the COVID-19 response exposed significant challenges and concerns in public health data collection, use, sharing, and governance. Third, de-identification remains a significant issue in part because (1) data science and reidentification methods have seemingly outgrown decade-old guidance, and (2) new scholarly thinking on group harms raises concerns about the effect of deidentification methods on groups. Fourth, there is increasing skepticism of the effectiveness of the notice-and-consent model within legal scholarship, which raises questions on the sustained reliance on this approach given available alternatives. OPPORTUNITIES FOR TIMELY ADVICE FROM NCVHS TO THE HHS SECRETARY REGARDING CONSTRUCTIVE ACTIONS THAT HHS AND OTHER FEDERAL DEPARTMENTS MIGHT TAKE. This environmental scan identifies four opportunities for timely advice to the HHS Secretary: 1. De-identification remains a critically important issue in privacy. It would be prudent to revisit the 2017 NCVHS recommendations on deidentification, which remain highly relevant to contemporary issues, in addition to other considerations (e.g., group harms). 2. Recent concerns about law enforcement access to and use of private information raise parallel questions about whether existing law enforcement disclosure exceptions in some privacy laws might enable inappropriate uses. An NCVHS convening could help refine and identify nuance within this area. Some of the issues that could be explored in more detail include narrowing the scope of law enforcement exceptions and imposing data protection requirements on data disclosed for law enforcement purposes (e.g., duties of data minimization or purpose limitation). 3. Artificial intelligence and machine learning tools are reshaping the structures of health care delivery as well as broader social structures, but many existing federal laws do not account for the fundamental difference in the scope and scale of the risks associated with these automated processes. A future NCVHS convening could explore the following issues: (1) standards and requirements for conducting algorithm impact assessments, (2) algorithm transparency requirements or standards, and (3) higher standards, duties, or penalties based on the size and sophistication of the data controller. 4. There are important health implications for the Federal Trade Commission advance notice of proposed rulemaking (ANPRM) on Commercial Surveillance and Data Security. Some unintended consequences could be mitigated by early communication between HHS and FTC to ensure that proposed rules consider the health perspectives and objectives. If FTC promulgates new regulations on commercial surveillance, joint guidance by the FTC and HHS might be needed to ensure that HIPAA covered entities understand their compliance obligations under both laws. A future NCVHS convening could explore whether timely comments or input could inform or assist the FTC rulemaking process and group harm considerations. NCVHSNational Committee on Vital and Health Statistics, U.S. Department of Health and Human Service

Exploring Ethnic Diversity on Managerial Choices in Nigeria.

In Nigeria, most citizens between the ages of 20-60 believe that ethnicity is the leading cause of discrimination. The central problem addressed in this study was how ethnic diversity influenced managerial choices in Nigeria. The purpose of this qualitative case study was to explore the role of ethnicity in managerial choices in a Nigerian federal traffic management agency to gain an understanding of how ethnicity influenced managers\u27 recruitment, placement, and promotion of employees. Complexity theory and a consideration of African management practices constituted the conceptual framework. Participants were 11 managers who were recruited from a Nigerian government agency using a combination of purposive and snowball sampling. Data collection occurred through interviews, observation, and government document reviews. Through use of Yin\u27s 5-step process for data analysis, data triangulation, and member checking, 10 themes emerged regarding managers\u27 decisions: (a) federal character principle, (b) merit, (c) ethnicity, (d) influence of godfathers, (e) favoritism, (f) promotion, (g) productivity, (h) morale, (i) frustration, and (j) health challenges. A conclusion was that ethnicity played a role in managerial choices. However, the execution of the current Nigerian law to manage ethnic diversity allowed the alleged discriminatory actions of managers in government agencies. Recommendations included a change in the implementation strategy of the federal character principle to reduce incidences of discriminatory actions in government agencies. This study may contribute to positive social change by providing public service managers the knowledge to create an enlightened and fair public service, free of ethnically induced barriers that have underpinned Nigeria\u27s underdevelopment

The Development and Use of Child Well-Being Indicators in the Prevention of Child Abuse and Neglect

Summarizes the conceptual framework and development of outcomes-based, measurable indicators focused on child safety, permanency, and well-being to help monitor the status of children in the child welfare system. Outlines recommended indicators