ge from lo-cal media outlets and can, therefore, shapepublic perceptions about the nature of crimeand the nature of race relations within thecommuni

e analyze the total number of hate crimeincidents reported in the Uniform Crime Re-port data for the ye

t state actors are most likelyto grant concessions to movements whenthey are generally sympathetic to the goalsof the movement and when support from amovement's adherents could potentially af-fect their chances of winning electoral con-tests

ombinesthese two approaches and proposes that it isthe interaction between organizationalstrength and political context that affects thelikelihood of movement succ

The central insight of the framingperspective in social movement research isthat, regardless of objective circumstances,individuals are unlikely to participate in col-lective action unless they first come to viewtheir circumstances in terms of a collectiveproblem that could be solved through collec-tive action

use each reported inci-dent represents a deliberate choice made bylocal authorities to take positive action onlegislation that endorses the validity ofclaims and demands asserted by various civilrights organizations

es. In fact, rec-ognition can be used as a tactic to avoidmaking real concessions to a move

While re-searchers disagree on whether such an in-crease has actually taken plac

applying direct pressure on legislators,but also by framing discussion about the is-s

It is clear that differences in the numberhate crimes reported in various regionsnot simply reflect differences in the numof criminal acts motivated by bias. They minstead reflect different incentives to callacts of bias to the attention of local authori-ties, as well as different incentives that in-fluence law enforcement agents to respondto, and to report, hate crim

Yet in other circumstances, fail-ure to report hate crime incidents can be po-litically perilou

) notes, there is astrong disincentive for police to identifycrimes as bias-motivated because a highnumber of reported incidents can tarnish theimage of the communit

dependent on the way in which lawenforcement agents interpret the event, andmany law enforcement agents are less thanenthusiastic about hate crime legislation

unit that has more expertise on hate crimes,then evaluates the case to determine whetherit qualifies as a hate cri

t, "Bias crimes require po-lice officers to examine not only what hap-pened, but also why it happened. Further-more, the search for what happened is com-plicated by contested stories and by victimswho are sometimes afraid to acknowledgethe bias nature of the crime for fear ofrevictimization" (p. 1

s. And, the HCSA does not specify themechanism for collecting hate crime d

art of the problem stems from the factthat the HCSA requires the federal govern-ment to collect data on hate crimes, but itdoes not require local law enforcementagencies to partici

tet 2001). Yet even with afederal mandate for collecting hate crimedata, comparisons across geographicboundaries remain problematic. For in-stance, a total of 1,943 hate crimes were re-ported to the federal government for thestate of California in the year 2000, whilenot a single hate crime was reported for thestate of Alabama, despite the fact that advo-cacy organizations identified several crimi-nal acts of bias that occurred within thatstat

). In 1994, theHCSA was amended to include crimes mo-tivated by bias against individuals withphysical or mental disabiliti

We are particularly interestedin the role that activist organizations play inpromoting, or impeding, compliance withpublic policie

First, what determines compli-ance with a public policy once it is put intoplace? Second, what factors explain varia-tion in compliance with public policy acrosslocal settings?

hose who possessample material resources or who hold insti-tutionally based power have a distinct ad-vantage in this competition because these re-sources can be used to formulate a persua-sive causal argument and to ensure that theargument captures the attention of lawmak-ers and the general public

). Stone (1989) argues that "prob-lem definition is a process of image making,where the images have to do fundamentallywith attributing cause, blame, and responsi-bility"

. Addition-ally, some conditions that cause pain andsuffering for large numbers of people maynever be defined as public proble

hich public policy forma-tion is influenced by socially constructeddefinitions of public problems

utcomes. The presence of resourceful civil rights organizations in a county can lead to higher numbers of re

Intuitive decision making is perhaps never more important than during a crisis. A crisissituation is a change—whether sudden or evolving—that results in an urgent problem that mustbe addressed immediately

Intu-ition can be described as emotionally charged judgments that arise through quick, nonconscious,and holistic associations.34

