Locked Up and Looking for a Way Out: First Nation Policy Control as a Path Out of the Indian Act Maze

The origin of the federal-state partnership in Maternal and Child Health (MCH) can be traced from the Children's Bureau grants of 1912, through the Sheppard-Towner Act, to the creation of Title V and other programs of today that mandate planning, accountability, and systems development. In the past decade with the transformation of the health care system and the emergence of managed care, there has been a resurgence of interest in public, professional, and governmental interest in quality measurement and accountability. Regional perinatal systems have been implemented in all states with varying levels of involvement by state health agencies and the public sector. This historical framework discusses two primary themes: the decades of evolution in the federal-state partnership, and the emergence in the last three decades of perinatal regional system policy, and suggests that the structure of the federal-state partnership has encouraged state variation. A survey of state MCH programs was undertaken to clarify their operational and perceived role in promoting quality improvement in perinatal care. Data and information from the survey, along with five illustrative state case studies, demonstrate great variation in how individual state agencies function. State efforts in quality improvement, a process to make things better, have four arenas of activity: policy development and implementation, definition and measurement of quality, data collection and analysis, and communication to affect change. Few state health agencies (through their MCH programs and perinatal staff) are taking action in all four arenas. This analysis concludes that there are improvements MCH programs could implement without significant expansion in their authority or resources and points out that there is an opportunity for states to be more proactive as they have the legal authority and responsibility for assuring MCH outcomes.

<p>Despite a significant increase in attention for uptake of scientific results, the integration of emerging science in policy development and implementation remains challenging. The persistent gap between science and policy may frustrate the parties involved. For the scientists, the intended impacts of what are typically very much applied research efforts remain unattained. Those involved in policy implementation and development may perceive a lack of scientific support. This may particularly be the case in transitional countries, where the development of science may struggle to keep up with rapid societal and policy development; with several factors either impeding or facilitating the uptake of emergent scientific knowledge.</p><p>We implemented a series of participatory and action research activities to support the development and implementation of groundwater management policies in Colombia and explore barriers and enabling conditions to a functional science-policy interface. The factors that either impede or facilitate the process are examined through three case studies in different regions of the country. Although the national policies that govern groundwater resources management in these three areas are the same; the degree to which scientific knowledge is used to support policy implementation varies. Several factors are identified that influence the effectivity of the linkage, including among others; the availability of scientific knowledge; the establishing of trust relationships and positioning of institutions and stakeholders; as well as institutional readiness in supporting the policy implementation process. This comparison provides useful insight into how addressing some of the impeding factors may enrich the science-policy process.</p>

The global introduction of the millennium Development Goals has drawn National attentions to pursuing gender and development policies, geared towards achieving gender equality. The Nigerian government keyed into this policy, replaced the erstwhile National Policy on women adopted in the year 2000 with National gender policy in 2006 The 2006 Gender and Development Policy was reviewed in Nigeria; which led to the 2021-2026 gender and development policy. The 2021-2026 policy draws from the 2006 National Gender and development Policy whose overall goal was to provide ‘strategic policy guidance for mainstreaming gender at all levels as well as address the inequalities that exist in the socio-economic sphere, and combat all forms of violence against women and girls, among other things. The policy goal is aimed at eliminating cultural, religious gender based biases and harmful cultural and religious practices which tend to reproduce inequalities in gender roles relations in the Nigerian society and thereby giving a subordinate status to women compared to men. Hence, development opportunities continue to elude women since the policy failed to challenge the structure which reproduces gender inequality and overall disempowerment of women. This study therefore examined effective implementation of gender and development policy in public health institutions in Nigeria. It is clear that implementation of gender and development policy is not effective and contrary to expectation. With the new and revised policy in place, the Nigerian government can learn from the previous policies and ensure that there is clear tracking and monitoring of the impact of each of the objectives so as to fully do away with gender inequality in the country; recommendations were also made.

