Urban Environmental Health and Sensitive Populations: How Much are the Italians Willing to Pay to Reduce Their Risks?

We use contingent valuation to elicit WTP for a reduction in the risk of dying for cardiovascular and respiratory causes, the most important causes of premature mortality associated with heat wave and air pollution, among the Italian public. The purpose of this study is three-fold. First, we obtain WTP and VSL figures that can be applied when estimating the benefits of heat advisories, other policies that reduce the mortality effects of extreme heat, and environmental policies that reduce the risk of dying for cardiovascular and respiratory causes. Second, our experimental study design allows us to examine the sensitivity of WTP to the size of the risk reduction. Third, we examine whether the WTP of populations that are especially sensitive to extreme heat and air pollution—such as the elderly, those in compromised health, and those living alone and/or physically impaired—is different from that of other individuals. We find that WTP, and hence the VSL, depends on the risk reduction, respondent age (via the baseline risk), and respondent health status. WTP increases with the size of the risk reduction, but is not strictly proportional to it. All else the same, older individuals are willing to pay less for a given risk reduction than younger individuals of comparable characteristics. Poor health, however, tends to raise WTP, so that the appropriate VSL of elderly individuals in poor health may be quite large. Our results support the notion that the VSL is “individuated.”Contingent valuation, Willingness to Pay, Mortality risk reductions, Value of a Statistical life, Scope test, Cardiovascular and respiratory risks, Heat waves, Heat advisories, Adaptation to climate change, Air pollution, Premature mortality

Bringing Primary Care Home: The Medical House Call Program at MedStar Washington Hospital Center

MedStar's program offers round-the-clock access to a care team comprising a geriatrician, nurse practitioner, and social worker. The house calls reveal and address problems that are missed when care is poorly coordinated, enabling team members to identify social supports for patients that can improve quality of life, reduce the burden on caregivers, and head off problems that can lead to high-cost institutional care.Based on the cost savings it achieved, the program became one of the models for the federal Center for Medicare and Medicaid Innovation's Independence at Home Demonstration, which is testing whether providing primary care at home to frail elderly patients with multiple chronic conditions or advanced illnesses improves outcomes and lowers health care spending. MedStar participates in the demonstration as part of a consortium that includes Virginia Commonwealth University and University of Pennsylvania Health System, both of which are implementing an approach similar to MedStar's. The consortium is one of nine participating groups to earn a share of the savings they produced for Medicare

If someone cares about you, you are more apt to come around: improving HIV care engagement by strengthening the patient-provider relationship.

Purpose:The patient-provider relationship is a central factor that can promote or hinder long-term engagement in care among people living with chronic illnesses. In this paper, we explore characteristics of the patient-provider relationship that facilitated or hindered engagement in care among patients receiving care at HIV specialty clinics. Patients and methods:We conducted 6 focus group discussions with a total of 43 well-retained and less well-retained HIV+ patients in San Francisco, Seattle, and Birmingham, to elicit a wide range of perspectives on engagement in HIV care. Borrowing from the field of psychotherapy, we examined patient-provider relationship characteristics through the lens of the therapeutic alliance, and with regard to their therapeutic efficacy and impact on patient engagement. Results:The majority of participants emphasized how a strong patient-provider relationship defined by trust, intimacy, and collaboration promoted engagement, while a weak patient-provider relationship impeded engagement. Conclusion:We discuss practical strategies and therapeutic techniques that may be helpful to providers in building strong patient-provider relationship and contend that a strong patient-provider relationship is crucial for patients to feel cared for during clinical encounters, which can promote long-term and sustained engagement in HIV care

Using a Mental Health Board Game Intervention to Reduce Mental Illness Stigma Among Nursing Students

Mental illness stigma can be displayed by anyone including those working in the health care field. Bachelor of Science in Nursing (BSN) students are one group within the health care field. The purpose of this project is to explore attitude change among BSN students related to mental illness stigma. The question guiding this project is whether a creative game implemented in conjunction with the existing educational and clinical experiences is helpful in reducing mental illness stigma in BSN students. Thirty-eight participants, 5 males and 33 females, a majority of whom were 20-21 years old, participated in this project. The intervention in this project was The Mental Illness Stigma Game for BSN Students and was implemented in addition to the existing educational and clinical course content. The comparison group and study group both received a pretest and posttest. The major differences between the two groups were that the comparison group did not receive the intervention and they participated in their mental health course content prior to receiving the pretest, as opposed to the study group. The Mental Illness Clinician Attitudes Scale-Version 4 (MICA-4) was used as a pretest and a posttest to measure the students’ attitudes. Data analysis was performed using SPSS with descriptive statistics, ttests and ANCOVA. The results showed there was a significant difference between the two groups and between the pretest and the posttest in the study group. Additionally, a majority of students in the study group felt this intervention was effective in positively changing their attitudes about those with a mental illness. While the results do not demonstrate this board game’s effectiveness in decreasing stigma in all populations, further research should focus on testing this intervention on a wider scale and reevaluating students after they have been on the job for several months

Advancing immunity : what is the role for policy in the private decision to vaccinate children?

