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This chapter discusses challenges faced by older adult health-care consumers in obtaining access to responsive care from physicians relevant to a broad spectrum of health issues ranging from prevention to chronic illness and end-of-life care. Based on our prior research with community-dwelling elders (E. Kahana & B. Kahana, 2003, 2010), we propose a conceptual model of consumer self-advocacy for better access to effective health care in late life. We argue that older adults who are well informed and confident health-care partners and who involve their physicians in active dialogue will experience better care, and will be more satisfied with their health care. We present findings from our studies of cancer prevention and from our research focused on end-of-life care relevant to patient self-advocacy. We also discuss the role of educational interventions and of patient empowerment in facilitating greater access to responsive health communication and health care, particularly among elders who are disadvantaged and who have low health literacy.

Health science librarians occupy a unique place in librarianship, guiding healthcare professionals and the public to quality sources of medical research and consumer health information in order to improve patient outcomes and quality of life. A broader impact of health sciences librarianship is its advocacy for improvements in public health. In recent years, health science librarians have been actively involved in advocating for adequate, responsive, and culturally competent health care for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals. Health sciences librarians have advocated for LGBTQ+ individuals through a variety of specialized outreach projects to address health disparities found in the LGBTQ+ community such as HIV/AIDS, women’s health, or substance abuse, have collaborated with public health agencies and community-based organizations to identify health disparities and needs, and have implemented outreach to address these needs.

This chapter maps the landscape of health sciences librarian outreach to LGBTQ+ people. The authors develop this theme through case studies of health science librarians providing health information to the LGBTQ+ community and healthcare professionals. Following an overview of advocacy for LGBTQ+ health by the US National Network of Libraries of Medicine and professional information organizations, they conclude the chapter by discussing the “pioneering” nature of these projects and the common threads uniting them, and by identifying the next steps for continued successful outreach through the development of an evidence base and tailoring of outreach and resources to address other demographic aspects of the members of the LGBTQ+ community.

In this closing chapter, the authors first draw on the contributed chapters in this volume to highlight some of the many ways in which libraries and librarians are moving us closer to health justice by working with their communities to increase consumer health literacy and to decrease health disparities. The authors then focus our attention on the COVID-19 pandemic, discussing the fact that disadvantaged populations are bearing the brunt of the negative impacts of this situation and the many existing and novel roles that libraries and librarians are playing to help to fight consumer health information injustice and to contribute toward better health outcomes for all. Next, Dr Beth Barnett brings her viewpoint as a Board Certified Patient Advocate to the volume, pointing out parallels between the roles of librarians and those of patient advocates, as well as important lessons for patient advocates gleaned from the volume. To conclude the chapter, the authors reiterate our aims for the volume and issue a call to the reader to join libraries and librarians in their important role as agents of health information justice.

The overall objective of this research was to elucidate the ecosystem of women’s health social enterprises (WHSEs) based in the United States. The Aim I was to conduct a secondary data analysis of a random national sample of non-profit WHSEs based in the United States regarding their characteristics and areas of intervention. Aim II was to conduct a qualitative assessment of a sample of WHSEs based in the United States regarding their perspectives on the ecosystem of WHSEs. Aim I utilized the GuideStar database and assessed enterprise size, geographic location, financial distress, health intervention area, and health activity category using descriptive statistics, statistical tests, and multivariable regression analysis via SPSS. Aim II utilized in-depth interviewing and grounded theory analysis via MAXQDA 2018 to identify novel themes and core categories while using an established framework for mapping social enterprise ecosystems as a scaffold.

Aim I findings suggest that WHSE activity is more predominant in the south region of the United States but not geographically concentrated around cities previously identified as social enterprise hubs. WHSEs take a comprehensive approach to women’s health, often simultaneously focusing on multiple areas of health interventions. Although most WHSEs demonstrate a risk for financial distress, very few exhibited severe risk. Risk for financial distress was not significantly associated with any of the measured enterprise characteristics. Aim II generated four core categories of findings that describe the ecosystem of WHSE: (1) comprehensive, community-based, and culturally adaptive care; (2) interdependent innovation in systems, finances, and communication; (3) interdisciplinary, cross-enterprise collaboration; and (4) women’s health as the foundation for family and population health. These findings are consistent with the three-failures theory for non-profit organizations, particularly that WHSEs address government failure by focusing on the unmet women’s health needs of the underserved populations (in contrast to the supply of services supported by the median voter) and address the market failure of over exclusion through strategies such as cross-subsidization and price discrimination. While WHSEs operate with levels of financial risk and are subject to the voluntary sector failure of philanthropic insufficiency, the data also show that they act to remediate other threats of voluntary failure.

Aim I findings highlight the importance of understanding financial performance of WHSEs. Also, lack of significant associations between our assessed enterprise characteristics and their financial risk suggests need for additional research to identify factors that influence financial performance of WHSE. Aim II findings show that WHSEs are currently engaged in complex care coordination and comprehensive biopsychosocial care for women and their families, suggesting that these enterprises may serve as a model for improving women’s health and health care. The community-oriented and interdisciplinary nature of WHSE as highlighted by our study may also serve as a unique approach for research and education purposes. Additional research on the ecosystem of WHSE is needed in order to better inform generalizability of our findings and to elucidate how WHSE interventions may be integrated into policies and practices to improve women’s health.