This manuscript reviews medical literature published pertaining to the management of chronic pain with medical marijuana therapy (MMJ), with an emphasis on the social, medical, and legal aspects of therapy. Narrative review of peer-reviewed literature. The 3rd Symposium on Controlled Substances and Their Alternatives for the Treatment of Pain was held in Boston on February 27, 2016, with a focus on MMJ for the treatment of chronic pain. Invited speakers had diverse backgrounds, including pain management, addiction psychiatry, neurology, and legal authorities. The purpose of this conference and this subsequent narrative review is to provide a medical, legal, and logistical framework for physicians and other health care providers to refer to when considering the initiation of medical marijuana therapy. The invited speakers each covered a unique aspect of MMJ therapy for the treatment of chronic pain. These presentations highlighted the current data for and against the use of MMJ as a pain therapy. Optimal patient selection and screening, in addition to policy developments, were discussed. Increasing interest in MMJ for chronic pain underscores a need for primary care and pain physicians to better understand the indications and evidence for its use free from cultural bias. Given a lack of full conclusive clinical utility, continued research is needed to better understand how to best utilize MMJ therapy for the treatment of chronic pain. Policy initiatives, such as enumerated indications, should follow medical science in order to prevent another abused substance epidemic.

Good public policies are vital for protecting the health of populations. For the prevention and control of noncommunicable diseases (NCD), a single national policy is essential. Such a policy ensures clarity of vision and purpose, sets the platform for joint action to address risk factors and determinants that are shared by major NCDs, and provides coherence with other health and social policies. A national NCD policy also provides an overarching framework that enables governments to combine and balance synergistic public health strategies that target the whole population and those that target high-risk groups. Given that the adopted strategies are evidence-based and cost-effective, national NCD policy development can provide a strong basis for appropriate legislation and regulation in relation to tobacco control and promotion of healthy diet and physical activity. A national policy also serves as a vehicle to facilitate efficient and effective use of available public finances for NCD-related health care, while safeguarding equity. For the reasons alluded to above, a single national NCD policy is more appropriate than separate national polices for each individual NCD, particularly in low-income and middle-income countries that have a critical shortage of human and financial resources, including those necessary for policy development and implementation.

BackgroundHarmful use of alcohol is one of the most common risk factors for Non-Communicable Diseases and other health conditions such as injuries. World Health Organization has identified highly cost-effective interventions for reduction of alcohol consumption at population level, known as “best buy” interventions, which include tax increases, bans on alcohol advertising and restricted access to retailed alcohol. This paper describes the extent of inclusion of alcohol related “best buy” interventions in national policies and also describes the application of multi-sectoral action in the development of alcohol policies in Malawi.MethodsThe study was part of a multi-country research project on Analysis of Non-Communicable Disease Preventive Policies in Africa, which applied a qualitative case study design. Data were collected from thirty-two key informants through interviews. A review of twelve national policy documents that relate to control of harmful use of alcohol was also conducted. Transcripts were coded according to a predefined protocol followed by thematic content analysis.ResultsOnly three of the twelve national policy documents related to alcohol included at least one “best buy” intervention. Multi-Sectoral Action was only evident in the development process of the latest alcohol policy document, the National Alcohol Policy. Facilitators for multi-sectoral action for alcohol policy formulation included: structured leadership and collaboration, shared concern over the burden of harmful use of alcohol, advocacy efforts by local non-governmental organisations and availability of some dedicated funding. Perceived barriers included financial constraints, high personnel turnover in different government departments, role confusion between sectors and some interference from the alcohol industry.ConclusionsMalawi’s national legislations and policies have inadequate inclusion of the “best buy” interventions for control of harmful use of alcohol. Effective development and implementation of alcohol policies require structured organisation and collaboration of multi-sectoral actors. Sustainable financing mechanisms for the policy development and implementation processes should be considered; and the influence of the alcohol industry should be mitigated.

BackgroundPhysical inactivity is one of the four leading behavioural risk factors for non-communicable disease (NCD). Like tobacco control, increasing levels of health-enhancing physical activity (HEPA) will require a national policy...

