Democratizing social scientists' impact on federal policy: Using the evidence act to help government and ourselves

It is common for social scientists to discuss the implications of our research for policy. However, what actions can we take to inform policy in more immediate and impactful ways, regardless of our existing institutional affiliations or personal connections? Focusing on federal policy, I suggest that the answer requires understanding a basic coordination problem. On the government side, the Foundations of Evidence-based Policymaking Act (2018) requires that large federal agencies pose, communicate, and answer research questions related to their effects on people and communities. This advancement has opened the black box of federal agency policy priorities, but it has not addressed capacity challenges: These agencies often do not have the financial resources or staff to answer the research questions they pose. On the higher education side, we have more than 150,000 academic social scientists who are knowledge producers and educators by training and vocation. However, especially among those in disciplinary departments, or those without existing institutional or personal connections to federal agencies, we often feel locked out of federal policymaking processes. In this article, I define the coordination problem and offer concrete actions that the academic and federal government communities can take to address it. I also offer leading examples of how academics and universities are making public policy impact possible in multiple governmental spheres. I conclude by arguing that both higher education institutions and all levels of government can do more to help academic social scientists put our knowledge to work in service of the public good.

Screening for quality with process analytical technology in a health-system pharmacy: A primer

PURPOSE

The University of Kentucky Drug Quality Study team briefly reviews the growing concerns over pharmaceutical manufacturing quality in the globalized environment, reviews the historical approach by the US Food and Drug Administration (FDA) that prioritizes process over product in enforcing quality with manufacturers, reviews the science of process analytical technology (PAT) such as near-infrared (NIR) spectroscopy, illustrates the use of PAT methods for assessing uniformity and quality in injectable pharmaceuticals, and demonstrates the application of NIR spectroscopy in a health-system pharmacy setting while maintaining current good practice quality guidelines and regulations (cGxP).

SUMMARY

Given that the current approach to monitoring quality in pharmaceutical manufacturing was developed in the late 1960s at a time when manufacturing was mostly domestic, the current approach prioritizes process over product, and the global footprint of manufacturing is straining federal resources to fulfill their task of monitoring quality, an approach to augment the quality monitoring process has been developed. PAT methodologies are supported by FDA for monitoring quality and offer a fast, low-cost, nondestructive solution. Given that the Accreditation Council for Pharmacy Education has not required qualitative/quantitative analysis and drug assaying in the pharmacy curriculum for several decades, the authors spend time explaining the science behind one of these PAT methodologies, NIR spectroscopy. This primer reviews the application of this technology in the health-system pharmacy setting and the relevant clinical applications.

CONCLUSION

Utilizing PAT methodologies such as NIR spectroscopy, health-system pharmacies can gain insights about whether process controls are in place or lacking in FDA-approved formulations.

The reignition of the Cancer Moonshot: An opportunity missed?

In relaunching the Cancer Moonshot in 2022, the Biden Administration is seeking to reduce the mortality rate from cancer by at least 50% over the next 25 years. In this Commentary, the authors discuss the history of the federal government’s efforts to reduce the morbidity and mortality of cancer, review the ontogeny of the President’s Cancer Moonshot initiative, and identify the challenges it faces in achieving its goals.

Rethinking diabetes in the United States

Despite the availability of effective medical treatments, the diabetes epidemic has accelerated in the United States, efforts to translate treatments into routine clinical practice have stalled, and health inequities have persisted. The National Clinical Care Commission (NCCC) was established by the Congress to make recommendations to better leverage federal policies and programs to more effectively prevent and control diabetes and its complications. The NCCC developed a guiding framework that incorporated elements of the Socioecological and Chronic Care Models. It gathered information from both health-related and non-health-related federal agencies, held 12 public meetings, solicited public comments, met with interested parties and key informants, and performed comprehensive literature reviews. The final report of the NCCC was transmitted to the Congress in January 2022. It called for a rethinking of the problem of diabetes in the United States, including the recognition that the lack of progress is due to a failure to confront diabetes as both a complex societal problem as well as a biomedical problem. To prevent and control diabetes, public policies and programs must be aligned to address both social and environmental determinants of health and health care delivery as they impact diabetes. In this article, we discuss the findings and recommendations of the NCCC as they relate to the social and environmental factors that influence the risk of type 2 diabetes and argue that the prevention and control of type 2 diabetes in the U.S. must begin with concrete population-level interventions to address social and environmental determinants of health.

