Kate H. Brown

Public Health Implications of Urban Agriculture

The article presents the case for stronger public policies in support of urban gardening as a means to improve public health. It considers several beneficial aspects of gardening, such as food security, economic development, exercise, psychological and community well-being, and environmental stewardship. It also considers some of the public health problems associated with urban agriculture and suggests policies to ameliorate them. In the balance, urban gardening has potential as an important element of urban public health.

Outside the Garden of Eden: Rural Values and Healthcare Reform

It should surprise no one familiar with the problems in rural healthcare that 87% of a randomly selected sample of Nebraskans recently called for either fundamental or complete change of the healthcare system. Rural communities in the United, States have been hard hit by the rising cost of healthcare at a time of economic and demographic decline. Unable to sustain operating costs and personnel needs, rural hospitals and medical, practices have been forced to close their doors at an, alarming rate. Furthermore, rural patients are decreasingly able to afford what services are available to them. Most must purchase insurance privately because they are unlikely to be insured through employment. Therefore, they pay dearly because they are not eligible for corporate rates and because insurance companies use experience instead of community rating to assess risk.

Ethical issues related to managed care: an in-depth discussion of an occupational therapy case study.

What are the ethical responsibilities of occupational therapists when managed care plans override their clinical judgment and deny reimbursement for needed assessment or therapy? Using an example from a true case, this article presents an analysis of the ethical problems experienced in managed care when explicit business goals are in conflict with the humanistic commitments of our field. Strategies for ethical action are recommended, including: good communication with the case manager, effective advocacy for the patient, consultation with ethics resources, and advocacy at the policy-making level. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworth.com].

Ethical Perspectives on School-Based Practice: Care, Rights, Justice, and Compromise

As the need for school-based therapy increases, so too do costs, and a growing public reluctance to pay for these services. This article examines the ethical complexities facing school-based therapists who must make hard choices about how best to allocate their time and skills to meet the needs of children living with disabilities. An actual case about the decision to reduce occupational therapy direct interventions provides the vehicle for articulating four different ethical perspectives. Hypothetical therapists respond to the case using the concepts and theoretical constructs from an Ethic of Care, Rights-Based Ethics, Justice, and Integrity-Preserving Compromise.

Competency: A study of informal competency determinations in primary care: edited by Mary Ann Gardell Cutter and Earl E. Shelp. Kluwer Academic Publishers, Dordrecht, 1991. 287 pp., U.S.

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