Programmeddecisions are decisions that become somewhat automatic because people’s knowledge allowsthem to recognize and identify a situation and the course of action that needs to be taken.

performance-avoid orientation focus on demon-strating their competence so that others will not think poorly of them

erformance-prove orientation focus on demonstrating their competenceso that others think favorably of them.

learning orientation,where building competence isdeemed more important thandemonstrating competence

behavioral modeling

social learning theory argues thatpeople in organizations have the ability to learn through the observation of others.20

Variable ratio schedules reward people after a varying number of exhibited behaviors

Fixed ratio schedules rein-force behaviors after a certain number of them have been exhibited

Variable interval schedules are designed to reinforce behavior at more random points in time

fixed interval schedule is probably the single most common form of reinforce-ment schedule. With this schedule, workers are rewarded after a certain amount of time, and thelength of time between reinforcement periods stays the same

Continuous reinforcement is the sim-plest schedule and happens when a specific consequence follows each and every occurrence of adesired behavior

Extinction occurs when there is the removal of a consequence following anunwanted behavior.

Pun-ishment occurs when an unwantedoutcome follows an unwanted behav-ior.

Negative reinforcement occurs when an unwantedoutcome is removed following a desired behavior

Positive reinforcementoccurs when a positive outcome follows a desired behavior

contingencies of reinforcemen

antecedents

REINFORCEMENT

Tacit knowledge, in contrast, is what employees can typically learn only through experience

Explicit knowledge is the kind of information you’re likely to think about whenyou picture someone sitting down at a desk to learn.

Expertiserefers to the knowledge and skills that distinguish experts from novices and less experienced peo-ple.4

decision making, which refers to the process of generating and choos-ing from a set of alternatives to solve a problem.

Learning reflects relatively permanent changesin an employee’s knowledge or skill that result from experience.1

Effects of Motivation on Performance and Commitment

psychological empowerment, which reflects an energyrooted in the belief that work tasks contribute to some larger purpose.7

internal comparisons, meaningthat they refer to someone in the same company.69 Others are external comparisons, meaning thatthey refer to someone in a different company.

ccording to equity theory, any imbalance in ratios triggers equity distress—an inter-nal tension that can only be alleviated by restoring balance to the ratios.65

Equity theoryargues that you compare your ratio of outcomes and inputs to the ratio of some comparisonother—some person who seems to provide an intuitive frame of reference for judging equity.64

quity theory acknowledges that motivation doesn’t just dependon your own beliefs and circumstances but also on what happens to other people.6

Rather than directly affecting other variables in the diagram, moderators affectthe strength of the relationships between variables. One moderator is feedback, which consistsof updates on employee progress toward goal attainment.52

askstrategies, defined as learning plans and problem-solving approaches used to achieve successfulperformance.51

Goal setting theory views goals as the primary drivers of the intensity and persistence of effort.44

Motivational Force = E P × Ʃ[(P O) × V ]

intrinsic motivation—motivation that is felt whentask performance serves as its own reward.30

xtrinsic motivation—motivation that is controlledby some contingency that depends on task performance

Needs can be defined as cognitivegroupings or clusters of outcomes that are viewed as having critical psychological or physiologi-cal consequences.26

alence reflects the anticipated value of the outcomes associated with performance(abbreviated V).24 Valences can be positive (“I would prefer having outcome X to not having it”),negative (“I would prefer not having outcome X to having it”), or zero (“I’m bored . . . are we stilltalking about outcome X?”)

Instrumentality represents the belief that successful performance willresult in some outcome(s).19

pastaccomplishments—the degree to which they have succeeded or failed in similar sorts of tasksin the past.15 They also consider vicarious experiences by taking into account their observa-tions and discussions with others who have performed such tasks.16 Self-efficacy is also dictatedby verbal persuasion because friends, coworkers, and leaders can persuade employees that theycan “get the job done.” Finally, efficacy is dictated by emotional cues

self-efficacy, defined as the belief that a person has the capabilities needed to execute the behav-iors required for task success.13

Expectancy represents the belief that exerting a high level of effort will result in the success-ful performance of some task.