Recommendations for Canada's National Action Plan to End Gender-Based Violence: perspectives from leaders, service providers and survivors in Canada's largest city during the COVID-19 pandemic

INTRODUCTION

The Canadian government has committed to a national action plan (NAP) to address violence against women (VAW). However, a formalized plan for implementation has not been published. Building on existing recommendations and consultations, we conducted the first formal and peer-reviewed qualitative analysis of the perspectives of leaders, service providers and survivors on what should be considered in Canada's NAP on VAW.

METHODS

We applied thematic analysis to qualitative data from 18 staff working on VAW services (11 direct support, 7 in leadership roles) and 10 VAW survivor participants of a community-based study on VAW programming during the COVID-19 pandemic in the Greater Toronto Area (Ontario, Canada).

RESULTS

We generated 12 recommendations for Canada's NAP on VAW, which we organized into four thematic areas: (1) invest into VAW services and crisis supports (e.g. strengthen referral mechanisms to VAW programming); (2) enhance structural supports (e.g. invest in the full housing continuum for VAW survivors); (3) develop coordinated systems (e.g. strengthen collaboration between health and VAW systems); and (4) implement and evaluate primary prevention strategies (e.g. conduct a gender-based and intersectional analysis of existing social and public policies).

CONCLUSION

In this study, we developed, prioritized and nuanced recommendations for Canada's proposed NAP on VAW based on a rigorous analysis of the perspectives of VAW survivors and staff in Canada's largest city during the COVID-19 pandemic. An effective NAP will require investment in direct support organizations; equitable housing and other structural supports; strategic coordination of health, justice and social care systems; and primary prevention strategies, including gender transformative policy reform.

Bioprotection of Transportation and Facilities from SARS-CoV-2 (COVID-19)

The recent COVID-19 pandemic has led to a nearly world-wide shelter-in-place strategy. This raises several natural concerns about the safe relaxing of current restrictions. This article focuses on the design and operation of heating ventilation and air conditioning (HVAC) systems in the context of transportation. Do HVAC systems have a role in limiting viral spread? During shelter-in-place, can the HVAC system in a dwelling or a vehicle help limit spread of the virus? After the shelter-in-place strategy ends, can typical workplace and transportation HVAC systems limit spread of the virus? This article directly addresses these and other questions. In addition, it also summarizes simplifying assumptions needed to make meaningful predictions. This article derives new results using transform methods first given in Ginsberg and Bui. These new results describe viral spread through an HVAC system and estimate the aggregate dose of virus inhaled by an uninfected building or vehicle occupant when an infected occupant is present within the same building or vehicle. Central to these results is the derivation of a quantity called the "protection factor"-a term-of-art borrowed from the design of gas masks. Older results that rely on numerical approximations to these differential equations have long been lab validated. This article gives the exact solutions in fixed infrastructure for the first time. These solutions, therefore, retain the same lab validation of the older methods of approximation. Further, these exact solutions yield valuable insights into HVAC systems used in transportation.

Occupational health promotion at a federal education institution: challenges and perspectives

Introduction

The Brazilian Federal Government developed the Occupational Health and Safety policy for the Federal Public Servant, supported by the following axes: health surveillance and promotion, health assistance for the civil servant, and medical surveillance expertise. As a federal public institution, the Federal Institute of Northern Minas Gerais (Instituto Federal do Norte de Minas Gerais) is responsible for implementing this policy.

Objectives

This study aimed to identify the challenges and perspectives associated with the health care provided to the servants of the Federal Institute of Northern Minas Gerais.

Methods

This was a documentary and field study, with a qualitative and quantitative approach, conducted using documentary research and semi-structured interviews. The collected data were submitted to descriptive and categorical content analyses.

Results

The Federal Institute of Northern Minas Gerais still presents several problems in the consolidation and structuring of the Occupational Health and Safety policy for the Federal Public Servant. Among the main obstacles faced are the lack of governmental and institutional support and the precariousness of financial and human resources, mainly directed to the axis of health promotion and surveillance. The institution plans to conduct periodic medical examinations, the establishment of Internal Health Commissions for Public Servants, and the implementation of a mental health program.

Conclusions

It is expected that the Federal Institute of Northern Minas Gerais will be able to perform better on the development of health policies and programs for its workers.

Priorities to accelerate workflow automation in health care

Inefficient workflows affect many health care stakeholders including patients, caregivers, clinicians, and staff. Widespread health information technology adoption and modern computing provide opportunities for more efficient health care workflows through automation. The Office of the National Coordinator for Health Information Technology (ONC) led a multidisciplinary effort with stakeholders across health care and experts in industrial engineering, computer science, and finance to explore opportunities for automation in health care. The effort included semistructured key informant interviews, a review of relevant literature, and a workshop to understand automation lessons across nonhealth care industries that could be applied to health care. In this article, we describe considerations for advancing workflow automation in health care that were identified through these activities. We also discuss a set of six priorities and related strategies developed through the ONC-led effort and highlight the role the informatics and research communities have in advancing each priority and the strategies.