Since the Cold War, at international, regional and domestic levels, there have been various dynamics which have been significantly impacting Africa's political economy. Taking the major historical developments prior to 1990s as background premises, this article intends to critically unveil the existential state (opportunities, challenges and imperatives) of the continent's political economy since the conclusion of the Cold War. Besides, it has to be noted that, except for some minor disparities among African countries, their communalities concerning their political and economic experiences could plausibly take the lion share, which in turn enable a researcher to come up with cogent explanations, evaluations, generalizations and finally conclusive remarks that could logically stand for the entire continent. Given this methodological consideration, in contrast with its successful but short lived historical precedent in the 1960s through deliberately owned national development policy measures by visionary post-independent African leaders, African political economy had been dragged into incommensurable crisis in the 1970s and 1980s. This had been primarily because of the imposition of alien neo-liberal development policies and reforms [1,2, p.4] (Fantu, 2014). Since the late 1990s, however, its overall performance has begun to recover following the demise of Uni-polar power structure for a new multi-polar global arrangement. The deteriorating influence of neo-liberal conditionalities because of national measures, policy independence, and alternative development policies as well as partnership [3,1 p.276]. In spite of its recent commendable signals justifying 'Afro-optimism', the continent's political economy has still been far from structural transformation. Thus, for its positive prospect, the underlying tasks that each African states are expected to undertake and realize are: strong democratic states with visionary political leadership, de-politicized and meritocratic civil service, state-lead or strategically regulated national economy, policy ownership as well as independence, deliberated and strategic integrations with regional and international economies, infrastructure expansion, human recourse development, diversifying development finance and partnership, giving priorities to strategic economic sectors, which could generate fast economic growth, create more job opportunities and could reduce poverty (Fatu, 2016; pp.1278-79).

A national safety incentive policy is a mix of policy instruments and strategies outlining the rules, templates, and standard procedures for designing and implementing safety incentives within a country. Through a Delphi study, this study assesses critical factors affecting the development of a national safety incentives policy for the construction industry in developing countries using Nigeria as a case study. A qualitative technique was adopted using the Delphi technique to select a representative sample of expert panellists for the study. The Delphi findings indicate fifteen (15) identified factors affecting the development of a national safety incentives policy in Nigeria. Of these fifteen (15) identified factors, six (6) had a very high impact (VHI: 9.00 – 10.00), four (6) had a high impact (HI: 7.00 - 8.99), and the remaining three (3) factors recorded a medium impact (MI: 5.00 - 6.99). The study's key findings reveal that the leading critical factors affecting developing countries, including Nigeria, in developing a national safety incentives policy include weak institutional framework, occupational safety and health agency’s corrupt practices, stakeholders’ absence in policy development, insufficient government budget for occupational safety and health agency, ineffective H&S code of practice, absence of national safety incentive vision, political influence on occupational safety and health enforcement agency, inadequate regulatory framework, ineffective occupational safety and health policy enforcement, and ineffective occupational safety and health policies. This study concluded by calling for a standalone national safety incentive policy that will holistically support the implementation of safety incentives within the construction industry.