Related links: http://www.richmondfed.org/publications/research/region_focus/2010/q2/feature2_weblinks.cfmPublic health - Economic aspects

Three Essays on Health, Risk and Behavior

Health-related decisions could be explained by a variety of factors, ranging from the perception of the risk the activity involves to the knowledge of the long-term effects of the decision. An individual deciding to eat unhealthy or not to exercise could face health problems in the long-run. Individuals with health issues have been found to be more risk averse when it comes to financial decisions, such as portfolio allocation. Financial incentives to engage in healthier behaviors have been successful but short-lived. Prior research leaves many questions such as: What are the factors that explain why an individual decides to engage in healthy or unhealthy behaviors? Are risk preferences a determinant in the decision to seek treatment for an illness? Do beliefs about the outcome of unhealthy and healthy decisions play a role? This dissertation aims at investigating the following questions: How do social aspects of risk impact health-related decisions? And, more broadly, what is the relationship between health, risk preferences and perception and behavior? I focus on three main applications: flu vaccinations, asthma in children and the impact of chronic illnesses (and other joint risks) in risky decisions. This dissertation investigates different ways in which risk, health and behavior interact with each other. I focus on three health-related applications: flu vaccines, asthma and how health influences individual risk preferences. The findings of these three chapters are intended to contribute to the discussion of how health impacts behavior and the perception of risk. I also analyze the effect of different sources of endogeneity, such as the beliefs about the flu vaccine and the severity of an influenza episode, beliefs about the severity of asthma or the effectiveness of treatments to tackle an asthma episode. This research will help policy makers better understand how risk perceptions about the outcomes of different health-related behaviors. I aim at continuing the conversation about which would be the best way to incentivize healthy behaviors and modify negative views of treatments to deal with chronic illnesses

Lifting the Burden of Addiction: Philanthropic Opportunities to Address Substance Use Disorders in the United States

Substance use disorders (SUDs), also known as substance abuse or addiction, affect an estimated 20 million or more adolescents and adults in the U.S. This guidance provides philanthropic funders with the tools & information to reduce immediate harm from substance use disorders and reduce the burden of the disorder over the long term. This includes reducing the damage the disorder causes to people with SUDs and their loved ones, reducing the overall incidence of SUDs, and reducing SUD-related costs to society. We present four strategies for philanthropic funders who want to help:- Save lives and reduce SUD-related illness and homelessness- Improve access to evidence-based treatment- Improve SUD care by changing systems and policies- Fund innovation to improve prevention and treatmen

Economics and Mental Health

This paper is concerned with the economics of mental health. We argue that mental health economics is like health economics only more so: uncertainty and variation in treatments are greater; the assumption of patient self-interested behavior is more dubious; response to financial incentives such as insurance is exacerbated; the social consequences and external costs of illness are formidable. We elaborate on these statements and consider their implications throughout the chapter. Special characteristics' of mental illness and persons with mental illness are identified and related to observations on institutions paying for and providing mental health services. We show that adverse selection and moral hazard appear to hit mental health markets with special force. We discuss the emergence of new institutions within managed care that address long-standing problems in the sector. Finally, we trace the shifting role of government in this sector of the health economy.

Inequality and risk aversion in health and income: an empirical analysis using hypothetical scenarios with losses

Four kinds of distributional preferences are explored: inequality aversion in health, inequality aversion in income, risk aversion in health, and risk aversion in income. Face to face interviews of a representative sample of the general public are undertaken using hypothetical scenarios involving losses in either health or income. Whilst in health risk aversion is stronger than inequality aversion, in the income context we cannot reject that attitudes to inequality aversion and risk aversion are the same. When we compare across contexts we find that inequality aversion and risk aversion are both stronger in income than they each are in health

Journalistic practices of science popularization in the context of users’ agenda: A case study of „New Scientist”

The article includes a discussion of two models which describe contemporary communication processes in journalism: agenda-setting and news value, indicating the need to expand their research tools to include qualitative methods, and merging the analyses of the reception and the message. It also includes indications as to the possibility, or even the social relevance, of the methods for applying those research perspectives to analysing journalism popularising science. Later, I present the results of an analysis of the content of a sample of 500 most read popular science texts available on the New Scientist website. I demonstrate which thematic areas were valued by the readers, and what values are most commonly applied. Further, upon applying a filter in the form of surveys regarding reader preferences, I discuss the main linguistic devices utilised for controlling readers’ attention. The shaping of the hierarchy of importance of items of news is the result of a dynamic interaction between (1) the thematic priorities and discursive strategies of imposing elite representations of science within media agenda, and (2) the means of negotiating order and values of specific content, which are correlated with readers’ preferences, both in terms of the content and the form of providing popular scientific information