The Prescription Drug User Fee Act: Much More Than User Fees

BACKGROUND

The Prescription Drug User Fee Act (PDUFA) is due for reauthorization in 2022. Beyond creating the user fee program which now generates a majority of the Food and Drug Administration (FDA) Human Drugs Program budget, PDUFA has made numerous additional changes to FDA policy during its 29-year history. FDA's budgetary dependence on user fees may advantage the industry in negotiating favorable policy changes through PDUFA.

METHODS

The full texts of all prior PDUFA reauthorization bills and all submitted public comments and meeting minutes for the 2022 reauthorization were reviewed. Provisions affecting FDA regulatory authority and processes were identified.

FINDINGS

PDUFA legislation has instituted a broad range of changes to FDA policy, including evidentiary standards for drug approval, accelerated pathways for approval, industry involvement in FDA decision-making, rules regarding industry information dissemination to providers, and market entry of generic drugs. Negotiations over the 2022 reauthorization suggest that industry priorities include increased application of real-world evidence, regulatory certainty, and increased communication between FDA and industry during the drug application process.

CONCLUSIONS

The need for PDUFA reauthorization every 5 years has created a recurring legislative vehicle through which far-ranging changes to FDA have been enacted, reshaping the agency's interactions and relationship with the regulated industry. The majority of policy changes enacted through PDUFA legislation have favored industry through decreasing regulatory standards, shortening approval times, and increasing industry involvement in FDA decision-making. FDA's budgetary dependence on the industry, the urgency of each PDUFA reauthorization's passage to maintain uninterrupted funding, and the industry's required participation in PDUFA negotiations may advantage the industry.

What Does the State Innovation Model Experiment Tell Us About States' Capacity to Implement Complex Health Reforms?

Policy Points To make progress implementing payment and delivery system reforms, state governments need to make genuine stakeholder engagement routine business, develop reforms that build on past successes, and ensure health reform is a top priority for bureaucrats and political leaders. To support state-led reform initiatives, the federal government needs to provide financial support directly to state governments; build bureaucratic capability in supporting state officials with policy design and implementation; develop more flexible, outcome-focused funding programs; reform its own programs, particularly Medicare; and commit to a long-term strategy for progressing payment and delivery system reforms.

CONTEXT

For decades, Americans have debated whether the states need federal government support to reform health care. The Affordable Care Act has allowed the federal government to trial innovative ways of accelerating state-led reform initiatives through the State Innovation Model (SIM), which was run by the Centers for Medicare and Medicaid Services Innovation Center between 2013 and 2019. This study assesses states' progress implementing health reforms under SIM and examines how well the federal government supported them.

METHODS

Detailed case studies were conducted in six states: Arkansas, Connecticut, Oregon, New York, Tennessee, and Washington. Data was collected from SIM evaluation and annual reports and through semistructured interviews with 39 expert informants, mostly state or federal officials involved in SIM. Preliminary findings were tested and refined through an online forum with health policy experts, facilitated by the Milbank Memorial Fund.

FINDINGS

States that made the most progress implementing reforms had a strong track record and managed to sustain stakeholder, bureaucratic, and political support for their reform agenda. There was a clear correlation between past reform success and success under SIM, which raises questions about the value of federal government support beyond providing funding. State officials said the federal government could better support states, particularly those with less reform experience, by providing tailored advice that helped state officials overcome problems designing and implementing reforms. State officials also said the federal government could better support them by reforming their own programs, particularly Medicare, and committing to a long-term strategy for health system reform.

CONCLUSIONS

States can make some progress reforming health care on their own, but real progress requires long-term cooperation between state and federal governments. Federal initiatives like SIM that foster cooperation between governments should be continued but refined so they provide better support to states.

Overview of the United States' Immunization Program

This manuscript describes the history, background, and current structure of the United States Immunization Program, founded upon public- and private-sector partnerships that include federal agencies, state and local health departments, tribal nations and organizations, healthcare providers, vaccine manufacturers, pharmacies, and a multitude of additional stakeholders. The Centers for Disease Control and Prevention sets the U.S. adult and childhood immunization schedules based on recommendations from the Advisory Committee on Immunization Practices. We review the current immunization schedules; describe the set of surveillance and other systems used to monitor the health impact, coverage levels, and safety of recommended vaccines; and note significant challenges. Vaccines have reduced the incidence of many diseases to historic lows in the US, and have potential to further reduce the burden of respiratory and other infectious diseases in the United States. Though the United States vaccination program has had notable successes in reducing morbidity and mortality from infectious disease, challenges-including disparities in access and vaccine hesitancy-remain. Supporting access to and confidence in vaccines as an essential public health intervention will not only protect individuals from vaccine-preventable diseases; it will also ensure the country is prepared for the next pandemic.

