Suchergebnisse

Sometimes government operates by inducement rather than order. Congress distributes money to the states. A state grants funds to nonprofit organizations. An administrative agency offers wages and professional opportunities to its staff. A high school provides instruction to its students. In each situation, the government furnishes something of value. And in each situation, it asks something in return—whether implementation of a government program, forbearance from activities deemed inconsistent with operational goals, conduct in pursuit of an employment mission, or compliance with standards of academic discipline. Though they arise in different contexts, these varied forms of government action present the same core question of constitutional justification. The issue in each case is the extent of the government's power to bargain for what it does not, will not, or cannot demand. It is beyond dispute that state and federal governments have broad authority to implement policy through inducements. It is just as clear that there are limits on what governments may buy. As it has explored those limits in recent years, the Supreme Court has turned repeatedly to the concept of leverage: the government's exploitation of a public asset to influence unrelated behavior.

The authors reviewed interventions using cultural leverage to narrow racial disparities in health care. Thirty-eight interventions of three types were identified: interventions that modified the health behaviors of individual patients of color, that increased the access of communities of color to the existing health care system, and that modified the health care system to better serve patients of color and their communities. Individual-level interventions typically tapped community members' expertise to shape programs. Access interventions largely involved screening programs, incorporating patient navigators and lay educators. Health care interventions focused on the roles of nurses, counselors, and community health workers to deliver culturally tailored health information. These interventions increased patients' knowledge for self-care, decreased barriers to access, and improved providers' cultural competence. The delivery of processes of care or intermediate health outcomes was significantly improved in 23 interventions. Interventions using cultural leverage show tremendous promise in reducing health disparities, but more research is needed to understand their health effects in combination with other interventions.

Much of what the US seeks to do elsewhere in the world will depend on its ability to gain the support & active engagement of European power -- & European powers -- politically, economically, & militarily. Adapted from the source document.