Policy Incongruence and Public Health Professionals' Dissonance: The Case of Immigrants and Welfare Policy
Tóm tắt
The steady increase in immigrants to the United States has fueled a critical analysis of the process of allocation of health and social benefits to these newcomers. The myriad of interests and values surrounding this issue precipitated the formulation and adoption of the Personal Responsibility and Work Opportunity (Welfare Reform) Act of 1996. This dramatic welfare reform impacts federal, state, and local agencies that are required to determine the eligibility of benefits and manage the attendant consequences to the public as well as members of this vulnerable group. Especially challenging are the decisions confronting public health professionals who struggle to reconcile the resulting policy, programmatic mandates, and compliance imperatives with prevailing public health principles and practice norms. This paper proposes a framework for understanding the incongruence between the provisions of the law as it pertains to legal and illegal immigrants and public health values. The impact of policy incongruence and professionals' dissonance on public health practice norms is explored with an explicit focus on public health outcomes and legal implications. The examination of tuberculosis as a health example reveals the policy conflicts and public health dilemmas. Finally, the paper elicits a range of options available to public professionals for responding to these legal mandates.
Tài liệu tham khảo
Preister R: A values framework for health system reform. Health Aff 1992; 11:84-107
Beauchamp DE: Public health as social justice. Inquiry 1976; 13:3-14
Aroskar MA: Exploring ethical terrain in public health. J Public Health Manage Practice 1995; 1(3):16-22
Turnock B: Public Health: What It Is and How It Works. Gaithersburg, MD: Aspen Publishers; 1997
Tursen M: Unhealthy paradox: A nation of immigrants debate harsh immigrant controls. Current Issues in Public Health 1996; 2:61-67
Espenshade TJ, Calhoun C: An analysis of public opinion toward undocumented immigration. Population Res and Policy Rev 1993; 12:189-224
National Research Council: The New Americans. Washington, D.C.: National Academy Press; 1997
Raviglione C, Snider DF, Kochi A: Global epidemiology of tuberculosis: Morbidity and mortality of a worldwide epidemic. JAMA 1995; 273(3):220
McKenna M, McCray E, Onorato I: The epidemiology of tuberculosis among foreign-born persons in the United States, 1986–1993. NEJM 1995; 332(16):1071-1076
Centers for Disease Control and Prevention: Tuberculosis morbidity—United States, 1995. JAMA 1996; 275:1629-1630
Cantwell MF, Snider D, Cauthen G, Onorato I: Epidemiology of tuberculosis in the United States, 1985 through 1992. JAMA 1994; 272:535-537
Loue S: Immigrants, immigration law and tuberculosis. Washington Law Review 1996; 71(4):969-988
Hargraves M: Immigrants needing health care in Texas. Texas Med 1996; October:64-77
Asch S, Leake B, Gelberg L: Does fear of immigration and authorities deter tuberculosis patients from seeking care. West J Med 1994; 61(4):161-373
Iseman MD, Starke J: Immigrants and tuberculosis control. NEJM 1995; 332(16):1094-1095
Lederberg J, Shope RE, Oaks S, eds: Emerging Infections: Microbial Threats to Health in the United States. Washington, D.C.: National Academy Press; 1992
Aday L, Begley C, Lairson D, Slater, C: Evaluating the Medical Care System: Effectiveness, Efficiency, and Equity. Ann Arbor, MI: Health Administration Press; 1993
Boland P: Making Managed Healthcare Work. Gaithersburg, MD: Aspen Publications; 1993
American Public Health Association: 9401: Ensuring access to health services for undocumented immigrants. AJPH 1995; 85(3):437-438
National Conference of State Legislatures: Welfare reform and immigrants. Immigrant Policy News 1997 Aug: 2-3
National Conference of State Legislatures: Welfare reform and immigrants. Immigrant Policy News 1997 October 21: 1
National Conference of State Legislatures: Welfare reform and immigrants. Immigrant News 1997 July 15: 2
Siddharthan K, Alalasundaram S: Undocumented aliens and uncompensated care: Whose responsibility? AJPH 1993; 83(3):410-412
Pyler v. Doe, 457 U.S. 202, 225 (1982)