Should I Stay or Should I Go? Employment Discrimination and Workplace Harassment against Transgender and Other Minority Employees in Canada's Federal Public Service

There is a growing literature interested in the workplace experiences of transgender individuals. The biggest limitation for researchers in this field continues to be the dearth of population-level data that captures information on gender identity and employment characteristics. Using the 2017 Public Service Employee Survey, this paper explores employment discrimination and workplace harassment against gender diverse (transgender, non-binary, genderqueer) and other minority employees working in Canada's federal public service. This study finds that gender diverse employees are between 2.2 and 2.5 times more likely to experience discrimination and workplace harassment than their cisgender male coworkers. Cisgender women, visible minorities, Indigenous, and those with disabilities are also more likely to report discrimination and workplace harassment. Cisgender women and gender diverse employees who occupy multiple minority statuses may experience an additive likelihood of discrimination and harassment. This study also finds that employee retention can be improved by providing more inclusive and tolerant workplaces.

Perceptions of Canadian Federal Policy Responses to COVID-19 among People with Disabilities and Chronic Health Conditions

This study examines how people with disabilities and chronic health conditions-members of a large and diverse group often overlooked by Canadian public policy-are making sense of the Canadian federal government's response to COVID-19. Using original national online survey data collected in June 2020 (N = 1,027), we investigate how members of this group view the government's overall response. Although survey results show broad support for the federal government's pandemic response, findings also indicate fractures based on disability type and specific health condition, political partisanship, region, and experiences with COVID-19. Among these, identification with the Liberal party and receipt of CERB stand out as associated with more positive views. Further examination of qualitative responses shows that these views are also linked to differing perspectives surrounding government benefits and spending, partisan divisions, and other social and cultural cleavages.

Leveraging the health information technology infrastructure to advance federal research priorities

Ensuring that federally funded health research keeps pace with the explosion of health data depends on better information technology (IT), access to high-quality electronic health data, and supportive policies. Because it prominently funds and conducts health research, the U.S. federal government needs health IT to rapidly evolve and has the ability to drive that evolution. The Office of the National Coordinator for Health Information Technology developed the National Health IT Priorities for Research: A Policy and Development Agenda (the Agenda) that identifies health IT priorities for research in consultation with relevant federal agencies. This article describes support for the Agenda from the Food and Drug Administration, the National Institutes of Health, and the Veterans Health Administration. Advancing the Agenda will benefit these agencies and support their missions as well as the entire ecosystem leveraging the health IT infrastructure or using data from health IT systems for research.

National health information technology priorities for research: A policy and development agenda

The growth of digitized health data presents exciting opportunities to leverage the health information technology (IT) infrastructure for advancing biomedical and health services research. However, challenges impede use of those resources effectively and at scale to improve outcomes. The Office of the National Coordinator for Health Information Technology (ONC) led a collaborative effort to identify challenges, priorities, and actions to leverage health IT and electronic health data for research. Specifically, ONC led a review of relevant literature and programs, key informant interviews, and a stakeholder workshop to identify electronic health data and health IT infrastructure gaps. This effort resulted in the National Health IT Priorities for Research: A Policy and Development Agenda, which articulates an optimized health information ecosystem for scientific discovery. This article outlines 9 priorities and recommended actions to be implemented in collaboration with the research and informatics communities for realizing this vision.

Veteran status, disability rating, and public sector employment

This paper used microdata from the 2013-2015 American Community Survey to examine differences in federal government, state and local government, private sector, and self-employment among employed veterans and nonveterans. The U.S. federal and state governments have hiring preferences to benefit veterans, especially disabled veterans. Other factors may also push veterans toward public sector employment. I found that veteran status substantially increased the likelihood of federal employment, with the largest magnitudes for severely disabled veterans. Differences in state and local government employment were modest and exhibited heterogeneity by disability severity.