Expectancy theory describes the cognitive pro-cess that employees go through to make choices among different voluntary responses.

engagement. You can think of engagement as a contemporary synonym, moreor less, for high levels of intensity and persistence in work effort. Employees who are “engaged”completely invest themselves and their energies into their jobs

motivationis defined as a set of energetic forces that originates both within and outside an employee, initiateswork-related effort, and determines its direction, intensity, and persistence.

Another reason is that job satisfaction is strongly correlated with normativecommitment. Satisfied employees are more likely to feel an obligation to remain with their firm74and a need to “repay” the organization for whatever it is that makes them so satisfied, whethergood pay, interesting job tasks, or effective supervision.

Effects of Job Satisfaction on Performance and Commitment

motionalcontagion shows that one person can “catch” or “be infected by” the emotions of another per-son.59

Such jobs are high in what’s called emotional labor, or the need to manage emotions tocomplete job duties successfully.58 Flight attendants are trained to “put on a happy face” in frontof passengers, retail salespeople are train

These events can trigger emotions, which are states of feel-ing that are often intense, last for only a few minutes, and are clearly directed at (and caused by)someone or some circumstance.

affective events theory, workplace events can generate affective reactions—reactions thatthen can go on to influence work attitudes and behaviors.54

First, the activityin question has to be challenging. Second, the employee must possess the unique skills neededto meet that challenge.

Moods are states of feeling that are often mild in intensity, last for an extended periodof time, and are not explicitly directed at or caused by anything.47

job crafting, where they shape,mold, and redefine their jobs in a proactive way.46

ob enrichment,such that the duties and responsibilities associated with a job are expanded to provide morevariety, identity, autonomy, and so forth.

feedback, is the degree to which carrying out theactivities required by the job provides employees with clear information about how well they’reperforming.40

Autonomy is the degree to which the job provides freedom, independence, and discretion to theindividual performing the work.37

Significance is the degree to which the job has a substantial impact on the lives of other people,particularly people in the world at large.

variety, is the degree to which the job requiresa number of different activities that involve a number of different skills and talents.

What kinds of tasks create these psychological states?” Job characteristics theory,which describes the central characteristics of intrinsically satisfying jobs, attempts to answer thisquestion.

mean-ingfulness of work, which reflects the degree to which work tasks are viewed as something that“counts” in the employee’s system of philosophies and belief

Put simply: Boring jobs may be easier, but they’renot necessarily better.Final PDF to printer

Value-percept theory argues that job satisfac-tion depends on whether you perceive that your job supplies the things that you value

alues are those things that peopleconsciously or subconsciously want to seek or attain.3

Shaping Public OpinionBecause policymakers are influenced by the electorate’s opinions, many interestgroups seek to influence the policymaking process by shaping public opinion

Such a situation is idiotic, of course. Yet elements of it already exist. And unless we beginto turn this around, there will be worse to come

They went one stepfurther and asked for a patent on the basic biological relationship between homocysteineand vitamin deficiency. A patent was granted that covered both the test and the scientificfact. Eventually, a company called Metabolite took over the license for the patent

He is not alone: nearly half of all Americans believe in thevaccine-autism link or are unsure about it

Now, if we agree that disability is not inherently a bad difference, thenwe can insist that disability should not be used to justify infanticide,lesser medical treatment, or any other treatment based on the assump-tion that a disabled person’s life must have diminished well-being

Doulia begins withthe fact of inevitable dependency and depends on an acknowledgmentof our inextricable interdependency.

Most dependency work, however, is done by family members, usu-ally women, but not exclusively

The decision becomes, ‘Wow, I think I’m goingto just stay put where I am.’ Which is the equivalent of a life sentenceof poverty” (quoted in Fessler 2015). Still worse, because the ADA is inplace, many will think that there is no longer a problem—legally, ob-stacles have been removed. It appears, then, that those who are disabledwho cannot find a way out of the precariat are themselves failures inthe modern economy. The fault redounds to them.

