A value-critical policy analysis of the nursing home reform act: a focus on care of African American and Latino residents

Improving nursing home care has been a central legislative focus since the 1980s; The major response effort to address these reports of poor-quality care was first met with a federal rule in 1987, the Nursing Home Reform Act (NHRA). Since enactment of the NHRA in 1987, and despite an increasing utilization of nursing home care by aging minorities, the standardization of care practice, or quality indicators (e.g., structural, process, and outcome measures), within long-term nursing home care have remained relatively unchanged. This paper reports a value-critical policy analysis of the most recent final action rule, effective on November 28 of 2016 by the Centers for Medicare and Medicaid Services (CMS) with a particular focus on its impact on African-American and Latino older adults. This paper presents results of two policy analyses. Taken together, this merged analysis focuses on an overview of the problem, the groups most affected by the problem, current program goals and objectives, forms of benefits and services, and a current state of the social problem. Following the analysis, we present changes and improvements to be made, as well as proposals for reform and recommendations for policy changes.

Health Justice: A Framework (and Call to Action) for the Elimination of Health Inequity and Social Injustice

Every aspect of society is dependent upon the health of its members. Health is essential to an individual’s well-being, quality of life, and ability to participate in society. Yet the healthcare industry, even at its optimal level of functioning, cannot improve the health of the population without addressing the root causes of poor health. The health of approximately 46.7 million individuals, most of whom are low-income and racial minorities, is threatened by economic, societal, cultural, environmental, and social conditions. Poor health in any population group affects everyone, leading to higher crime rates, negative economic impacts, decreased residential home values, increased healthcare costs, and other devastating consequences. Despite this fact, efforts to improve health among low-income and minority communities are impeded by inequitable social structures, stereotypes, legal systems, and regulatory schemes that are not designed to take into account the social determinants of health in decision making models and legal interpretation. As a result, a large segment of the population is continually denied the opportunity to live long, productive lives and to exercise their rights under democratic principles. Health, equity, and justice make up the keystone of a functional, thriving society. These principles are unsatisfied when they do not apply equally to all members of society. This Article describes the social and legal roots of poor health and how health inequity, social injustice, and poverty are inextricably linked. For example, it provides an in depth overview of the social determinants of health, including poverty, institutional discrimination and segregation, implicit bias, residential environmental hazards, adverse childhood experiences, and food insecurity. It then discusses how the law is a determinant of health due to court systems that do not evaluate individual circumstances, the enactment of laws that perpetuate poor health, and the lack of primary prevention laws. It demonstrates how addressing these issues requires true adherence to equality principles and making justice and freedom of opportunity accessible to everyone. Finally, it recommends the creation of "health justice," a new jurisprudential and legislative framework for the achievement and delivery of health equity and social justice.

Sexual minorities, human rights and public health strategies in Africa

Remarkable progress has been made towards the recognition of sexual minority rights in Africa. At the same time, a marked increase in attacks, rhetorical abuse, and restrictive legislation against sexual minorities or ‘homosexuality’ makes activism for sexual rights a risky endeavour in many African countries. Campaigns for sexual rights and ‘coming out’ are frequently perceived as a form of Western cultural imperialism, leading to an exportation of Western gay identities and provoking a patriotic defensiveness. Cultures of quiet acceptance of same-sex relationships or secretive bisexuality are meanwhile also problematic given the high rate of HIV prevalence on much of the continent. This article examines specific initiatives that are using subtle, somewhat covert means to negotiate a path between rights activism and secretive bisexuality. It argues that strategies primarily focused on health concerns that simultaneously yet discreetly promote sexual rights are having some success in challenging prevalent homophobic or ‘silencing’ cultures and discourses.

A Decade Later: assessing successes and challenges in Manitoba's Provincial Immigrant Nominee Program

During the past decade, Manitoba's Provincial Nominee Program (MPNP) has increased immigration to the province and dispersed immigrants more widely within Manitoba. At the same time, the rapid growth of the program and the decentralized way in which it has been implemented have contributed to some challenges. This ten-year analysis of the MPNP finds that many places in Manitoba are experiencing settlement service gaps, and that immigrants and communities are taking on much of the burden for MPNP application and settlement. In addition, the analysis demonstrates that the fragmented way in which the MPNP has been marketed and implemented (i.e., by relying on particular employers, consultants, and ethnocultural organizations) has resulted in a sort of ethnocultural inequality where certain groups are ushered into the province-often to perform particular occupations-while others are bypassed.

Projections of the ethnic minority populations of the United Kingdom 2006-2056

The ethnic minority populations in the UK are growing substantially through immigration, a youthful age structure, and in some cases relatively high fertility. Their diverse demographic and socioeconomic characteristics have attracted considerable academic and policy attention, especially insofar as those distinctive characteristics have persisted in the generations born in the UK. No official projections of the UK ethnic populations have been published since 1979. This article provides projections to 2056 and beyond of 12 ethnic groups. Given overall net immigration and vital rates as assumed in the office for National Statistics 2008-based Principal Projection, and the ethnic characteristics estimated here, the ethnic minority populations (including the Other White) would increase from 13 percent of the UK population in 2006 to 28 percent by 2031 and 44 percent by 2056, and to about half the 0-4 age group in 2056. Alternative projections assume various lower levels of immigration. Possible implications of projected changes are discussed.

Constructions of community and identity among Indians in colonial Natal, 1860-1910: the role of the Muharram festival

This article is concerned with the historical construction of communities, cultures and identities in colonial Natal, in this case an Indian grouping that emerged from the heterogeneous collection of indentured workers imported between 1860 and 1911. Despite the difficulties of indenture, Indians set about re-establishing their culture and religion in Durban. The most visible and public expression of ritual was the festival of Muhurram, which played an important role in forging a pan-Indian ‘Indianness’ within a white and African colonial society. This was significant when one considers that the nationalist movement was in its formative stages and there was no national identity when indentured workers had left India.

"The abandoned mother": ageing, old age and missionaries in early and mid nineteenth-century South-east Africa

This essay examines issues of ageing and old age in Xhosa-speaking communities to c. 1860. Drawing primarily on records of the Wesleyan Methodist and London Missionary societies, the article examines the construction of Xhosa ageing, old age and death in missionary writings. The primary medium of missionary reflection was the figure of the ‘Abandoned Mother’, modelled on contemporary British metaphors, that represented yet another atrocity story for legitimating the mission enterprise and the emerging colonial regime. It also argues that there were fundamental contrasts in the images of ageing and dying between those of the Xhosa and those of the missionaries. Though older persons found certain themes in the Christian message attractive, they preferred the local cultural model of ageing, old age and death.