Strategic Foresight in the Federal Government: A Survey of Methods, Resources and Institutional Arrangements

The goal of this study is to help identify approaches and practices for improving Federal foresight efforts and the means for integrating foresight work into strategic planning and decision making. We present the results of semi-structured interviews with people involved with foresight in 19 Federal agencies, and with two non-Federal experts on foresight in government. We discuss where agencies use similar approaches and where their approaches diverge and include particularly insightful quotes from interviewees. We also discuss "broader observations" regarding the state of strategic foresight efforts across the Federal government and how our findings relate to opportunities and challenges to institutionalizing foresight in the Federal government.

Trends in deforestation and forest degradation after a decade of monitoring in the Monarch Butterfly Biosphere Reserve in Mexico

We used aerial photographs, satellite images, and field surveys to monitor forest cover in the core zones of the Monarch Butterfly Biosphere Reserve in Mexico from 2001 to 2012. We used our data to assess the effectiveness of conservation actions that involved local, state, and federal authorities and community members (e.g., local landowners and private and civil organizations) in one of the world's most iconic protected areas. From 2001 through 2012, 1254 ha were deforested (i.e., cleared areas had <10% canopy cover), 925 ha were degraded (i.e., areas for which canopy forest decreased), and 122 ha were affected by climatic conditions. Of the total 2179 ha of affected area, 2057 ha were affected by illegal logging: 1503 ha by large-scale logging and 554 ha by small-scale logging. Mexican authorities effectively enforced efforts to protect the monarch reserve, particularly from 2007 to 2012. Those efforts, together with the decade-long financial support from Mexican and international philanthropists and businesses to create local alternative-income generation and employment, resulted in the decrease of large-scale illegal logging from 731 ha affected in 2005-2007 to none affected in 2012, although small-scale logging is of growing concern. However, dire regional social and economic problems remain, and they must be addressed to ensure the reserve's long-term conservation. The monarch butterfly (Danaus plexippus) overwintering colonies in Mexico-which engage in one of the longest known insect migrations-are threatened by deforestation, and a multistakeholder, regional, sustainable-development strategy is needed to protect the reserve.

Addressing racial and ethnic disparities in health care: using federal data to support local programs to eliminate disparities

To reduce racial and ethnic disparities in health care, managers, policy makers, and researchers need valid and reliable data on the race and ethnicity of individuals and populations. The federal government is one of the most important sources of such data. In this paper we review the strengths and weaknesses of federal data that pertain to racial and ethnic disparities in health care. We describe recent developments that are likely to influence how these data can be used in the future and discuss how local programs could make use of these data.

A First Nations voice in the present creates healing in the future

This paper discusses the urgency for change and improvements in health policy determined by the exploding demographics and inequities in the health status of First Nation people. A historical overview of health services for First Nation clients was conducted as set out through government legislation and health and social policies. Until WWII ended, the federal government provided assistance to First Nations through Indian Affairs branches of several departments. This responsibility was gradually transferred to National Health and Welfare. In 1962, the federal government established a Medical Services Branch, later renamed First Nations and Inuit Health Branch, and mandated to provide services to First Nation clients, which fell outside the provincial jurisdiction of health care. Initially centered on public health priorities, services have expanded to include primary health care, dental, mental health, environmental health, home and continuing care, and Non-Insured Health Benefits. The Romanow Report substantiated the urgency for health policy improvements voiced by many First Nations. However, it generalized Aboriginal issues in health care on a national front. Furthermore, its recommendations were specific to health care providers and delivery models and did not address the social and spiritual determinants of health, which are fundamental to a First Nations' holistic approach. Health planners must think holistically, considering traditional and westernized medicine, First Nations' values, priorities and government systems, and present and evolving health systems. Universities, health authorities, provinces and the federal government are continually developing new research and health models, which will also need consideration. Further, the imperative of involving community-level input must be recognized.

American Indians and alcohol

The high prevalence of alcohol use and its consequences among American Indians may be attributed to a number of factors, including the influence of the European colonists who first made large amounts of alcohol available to Indians, as well as current social and cultural factors. Efforts to prevent and treat alcohol problems among the American Indian population may be more effective if native beliefs and approaches are incorporated. Alcohol problems also may be prevented through policies regulating the sale and use of alcohol in Indian communities.

Alcohol Research and Social Policy: An Overview

Science can facilitate the task of choosing among complex social policies, although it rarely serves as the only basis for policy development. Science's role in policy formation can be decisive when public support already exists, as with the passage of the Federal Uniform Drinking Age Act. Science can assess a policy after it has been implemented, as in the scientific evaluation of the health warning labels on alcoholic beverage containers. In addition, science can investigate the short- and long-term benefits and risks of areas where the development of policies is likely. An example is the current scientific examination of the tradeoffs involved in moderate alcohol consumption.