The portrait of Emeka Nnaka, a former semipro football player fromTulsa, Oklahoma, who broke his neck making a tackle, illustrates howeasily employment opportunities are frustrated and how the only op-tions available are low paid, part-time, and insecure. Nnaka recentlywas able to get an accessible van to transport him to work. Prior to that,Nnaka said, “I’d spend about three hours in transportation daily whenI was riding the lift. So, think about three hours out of your day inwhich you’re not doing anything” (Fessler 2015).

Precarity is perhaps most closely associated with labor and economicinsecurity

Furthermore, our well-being is dependent on others:

hat disability, as opposed tothe impairment in the body, is a social factor often caused by builtphysical environment that can, if the political will is there, be builtdifferentl

Let us ac-cept that disability is a constructed concept: the construction differsrelative to the time, place, and purpose for which it is employed.

Rather than effectively support-ing the aspiration of those disabled people who are able to be integratedinto productive labor, the withdrawal of care support undermines thoseaspirations, and it makes life still more precarious for those for whomthe ideal is meaningles

The first, I claim, has to do withthe inadequate conceptualization of dependence.

With the rise of neoliberalism and the advent of the disability move-ment, disabled people, who were one class of adults who were previouslyexempted from the ideal of self-sufficiency, are now expected to be“independent and productive.”

iberal ideal of the citi-zen and worker as independent and self-sufficient

Not only were there no guards, there were no rules.

“Misbehavior is as important in the study of nature as in people.

“It did not look like a museum,” recalled Alan Friedman, aphysicist and now the director of the New York Hall of Science.“The look of the exhibits was right off the lab bench. Roughwood. Things nailed into the table. This looked just like my low-temperature physics lab when I was a graduate student. It lookedreally friendly. It looked like home.

This“accelerator,” I later learned, was built by Robert Wilson, a physi-cist and Frank’s close friend from Los Alamos; it was, in essence, aminiature version of the four-mile- circumference particle accelera-tor Wilson had built at Fermi National Laboratory in Illinois

resulting in a final sample of 1,475 rural stakeholders in the United States

When Sloane left Jamaica, he filled his ship with species both dead and alive.

He used enslaved people as guides to the trees and animals of Jamaica.

but that they are different specimens, though going under one general name.”

adding and adding and never taking away.

influential man in the context of his time, describing his non-aristocratic birth, his rifts with other Royal Society members, and the deep complicity he and his collection enjoyed with slavery and imperialism.

General practitioners (GPs), who run private practices, are paid based on the number of patients they see

"socialized medicine" because the government both provides and pays for health care.

8.3

a permission slip to name the grief we experience vicariously and the helplessness we feel when medicine has reached its limits.

I asked the students if the poem related at all to their experience in the ICU. One of them, an aspiring surgeon, drew our attention to a particular image: “Day after day, on the same narrow coast, / we stood guard, waiting / for some speck to reappear …” The poem made him think of one of our patients, a man who had become paralyzed and could only blink. Each morning the student went into this patient’s room and spoke with his son, who was standing alert at his father’s side.

As I read “The Rabbit,” I saw my patients: bleeding, moaning, gasping. I pictured what once was, and what was lost.

I had enjoyed puzzles like that in the classroom, but I couldn’t reconcile this academic discussion with the existence of the man in the bed

I had so many questions: Who was he? Who had he been? What had happened to him? I hadn’t been to church since I left for college when I was 17 and yet, in that moment, my agnostic mind grasped for a higher being.

suspended in the netherworld between the living and the dead

In the United States, the health system is divided into two distinct components:(1) public health, and (2) healthcare services delivery and financing organiza-tions

