Policy Analysis: Public Health Service Act Courtney Barker, April Carter, Keith Washburn Ohio University – Chillicothe Fall 2013 “Before Ronald Regan came to power, federal policy emphasized treatment and Stoesz, 2013, p. 306). Substance addiction has been a growing problem ever since the late 1800’s when the addiction of cocaine, opium and heroin started. “Chinese laborers who came to work on U. S. railroads in the 1850s and 1860s brought with them the practice of opium smoking” (A social history, 1995-2013).
This analysis examines the problem with drug addiction and how the Public Health Service Act of 944 helps fund treatment for recovery. Prior to the early 1940’s when the Public Health Service Act was indorsed, there weren’t many cases of people dying from the abuse of illicit drugs. Individuals that had a physician prescribe the medication were the only ones that used illegal drugs. In the early 1900’s “heroin was heavily promoted as being non-addicting, and therefore an excellent treatment for morphine addiction. Bronchitis, tuberculosis and other cough-inducing illnesses were also treated with heroin.
In 1906, the American Medical Association approved heroin for eneral use, and recommended that it be used in place of morphine” (“Herion history: 1900’s,” 2010). In certain areas of the United States medical resources were uncommon and the communities had to deal with this in some way. Drugs that were used in the Mid-1940’s is when the problems with drug abuse really started. “By the 1950’s the prevailing concept of drug abuse and addiction was that of heroin addiction on the streets and alleys of urban ghettos,” especially in New York (The history of, 2009).
In New York between 1950 and 1961, males topped females in percentage of heroin use, with 57% being African Americans, by 56%. In January, 35 persons were arrested in Brooklyn and the Bronx on charges of selling narcotics, some of whom were caught while plying their trade with high school students” (Congressional Research Service, 1951). “Congress passed the Public Health Service Act of 1944, which committed the federal government to provide state grants and research funding to advance mental health service provisions” (Hellman & Drescher, 2004).
President Roosevelt signed the Act into law on July 3, 1944. In the following years, Americans faced wars, crimes, depression and political assignations. President Franklin D. Roosevelt felt that this Act was a footstep closer to the goal of improved national health. “The news media believed and reported that drug abuse and addiction was a problem among blacks ‘because of their newly found freedoms after WW II” (The history of, 2009). Although these drugs were being abused by African Americans, they weren’t the only ones that would become addicts of the illicit drugs. During World War II, amphetamines were widely distributed to soldiers to combat fatigue and improve both mood and endurance, and after the war physicians began to prescribe amphetamines to fght depression” (A social history, 1995-2013). Students also used drugs to support them when studying for school. “In late 1960s recreational drug use becomes fashionable among young, white, middle class Americans” (Thirty years of, 1995-2013). As death rates related to heroin use raised nearly 30% in New York between 1950 and 1961, “the Narcotics Register recorded a 26% increase during the years 1964 through 1967” (Frank, 2000).
Over 150,000 individuals’ names Joined to the Narcotics Register in New York City from 1967 to 1974. While male drug use percentage increase between years 1964 to 1967, female percentages drops by 1%. Caucasian and African American drug use continues to ise while the percentage of drug use increases for Hispanics up to 18% through the drugs. “During the decade of the 1970s, eleven states, encompassing one-third of the population of the United States, decriminalized small-quantity marijuana possession” (Good & Ben-Yehuda, 1994).
In 1971 Nixon announced a war on drugs. In the 1970’s death rates according to the Narcotics Register increase to 145,577 within New York City. While in the 1980’s people were finally committing to treatment with 70% of men and 30% of women, “injection declined from 71% to 39%, while inhalation increased from 5% to 59%” (Frank, 2000). “It appears that general drug abuse has begun to decline after peaking during the 1979 – 1980 period” (Karger & Stoesz, 2013, p. 306). Yet by “1985, there were estimated to be 500,000 i. . Heroin addicts, 250,000 non-addicted heroin i. v. users and 150,000 heroin and cocaine i. v. users in the United States, giving a total estimate of 900,000 i. v. Heroin users” (Hartnoll, 1994). As the median age of drug users raised from age 32 to 34, across the years of 1991 to 1993 death rates in New York increased again while percentages of treatment stayed the same (Frank, 000). As America emerged further into the twentieth century, heroin usage, among many other illicit drug uses, skyrocketed.