Corporate foundations – entities established to regularize corporate giving at an arm’s length removed from the firm – command substantial resources, root companies in the nonprofit sectors of their host communities, indirectly augment perceptions of corporate responsibility, and help firms to deflect controversies in an attentive global media environment. Despite these important roles, relatively little research has examined the institutional and strategic factors that influence such proximate charitable giving by firms. Using systematic data on foundations linked to S&P 3000 firms in the health sector – a growing domain in which public trust in high-stakes products and services is critical – fixed-effects models illustrate the primary role of network influences on giving: corporate foundations give substantially more in years following higher contributions by other (noncorporate) foundations in the health sector in a firm’s headquarters locality and also following increased contributions by industry peers through their corporate foundations. Giving also appears to reflect strategic reputational concerns, in that foundation contributions increase significantly following controversies associated with the corporate parent’s products and/or services. By contrast, giving tends to decline as the presence of outside directors on a firm’s board increases, as well as when firms carry heavier debt loads. Combined, these findings suggest that corporate foundations serve as a strategic proxy for the firm, reflecting both a company's position in community and interfirm networks while also mitigating the threat of reputational challenges.

While the steep increases in rates of incarceration seen in the United States in the late twentieth century have begun to level out, one form of incarceration has seen more drastic reductions in rates of use in the 2010s: long-term solitary confinement. Across the United States, prisons that once isolated prisoners for decades at a time stand hauntingly empty. The solitary confinement reform movement provides an important lens for examining what happens when an entrenched punitive practice faces widespread and sustained criticism and reveals the multiple paradigms through which reform operates – through politics, litigation, or charismatic leadership.

Social and economic trends toward local governance form the context for health and mental health policy and the reorganization of care systems for cost-containment in the United States. Local management of public–private collaborations is promoted by state agencies as a means of rationalizing mental health care and community support services. This chapter analyses the local process of developing public–private partnerships for mental health care, based on an ethnographic case study of county Mental Health/Mental Retardation and behavioral health committees and coalitions in Texas, from 1995 to 2001. Following this period, local service agencies continued collaboration to increase community awareness and resources for care. Findings were that while the rapid transition to local control under conditions of reduced resources impeded implementation of a public–private mental health care system, commitment to a service safety net for persons with mental disabilities was sustained.

The Bureau of Economics in the Federal Trade Commission has a three-part role in the Agency and the strength of its functions changed over time depending on the preferences and ideology of the FTC’s leaders, developments in the field of economics, and the tenor of the times. The over-riding current role is to provide well considered, unbiased economic advice regarding antitrust and consumer protection law enforcement cases to the legal staff and the Commission. The second role, which long ago was primary, is to provide reports on investigations of various industries to the public and public officials. This role was more recently called research or “policy R&D”. A third role is to advocate for competition and markets both domestically and internationally. As a practical matter, the provision of economic advice to the FTC and to the legal staff has required that the economists wear “two hats,” helping the legal staff investigate cases and provide evidence to support law enforcement cases while also providing advice to the legal bureaus and to the Commission on which cases to pursue (thus providing “a second set of eyes” to evaluate cases). There is sometimes a tension in those functions because building a case is not the same as evaluating a case. Economists and the Bureau of Economics have provided such services to the FTC for over 100 years proving that a sub-organization can survive while playing roles that sometimes conflict. Such a life is not, however, always easy or fun.

Workplace voice is well-established and encompasses behaviors such as prosocial voice, informal complaints, grievance filing, and whistleblowing, and it focuses on interactions between the employee and supervisor or the employee and the organizational collective. In contrast, our chapter focuses on employee prosocial advocacy voice (PAV), which the authors define as prosocial voice behaviors aimed at preventing harm or promoting constructive changes by advocating on behalf of others. In the context of a healthcare organization, low quality and unsafe patient care are salient and objectionable states in which voice can motivate actions on behalf of the patient to improve information exchanges, governance, and outreach activities for safer outcomes. The authors draw from the theory and research on responsibility to intersect with theories on information processing, accountability, and stakeholders that operate through voice between the employee-patient, employee-coworker, and employee-profession, respectively, to propose a model of PAV in patient-centered healthcare. The authors complete the model by suggesting intervening influences and barriers to PAV that may affect patient-centered outcomes.

Amid widespread social and cultural shifts and advocacy toward lesbian, gay, bisexual, and transgender (LGBT) rights remain a hidden population of homeless adolescents who are cast out from families and communities because of their sexual and gender orientation. The result is an over-representation of LGBT adolescents among the homeless in the United States. The purpose of this paper is to provide a review of literature and research which explores the status and needs of LGBT homeless adolescents in the United States.

To understand the experiences of LGBT adolescents leading up to and during homelessness, I provide a thematic and critical review of four decades of research to connect our understanding of the LGBT homeless experience with institutional and collective efforts that work to promote their well-being.

Bringing together this body of literature, I explore four interrelated questions. First, has the rate of homelessness increased for LGBT adolescents in recent decades? Second, what is the experience of LGBT adolescents who become homeless? Third, what role does advocacy and support play in ameliorating the difficulties these young people face? Finally, what role can future research and policy play in shaping the well-being of LGBT adolescents who become homeless?

Understanding the experience of homeless LGBT adolescents and the collective advocacy efforts designed to promote their well-being offers insight into the intersection of symbolic, inter-personal, and institutional forces which shape their trajectories.