Technology

Loan repayment programs and scholarships for nursing students• Public service announcements to encourage more people to enter thenursing profession• Career ladder programs for those who wish to advance in the profession• Best-practice grants for nursing administration• Long-term care training grants to develop and incorporate gerontologycurriculum into nursing programs• A fast-track faculty loan repayment program for nursing students whoagree to teach at a school of nursing

The effect of economic conditions on the health of children is espe-cially dramatic. Impoverished children, on average, have lower birth weightsand more conditions that limit school activity compared with other children.These children are more likely to become ill and to have more serious illnessesthan other children because of increased exposure to harmful environments,inadequate preventive services, and limited access to health services

African Americans and Hispanics feel the impact of this more acutely,as they are represented disproportionately below the poverty line

A number of social factors can affect health. Chronic unemployment, theabsence of a supportive family structure, poverty, homelessness, and discrimi-nation, among other social factors, affect people’s health as surely—and oftenas dramatically—as harmful viruses or carcinogens

Over many decades, government has made efforts to exorcise environ-mental health hazards through public policies. Examples of federal policiesinclude:• Clean Air Act (P.L. 88-206)• Flammable Fabrics Act (P.L. 90-189)• Occupational Safety and Health Act (P.L. 91-596)• Consumer Product Safety Act (P.L. 92-573)• Noise Control Act (P.L. 92-574)• Safe Drinking Water Act (P.L. 93-523)

The SymbioticRelationshipAmong HealthPolicy, HealthDeterminants,and HealthStatu

Social regulation

Market-preserving controls

Quality-control regulations

Price or rate-setting regulations

Market entry–restricting regulations

Regulatory policies are designed to influence the actions, behaviors, and decisionsof others by directive

Allocative policies provide net benefits to some distinct group or class of individualsor organizations at the expense of others to meet public objectives

allocative or regulatory

Although the judicial branch of government has played an important rolein health policy for decades, its role is increasingly relevant. For example, as we sawin the policy snapshot, in National Federation of Independent Business (NFIB) v.Sebelius, the US Supreme Court ruled in 2012 that the ACA was indeed consti-tutional. This ruling was a crucial milestone for the law, permitting it to proceed(Liptak 2012). Its rationale and importance will be discussed in detail in chapter8, which is devoted to the vital role played by the judiciary in health policy.

Policies can take several forms:• Laws• Rules or regulations• Implementation decisions• Judicial decisions

The healthcare system has been describedaccurately as “unsustainable” and “flawed” and is characterized by uncon-trolled costs, variable quality, and millions of uninsured and underinsuredpeople

If we are spending more forhealthcare services than anyone in the world by any measure, do we have thebest healthcare system in the world? Regrettably, the answer is no

After entering office, President Donald Trumpreduced or eliminated previous promotional efforts. Consequently, the num-ber of newly insured Americans has declined

21 million people not previously insured became beneficiarie

“iron triangle” of cost, quality, and access is important

and the healthcaredelivery system remains Kafkaesque with misaligned incentives

Thus, a govern-ment’s health policy is a large set of authoritative decisions made through thepublic policymaking process

public-sector health policy asauthoritative decisions regarding health or the pursuit of health made in the legis-lative, executive, or judicial branches of government that are intended to direct orinfluence the actions, behaviors, or decisions of other

efines public policy as the “sumof government activities, whether acting directly or through agents, as thoseactivities have an influence on the lives of citizens.” Birkland (2001) definesit as “a statement by government of what it intends to do or not to do, suchas a law, regulation, ruling, decision, or order, or a combination of these.”Cochran and Malone (1999) propose yet another definition: “Political deci-sions for implementing programs to achieve societal goals.”

potential of technological rescue and a cultural preferencefor the prolonging of individual life regardless of the monetary cost

Americans place a high value on individual autonomy,self-determination, and personal privacy and maintain a widespread, althoughnot universal, commitment to justice

Problems payingmedical billsDissatisfied withcare<200% FPL 200%–400% FPL >400% FPLCopying and distribution of this PDF is prohibited without written permission.For permission, please contact Copyright Clearance Center at www.copyright.comMeacham, Michael R.. Longest's Health Policymaking in the United States, Seventh Edition, Health Administration Press, 2020. ProQuest EbookCentral, http://ebookcentral.proquest.com/lib/creighton-ebooks/detail.action?docID=6417876.Created from creighton-ebooks on 2024-01-15 18:44:22.Copyright © 2020. Health Administration Press. All rights reserved.

if all states couldreach the benchmarks set by leading states, an estimated 86,000 fewer peoplewould die prematurely and tens of millions more adults and children wouldreceive timely preventive care

what government does about supportingpeople with low incomes.

