Policy implementation strategies to address rural disparities in access to care for stroke patients

ContextStroke systems of care (SSOC) promote access to stroke prevention, treatment, and rehabilitation and ensure patients receive evidence-based treatment. Stroke patients living in rural areas have disproportionately less access to emergency medical services (EMS). In the United States, rural counties have a 30% higher stroke mortality rate compared to urban counties. Many states have SSOC laws supported by evidence; however, there are knowledge gaps in how states implement these state laws to strengthen SSOC.ObjectiveThis study identifies strategies and potential challenges to implementing state policy interventions that require or encourage evidence-supported pre-hospital interventions for stroke pre-notification, triage and transport, and inter-facility transfer of patients to the most appropriate stroke facility.DesignResearchers interviewed representatives engaged in implementing SSOC across six states. Informants (n = 34) included state public health agency staff and other public health and clinical practitioners.OutcomesThis study examined implementation of pre-hospital SSOCs policies in terms of (1) development roles, processes, facilitators, and barriers; (2) implementation partners, challenges, and solutions; (3) EMS system structure, protocols, communication, and supervision; and (4) program improvement, outcomes, and sustainability.ResultsChallenges included unequal resource allocation and EMS and hospital services coverage, particularly in rural settings, lack of stroke registry usage, insufficient technologies, inconsistent use of standardized tools and protocols, collaboration gaps across SSOC, and lack of EMS stroke training. Strategies included addressing scarce resources, services, and facilities; disseminating, training on, and implementing standardized statewide SSOC protocols and tools; and utilizing SSOC quality and performance improvement systems and approaches.ConclusionsThis paper identifies several strategies that can be incorporated to enhance the implementation of evidence-based stroke policies to improve access to timely stroke care for all patient populations, particularly those experiencing disparities in rural communities

Contestations Over Indigenous Participation in Bolivia's Extractive Industry: Ideology, Practices, and Legal Norms

The participatory rights of indigenous peoples have been at the center of conflicts over resource extraction, which have recently increased in number and intensity across Latin America. Using comprehensive empirical data about the Guaraníes' participation in Bolivia's gas sector, this study finds that competing claims regarding territory, property, participation, and decision making provide important explanations for contestations over consultation practices and legal norms in the country. It argues that the main conflicts can be explained by (1) the Bolivian state's focus on directly affected communities and those with formally recognized land titles, something that clashes with the Guaraníes' principle of "territorial integrity"; (2) the state's conviction that it holds a monopoly over subsoil resources, and the limited rights to participation that it is willing to grant as a consequence, which the Guaraníes reject; and (3) the dissonance between state customs and regulations and Guaraní uses and customs

La consulta a los pueblos indígenas y su evolución como herramienta de negociación política en América Latina. Los casos de Perú y Guatemala

This article analyzes the right to consultation, guaranteed to indigenous peoples by ILO Convention 169, in its social, cultural, legal and political context. I draw on two case studies, one in Peru (the Rio Blanco case) and one in Guatemala (the Marlin mine case). Consultation has been an important element of both cases, but has played a different role in the two cases. Based on sixteen months of research in both countries, I argue that the right to consultation has been important for indigenous mobilization, primarily as a symbolic tool of legitimation, and less so as a legal mechanism.Este artículo analiza el derecho a la consulta, garantizada a los pueblos indígenas por el Convenio 169 de la OIT, en su contexto social, cultural, legal y político. Uso dos casos de estudio: uno en Perú (Río Blanco) y uno en Guatemala (la mina Marlin). La consulta ha sido un elemento importante de ambos casos, pero su función fue distinta en cada uno de ellos. En base a dieciséis meses de investigación en ambos países, sostengo que el derecho a la consulta ha sido importante para la movilización indígena, básicamente como una herramienta simbólica de legitimación y menos como un mecanismo legal

Human Rights and International Law from the Ground Up: Mining, Indigenous Communities, and the Community Consultation Movement in Latin America

Thesis (Ph.D.)--University of Washington, 2020My dissertation analyzes the role that international human rights treaties play in local struggles over natural resources in Latin America. I examine how the right of indigenous communities to consultation in the event of a proposed project or law that affects them, protected in Convention 169 of the International Labor Organization, influences the politics of battles over three controversial mines in Peru and Guatemala. Based on extensive field research, I argue that the treaty protection of the right to consultation is central to the region-wide political mobilization against unwanted mines, but that its importance has rested not on the use of formal legal institutions like courts, but on the cultural importance of international law and human rights norms. Community activists and their nonprofit allies have been able to use Convention 169 and the right to consultation to their advantage by rhetorically invoking the legitimacy and authority of international human rights law, even though there have been few legal victories in court based on the right. My study complements “compliance” studies of international law and contributes to work on the cultural power of law

La consulta a los pueblos indígenas y su evolución como herramienta de negociación política en América Latina. Los casos de Perú y Guatemala

This article analyzes the right to consultation, guaranteed to indigenous peoples by ILO Convention 169, in its social, cultural, legal and political context. I draw on two case studies, one in Peru (the Rio Blanco case) and one in Guatemala (the Marlin mine case). Consultation has been an important element of both cases, but has played a different role in the two cases. Based on sixteen months of research in both countries, I argue that the right to consultation has been important for indigenous mobilization, primarily as a symbolic tool of legitimation, and less so as a legal mechanism.Este artículo analiza el derecho a la consulta, garantizada a los pueblos indígenas por el Convenio 169 de la OIT, en su contexto social, cultural, legal y político. Uso dos casos de estudio: uno en Perú (Río Blanco) y uno en Guatemala (la mina Marlin). La consulta ha sido un elemento importante de ambos casos, pero su función fue distinta en cada uno de ellos. En base a dieciséis meses de investigación en ambos países, sostengo que el derecho a la consulta ha sido importante para la movilización indígena, básicamente como una herramienta simbólica de legitimación y menos como un mecanismo legal

La consulta a los pueblos indígenas y su evolución como herramienta de negociación política en América Latina. Los casos de Perú y Guatemala

Este artículo analiza el derecho a la consulta, garantizada a los pueblos indígenas por el Convenio 169 de la OIT, en su contexto social, cultural, legal y político. Uso dos casos de estudio: uno en Perú (Río Blanco) y uno en Guatemala (la mina Marlin). La consulta ha sido un elemento importante de ambos casos, pero su función fue distinta en cada uno de ellos. En base a dieciséis meses de investigación en ambos países, sostengo que el derecho a la consulta ha sido importante para la movilización indígena, básicamente como una herramienta simbólica de legitimación y menos como un mecanismo legal.This article analyzes the right to consultation, guaranteed to indigenous peoples by ILO Convention 169, in its social, cultural, legal and political context. I draw on two case studies, one in Peru (the Rio Blanco case) and one in Guatemala (the Marlin mine case). Consultation has been an important element of both cases, but has played a different role in the two cases. Based on sixteen months of research in both countries, I argue that the right to consultation has been important for indigenous mobilization, primarily as a symbolic tool of legitimation, and less so as a legal mechanism