BackgroundApproximately half of the countries in the African Region had a mental health policy by 2005, but little is known about quality of mental health policies in Africa and globally. This paper reports the results of an assessment of the mental health policies of Ghana, South Africa, Uganda and Zambia.MethodsThe WHO Mental Health Policy Checklist was used to evaluate the most current mental health policy in each country. Assessments were completed and reviewed by a specially constituted national committee as well as an independent WHO team. Results of each country evaluation were discussed until consensus was reached.ResultsAll four policies received a high level mandate. Each policy addressed community-based services, the integration of mental health into general health care, promotion of mental health and rehabilitation. Prevention was addressed in the South African and Ugandan policies only. Use of evidence for policy development varied considerably. Consultations were mainly held with the mental health sector. Only the Zambian policy presented a clear vision, while three of four countries spelt out values and principles, the need to establish a coordinating body for mental health, and to protect the human rights of people with mental health problems. None included all the basic elements of a policy, nor specified sources and levels of funding for implementation. Deinstitutionalisation and the provision of essential psychotropic medicines were insufficiently addressed. Advocacy, empowerment of users and families and intersectoral collaboration were inadequately addressed. Only Uganda sufficiently outlined a mental health information system, research and evaluation, while only Ghana comprehensively addressed human resources and training requirements. No country had an accompanying strategic mental health plan to allow the development and implementation of concrete strategies and activities.ConclusionsSix gaps which could impact on the policies' effect on countries' mental health systems were: lack of internal consistency of structure and content of policies, superficiality of key international concepts, lack of evidence on which to base policy directions, inadequate political support, poor integration of mental health policies within the overall national policy and legislative framework, and lack of financial specificity. Three strategies to address these concerns emerged, namely strengthening capacity of key stakeholders in public (mental) health and policy development, creation of a culture of inclusive and dynamic policy development, and coordinated action to optimize use of available resources.

This article summarizes the findings of an international research effort, presented in this Special Issue, intended to identify the opportunities and challenges in creating institutional arrangements that could lock in, and exploit, a dynamic in which development policies alter socio-technical systems and indirectly promote various climate activities. In doing so, it also introduces and assesses intervention theory as a novel approach to analyse the link between international institutions and national policies. The conclusions are based on an analysis of Sustainable Development – Policies and Measures (SD-PAM), a precursor to National Appropriate Mitigation Action, a suggested mechanism in the current climate negotiations, built around a set of national case studies in Brazil, China and Mozambique, covering a diverse set of sectors – biofuels, bioenergy, agriculture and transportation. The article concludes that a mechanism like SD-PAM could play a vital role in promoting the changes in socio-technical systems necessary to meet the 2°C target defined as a precondition to avoid dangerous climate change. Most critically, it constitutes a means to provide recognition for national activities that are otherwise not viewed as climate policies. This could in turn generate (1) new commitments; (2) additional direct funding; (3) indirect financing in the form of tradable permits; and (4) different forms of technology transfer.

The study of the features of the formation and implementation of the state economic policy is aimed at the analysis of the current state of the organization, the stage and perspective of development, the normative support of the national economic policy, and the identification of the advantages and disadvantages of the specified policy. The relevance of the study of the state economic policy lies in the fact that in the conditions of globalization and European integration it is necessary to activate theoretical and practical research in order to solve the most important and priority problems of the country. The subject of the study is the state economic policy of Ukraine from the point of view of its transformation with the current challenges of economic interests of the society. This understanding of the problem has led to the formulation of the research objective: theoretical substantiation of the content, principles, model and regulation of economic policy, taking into account the transitivity of the national economic system. The theoretical and methodological basis of the study is the dialectical method of cognition and systematic approach to the study of the problems of state economic policy and its transitivity; scientific works of domestic and foreign scientists based on the application of the abstract-logical method, systematic approach, critical legal approach, etc. It is established that the state economic policy is a component of the general political process, an integral system of measures of the state influence on the economy, the effectiveness of which is manifested in the interconnection of its elements. The transitory nature of the state economic policy, based on the ability of the national economy to expand self-reproduction to meet the needs of the population and the state, and on the other hand, the ability to withstand the destabilizing factors caused by Russia's military aggression against Ukraine, allows to talk about the formation of a new vector of development of the state economic policy of Ukraine. The issues that should be taken into account by public authorities when developing and implementing the State economic policy under martial law are outlined. The need for further research on the institutional foundations of the theoretical approach to justifying the definition of the state economic policy and highlighting the main positions of its constructive formation is substantiated. Results. The essence and separate components of the state economic policy are revealed, in particular, the principles of policy formation and the model of the national economy. The priority areas, which should be considered in the development of the state economic policy, were determined. Certain problems of implementation of the economic policy in the conditions of martial law were identified. The peculiarities of the normative consolidation of the state economic policy of Ukraine are pointed out. Recommendations on improvement of the development of the state economic policy are given.