Wealthier Americans tend to be inbetter health than their poorer counterparts primarily because of differencesin education, behavior, and environment

In spite of progress, continued racial disparity is easily identified. Forexample, an African American woman is 22 percent more likely to die from heartdisease than her white counterpart, 71 percent more likely to die from cervicalcancer, and 243 percent more likely to die from pregnancy- and childbirth-related causes (Hostetter and Klein 2018). As a matter of equity, statistics likethese are unacceptable

with notable, although unfinished, progress

There is evidence that the ACA contributedto reducing disparities that existed for Hispanics and African Americans (Hayeset al. 2017)

Health-care disparities refer to differences in such variables as access to care, insurancecoverage, and quality of services received. Health disparities occur when onepopulation group experiences higher burdens of illness, injury, death, or dis-ability than another group

Older people consume relatively more health services, and their health-related needs differ from those of younger people. Older people are more likelyto consume long-term care services and community-based services intended tohelp them cope with various limitations in the activities of daily living.

particular prioritizationamong determinants

United States ranks first in health expenditures but twenty-fifth in spendingon social service

fixed fac-tors, is unchangeable and includes such variables as age and gender. A secondcategory, named modifiable factors, includes lifestyles, social networks, com-munity conditions, environments, and access to products and services such aseducation, healthcare, and nutritious food

Force Field paradigm (Blum 1974). In this theory, four major influences, orforce fields, determine health: environment, lifestyle, heredity, and medicalcare

Health determinants are defined as factors that affect health or, moreformally, as a “range of personal, social, economic, and environmental fac-tors that influence health” both at the individual and population levels

Source: Adapted from OECD (2019).

the moment is no: the US does not obtain good results, especially in light ofcosts, in a number of metrics intended to elucidate the quality of a healthcaresystem

US spends more on healthcare services than anyother nation: in total dollars, dollars per capita, or percentage of the GDP.But does that spending represent value?

ood health is also an integral part of thriving modern societies,a cornerstone of well performing economies, and a shared principle of . . .democracies

state of physical and mental well-being necessary to live a meaningful, pleasant, and productive lif

state in which the biological and clinical indica-tors of organ function are maximized and in which physical, mental, and rolefunctioning in everyday life are also maximize

and a basic anduniversal human right

dynamic state

“state of complete physical, mental, and social well-being and not merelythe absence of disease or infirmity,”

In this book, policy competence simply means that healthprofessionals understand the policymaking process sufficiently to exert someinfluence and achieve their goals—improved healthcare services delivery. Thepath toward policy competence begins with some key definitions—of health,health determinants, public policy, and health policy

Despite government’s substantive role through health policy, most ofthe necessary clinical, diagnostic, and ancillary resources used in the pursuitof health in the United States are owned and controlled by the private sec-tor.

early one-half of NHE will most likelycome from public source

growing percentage of elderly in the population and their greater use ofhealthcare resources, and Medicaid, because of the expansion funded in partby the Affordable Care Act

$3.5 trillion in pursuit of health in 2017, represent-ing about 17.9 percent of the nation’s gross domestic product (GDP) andequaling about $10,739 per person (CMS 2020a)

Health is essential not only to the physicaland mental well-being of people but also to nations’ economies

corporate taxes,

capital gains

personal (individual) taxes

missionstatement

stakeholders

benefit corporation (B corporation)

gency problem

transparency,

community benefits