In the late 1990’s, the United Nations Office on Drugs and Crime recorded 180 million people ages 15 through 64 had used illicit drugs, with nearly 13 million of that number being cocaine users (World drug report 2011, 2011). In 1995, about 10. 2 percent of drug users were composed of Hispanics. “African Americans comprise 12. 1 percent of the total U. S. population” in 1996 (Drug use among, 2003). From the years 2000 to 2008 there was a steady fluctuation in the illions of people abusing drugs, whether it was cocaine, heroin, marijuana or opiates. “In the United States, 7 million people – or 2. % of the population aged 12 and older – were considered substance dependent, abusing illicit substances in 2008” (World drug report 2010, 2010). As drugs became an ongoing problem, the government decided to keep block grants through the years until the present day. In World War II “methamphetamine and amphetamine are given to Allied bomber pilots to sustain them on long flights. Primarily, amphetamines were used by soldiers to fght off fatigue and enhance performance” (“A brief history,” 2013). As if one war wasn’t enough for the American people, the Civil War started in 1947.
Struggling during this war, women, African Americans and soldiers took the hardest hit. This is the time that the drug war replaced the cold war. After the war doctors started prescribing these drugs to treat depression, as many were going through ever since the end of World War II. There were so many people in America using drugs at the time and may have not known how addicting these drugs could be. Women, soldiers, African Americans and even students were using drugs in the 1940’s and early 1950’s. With a country full of wars they needed a way to escape for a little while. The Act signed today gives authority to make grants-in-aid for research to public or private institutions for investigations in any field related to the public health. It authorizes increased appropriations for grants to the States for general public health work” (Roosevelt, 1944). One goal of the Public Health Service Act is to provide block grants to the States which allow the state to distribute money to each county for organizations that is used for “prevention, treatment, recovery supports and other insurance” (“Samhsa block grants,” 2013).
Block grants are used for prevention and treatment for drug addictions from substance abuse services. “Substance abuse services includes detoxification, risk reduction, outpatient treatment, residential treatment, and rehabilitation for substance abuse provided in settings other than hospitals” (“P. l. 78-410, approved,” 1944). l. Analysis Prior to the passage of the Public Health Service Act of 1944 there were few occurrences of illegal drug use each year. As the abuse built up over the years, laws started to come into play to help prevent people from abusing and misusing illicit rugs.
Most laws or acts that were passed prior to the Public Health Service Act of 1944 were specifically for certain states or cities. In 1875, “opium, morphine, and heroin could be legally purchased without a prescription, and there was little demand for opiate prohibition” (Breecher, 1972). This was the first real outbreak none as a problem for illicit drug users. The City of San Francisco adopted an ordinance prohibiting the smoking of opium in smoking-houses or ‘dens” (Breecher, 1972). The passage of the Harrison Anti-Narcotic Act of 1914, also known as the Harrison
Narcotics Tax Act, put a slow halt on the production, distribution and importation of narcotics. “It is daily becoming better known that opium, its derivatives and cocaine are being used in alarming amounts all over” the country. Various factors, such as the careless prescribing of these drugs by physicians, the spread of habit from person to person” are some that are accountable for the current environments in the United States (Terry, 1915). In the 1920’s the 18th Amendment was approved. This Amendment started the prohibition of alcohol. In 1935, thirty-six states had laws regulating the sale, use and possession of marijuana.