BackgroundGiven the persistence of Indigenous health inequities across national contexts, many countries have adopted strategies to improve the health of Indigenous peoples. Governmental recognition of the unique health needs of Indigenous populations is necessary for the development of targeted programs and policies to achieve universal health coverage. At the same time, the participation of Indigenous peoples in decision-making and program and policy design helps to ensure that barriers to health services are appropriately addressed and promotes the rights of Indigenous peoples to self-determination.Due to similar patterns of Indigenous health and health determinants across borders, there have been calls for greater global collaboration in this field. However, most international studies on Indigenous health policy link Anglo-settler democracies (Canada, Australia, Aotearoa/New Zealand and the United States), despite these countries representing a small fraction of the world’s Indigenous people.AimThis paper examines national-level policy in Australia, Brazil, Chile and New Zealand in relation to governmental recognition of differential Indigenous health needs and engagement with Indigenous peoples in health. The paper aims to examine how Indigenous health needs and engagement are addressed in national policy frameworks within each of the countries in order to contribute to the understanding of how to develop pro-equity policies within national health care systems.MethodsFor each country, a review was undertaken of national policies and legislation to support engagement with, and participation of, Indigenous peoples in the identification of their health needs, development of programs and policies to address these needs and which demonstrate governmental recognition of differential Indigenous health needs. Government websites were searched as well as the following databases: Google, OpenGrey, CAB Direct, PubMed, Web of Science and WorldCat.FindingsEach of the four countries have adopted international agreements regarding the engagement of Indigenous peoples in health. However, there is significant variation in the extent to which the principles laid out in these agreements are reflected in national policy, legislation and practice. Brazil and New Zealand both have established national policies to facilitate engagement. In contrast, national policy to enable engagement is relatively lacking in Australia and Chile. Australia, Brazil and New Zealand each have significant initiatives and policy structures in place to address Indigenous health. However, in Brazil this is not necessarily reflected in practice and although New Zealand has national policies these have been recently reported as insufficient and, in fact, may be contributing to health inequity for Māori. In comparison to the other three countries, Chile has relatively few national initiatives or policies in place to support Indigenous engagement or recognise the distinct health needs of Indigenous communities.ConclusionsThe adoption of international policy frameworks forms an important step in ensuring that Indigenous peoples are able to participate in the formation and implementation of health policy and programs. However, without the relevant principles being reflected in national legislature, international agreements hold little weight. At the same time, while a national legislative framework facilitates the engagement of Indigenous peoples, such policy may not necessarily translate into practice. Developing multi-level approaches that improve cohesion between international policy, national policy and practice in Indigenous engagement in health is therefore vital. Given that each of the four countries demonstrate strengths and weaknesses across this causal chain, cross-country policy examination provides guidance on strengthening these links.

Reviewed by: Science, Policy, and Development in Africa: Challenges and Prospects by R. Sooryamoorthy Cathy Skidmore-Hess Sooryamoorthy, R. Science, Policy, and Development in Africa: Challenges and Prospects. Cambridge: Cambridge University Press, 2020. Opening with the statement, "A great deal is written and known about Africa but not much about science from Africa, or what Africa can give to science" (1), Science, Policy, and Development in Africa posits that Africa-based science would benefit the global production of scientific knowledge as well as individual nations. Sooryamoorthy, a sociologist at the University of KwaZulu-Natal, has written extensively on technology and science in South Africa as well as the role of science in development in both colonial and postcolonial Africa, and he argues for the need to integrate locally produced science into Africa's development plans. For Sooryamoorthy, it is critical to create knowledge and technological capacity, because production of scientific knowledge is necessary to obtain international funding and is a key component of economic growth. As the gap between rich and poor countries widens in terms of knowledge production, the gap in economic development and wealth also increases. However, national development policies of African countries still contain very little focus on science and technology. To remedy this, Sooryamoorthy suggests that science and development policies be more closely aligned with the objectives expressed in national development plans. He also argues for more African-centered scientific programs. [End Page 226] Science, Policy, and Development in Africa makes a strong argument for the development and use of Africa's human capital. Higher population produces greater demand for technology and a larger amount of human capital from which to draw new methods and invention. Lack of appreciation for scientific research also means that an insufficient number of people know how to carry out scientific research (234). Part of the development of human capital involves the creation of more African scientists and more development plans based in science. This requires institutional capacity. According to Sooryamoorthy, the African continent has a poor record of building institutions for development and advancement. To balance technology transfer, and with science developed locally, education is key. African governments need to rely less on foreign capital and make more use of indigenous knowledge, not just in agriculture and medicine but in development more broadly. This means incorporating local knowledge into the formal education system and breaking with some of the patterns created by history and global capital. Sooryamoorthy notes that under colonialism, scientific inquiry was focused on solving the problems of the colonizers, but he focuses his analysis on the postcolonial period and the challenges to Africanizing science. During the 1960s and 1970s, newly independent African countries often needed to develop institutions, such as universities. These universities were, in turn, concerned with the "Africanisation of research, creation of academic positions and expansion of scientific establishments" (45). However, the global recession of the 1970s and a dip in oil prices slowed the production of science, confined it to universities and the public sector, and limited the growth of universities and the public sector as well. This downturn slowed the Africanization of and growth of African science, because scientific development and collaboration is linked with the growth of universities, the number of students enrolled in the sciences, and gross domestic expenditure on research and development (GERD) (85). Sooryamoorthy's analysis indicates a high correlation between scientific production, wealth, and collaboration with the global scientific community. However, while essential, collaboration is often exploitative in the African context as "Africa is often mined for resources of interest to the international community, and African scientists become the under-recognized workers who collect those resources" (195–96). In regard to this and failures in development policy, Sooryamoorthy notes that the problems of science and technology (S&T) on the continent are twofold: first, social systems of science have not been able to attract "sufficient [End Page 227] political legitimacy" and international cooperation; and second, international aid cannot "replace local and national support in harnessing S&T for development" (285). To develop Africa's human potential and "science from Africa," a policy shift is also important. Sooryamoorthy makes use of Andrew Moravcsik's distinction between policy with science...

Close to 8 million children are born annually with a serious birth defect, accounting for 5% of all newborn deaths globally. Many birth defects are associated with folic acid insufficiency, non-communicable diseases (NCDs), teenage or advanced age pregnancies, short birth intervals, and exposure to harmful substances. The majority of countries with the highest birth defects prevalence are in Africa, and the East African Community has made important commitments to improving reproductive, child, and adolescent health and nutrition. The aim of this review was to identify the advances and gaps in national policies addressing birth defect risk factors in the East African Community (Burundi, Kenya, Rwanda, Tanzania, and Uganda) in order to inform additional actions. National laws, regulations and policies were reviewed from the East African Community countries related to grain fortification and supplementation with folic acid; reducing too-early, unwanted and rapid successive pregnancies; and addressing NCDs and exposure to tobacco. All five countries have adopted a policy of mandatory folic acid fortification of wheat and maize flour. However, only in Kenya and Tanzania, are the folic acid levels in line with international recommendations. And, only Uganda has a policy requiring folic acid supplementation administration in the preconceptional period. The East African Community countries have made efforts to reduce too-early, unwanted and rapid successive pregnancies. All countries have banned child marriage and three of five countries have introduced laws to allow unrestricted access to contraception for adolescents. With regards to promoting prevention and control of NCDs and reducing populations' exposure, compliance with World Health Organization (WHO) guidelines is limited. Only two countries have developed multi-sectoral policies for NCDs and no countries comply fully with the recommendations of the Framework Convention on Tobacco Control. Much work remains in ensuring that opportunities for prevention of birth defects are fully realized in the East African Community countries. This review revealed that all countries in the East African Community have, to some extent, adopted policies that are conducive to reducing the risk of birth defects in the region, but significant gaps remain in some key areas of either policy development or implementation.