Most of the people that were on board for the passage of the Public Health Service Act were the citizens that the epidemic affected the most. Family and friends of the loved ones that were addicted, and even the individuals that were addicted wanted the act to be passed. “The earliest block grants were enacted as Democratic initiatives. The Democratic Congress enacted the first two block grants, the Partnership for Health program, approved in 1966, and the Safe Streets program, created under the Omnibus Crime Control and Safe Streets Act of 1968, during the Johnson administration (Finegold, Wherry & Schardin, 2001).
In the late 1970’s and early 1980’s, 3 more block grants were in use and associated with the Republicans. The block grants are there to help the people in the community and most of those people were for it. In American Social Welfare Policy (2013), the National Association of Social Workers make a statement that “the consolidation of categorical grants into a federal block grant program under SAMHSA reflected the preference of many human service professionals for preventive programs that apply generically to all forms of substance abuse” (p. 04). The National Association of Social Workers also asks “what is the logic n having separate preventive programs for tobacco, alcohol, and illegal drugs when effective prevention programs can be developed for all of them? ” (p. 304). The association definitely agrees on having programs to help the people of this country and agrees on having help from federal grants.
Most rehabilitation organization and treatment organizations would not be open today if it wasn’t for the federal grants Although there were no voting records noted or any records of who was for or against the Public Health Service Act of 1944, there are public records available today. With the act being amended several times, the most recent is the Patient Protection and Affordable Care Act of 2010. This act was introduced in the House in 2009. The act was passed in the House in October of 2009 as H. R. 3590 receiving a vote of 416 to O. The act then went to the Senate in December of 2009 for a vote of 60 to 39 passing in the Senate.
Of those votes, 58 democrats voted yes with O voting no and O republicans voted yes with 39 voted no. It was clear that the republicans of the Senate were not for this bill, as every one of the republicans voted against it (“H. r. 3590 (1 1 lth):,” ). II. Policy Enactment “The creation of the U. S. Public Health Service (PHS) dates to 1798 when Congress passed an act authorizing the provision of medical care to merchant seamen” (“The basics;The public,” 2013). Initially the act was “introduced in September 1942 and again in January 1943 in the House by Rep. Alfred Bulwinkle, and by Sen.
Elbert Thomas in the Senate” (1994). Alfred L. Bulwinkle, a House Representative democrat of North Carolina, introduced the Public Health Service Act to the house as H. R. 4624. Approved by the 78th United States Congress, the Public Health Service Act was assed on July 1, 1944 and signed by President Roosevelt as public law 78-410. The current version of the law is still known as the Public Health Service Act, yet it entitles more sections than before. Centers and programs are apart of part B in the most recent form of the law. This section is devoted to substance abuse treatment.
Sections 507, 508, 509 and 513 review the establishment of the substance abuse treatment center and the director’s duties. Under section 1911 it states the current purpose of the block grants, “A funding agreement for a grant under subsection is hat, subject to section 1916, the State involved will expend the grant only for the purpose of: carrying out the plan submitted under section 1912(a) by the State for the fiscal year involved; evaluating programs and services carried out under the plan; and planning, administration, and educational activities related to providing services under the plan” (“Title ill??”general powers,” 2013).
Therefore, grants are for prevention and treatment of drug abuse. Each organization applying for the block grants still have to submit an application under section 1932 and produce and annual report and audit required by the state under section 1942. Eligibility for substance abuse and treatment block grants comes down to state and U. S. territory governments or tribal organizations of only the Red Lake Band of Chippewa Indians. Ill. Policy Implementation Revised code 5119. 2 entitles the Department of Mental Health and Addiction Services block grants for substance abuse prevention treatment and grants for community mental health authorized by the Public Health Service Act (“Ohio administrative code,” 2013). Section 5119. 60 of the revised code also promotes federal block grants for alcohol, drug abuse and mental health services by having the agencies do an annual report. The department of mental health and addiction services shall submit an annual report to the governor that shall describe the services the department offers and how appropriated funds have been spent” (“5119. 0 [renumbered from,” 2013). The annual report keeps track of the services that are aided, the organizations success with the individuals and any information that the director feels is noteworthy. As of the present the Recovery Council is not releasing any information on reports because they have yet to publish it, therefore is it not available for the public. As far as reviewing the information that s available about the Recovery Council and knowing how far the organization has come since 1977, they are doing really well and the block grants are helping them in their success.
Growing from one establishment in 1977, this organization has grown a lot. The Recovery Council has developed in Chillicothe with having many services that range from outpatient services to parenting classes. Block grants have been a huge help of expanding so that they now have more patients than ever before. ‘V. Policy Evaluation and Conclusion Other countries do have grants, such as the United States, to help with substance buse recovery. Canada, for example, has the Drug Treatment Funding Program (DTFP). The Drug Treatment Funding Program (DTFP) provides $121 million over five years to provincial, territorial (PIT) governments and other key stakeholders to assist in strengthening treatment systems and invest in early intervention treatment services for at-risk youth” (“Drug treatment funding,” 2011). This program offers $121 million throughout a 5 year interval to help with substance abuse. The difference between the United States and the Canada acts is that the Canada act integrates arly intervention treatment for at-risk youth and the United States doesn’t.
This is something that the United States needs to improve. Even though the Public Health Service Act started block grants for substance abuse organizations, the federal money that organizations receive from this act will not be able to keep up with the rising cost of healthcare in the United States. With healthcare rising faster than inflation has over the years, Medicaid is bound to be hurt too. “As costs grow over time, a limit on federal funds will force governors and state legislators to pit the eeds of different populations against one another, leaving some unserved” (“Capping the Medicaid,” 2003).
Even though there are 3 varying conclusions about block grants and substance abuse, they all seem to have similarities. These similarities mostly consist of bring more prevention to the table. There are not enough prevention programs out there to help rural communities and poor communities. There is a lot of money going into recovery of the individuals that are addicted to drugs and alcohol, yet there is not that much money going into the prevention of addiction. “Getting treatment can be ard in rural areas.
Treatment facilities are few and far between, the lack of public transportation presents logistical problems, and the stigma attached to substance abuse can prevent many from seeking and accessing services” (Clay, 2007). Most of these issues come with living in a rural area, such as Pike County. Residents of Pike County and surrounding areas are lucky to have the Recovery Council to go to as a source of help when they are addicted. There are not many prevention organizations within the rural area. The stigma behind and individual can have a lot to do with whether a person seeks help or not.
Stigma involves processes of labeling, stereotyping, social rejection, exclusion, and extrusion as well as the internalization of community attitudes in the form of shame by the person/family being anonymous meetings to seek help feel stigma. They wonder how people will Judge them. In previous experiments people have given signs of fear and anxiety. “Samples of substance abusing individuals self-report fear of stigma as a reason for not seeking treatment” (Luoma, Twohig, Waltz, Hayes, Roget, Padilla & Fisher, 2007). Stigma is Just another reason to have some privacy in prevention programs.
Another onclusion is that there needs to be more focus on programs for prescription drug abuse. Most individuals that the Recovery Council is serving are abusing prescription drugs. In 2011 the Obama National Drug Control Strategy (ONDCP) had developed “convenient and environmentally responsible prescription drug disposal programs to help decrease the supply of unused prescription drugs in the home” (“Prescription drug abuse”). Pharmacies have already been trying to prevent the abuse of elders medications or medications that aren’t being used by properly disposing of the medication.
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Describe the evidence and scope of the problem, and the demographics of people affected Just prior to the focal law being enacted. How did the social problem affect people differently by race, class, and/or gender? Note injustice issues. Discuss the context of the social problem at that time (e. g. , political climate, influencers, crisis event). Describe goals of the proposed bill. April, Courtney, Keith l. Analysis – Prior to the Passage of the Law