Attacks on public administration are commonplace in today’s anti-bureaucratic approach to government. The legitimacy of public administration has long been questioned. Public administration is not one of the three branches of government explicitly formed by the Constitution. Further, public administrators are not elected by the people. Numerous attempts have been made to develop an idea of legitimacy that is grounded in the Constitution and that renders public administration consistent with the representative character of American government. A recent attempt presents public administration as an institution of governance that is derived from, and grounded in, the Agency Perspective. This perspective provides a new foundation stone for the legitimacy of public administration. Central to the perspective is public administration’s ability to evoke dialogue in a way that takes into account the public interest and brings about communities of shared meaning. This literature, however, does not provide a specific enough perspective, i.e., a perspective that has been given a practical specification. Simply exhorting public administrators to evoke dialogue is not sufficient. Public administrators who are encouraged in this general manner will have no choice but to look to what they know: interest group liberalism. Public administration needs a more specific alternative to interest group liberalism and a new methodology from which public administrators can work. In the research at hand, a new methodology is developed and demonstrated. The outline of the new methodology can be seen through the lens of principled negotiation. This literature maintains that negotiation from the positions of the various parties involved in a conflict, as is characteristic of interest group liberalism, is inefficient. Principled negotiation, on the other hand, recognizes that vital interests, not positions, are the key to creating consensus and achieving collaboration. The difficulty with this approach is that people, either as individuals or as role occupants in organizations, typically are unaware of their vital interests. Therefore, it is the task of the negotiator or, in this case, the public administrator to help surface these deeper interests. The new methodology is grounded in the literature of structuralism. Structuralism is a social theory and a method of inquiry (Gibson, 1984:2) that provides a means of looking beneath the surface of events or issues to identify patterns of meaning that are not evident at the surface. The work of linguist Ferdinand de Saussure served as the basis for modern structuralism (Sturrock, 1988:6). Working from Saussure’s writings, Claude Levi-Strauss "treats all forms of cultural expression as language and he assumes that like language it is all [structured] by unconscious laws that constitute a grammar for each" (White, 1983:12). In a similar vein, the structuralist undertaking in this research views the vital interests of the related groups and role occupants as the "underlying grammar" that structures the various approaches to policy formulation. This research employs a case study design to which the theory of structuralism and the technique of structural analysis have been applied. The case study is that of national long-term care policy. Role occupants from 23 national organizations involved in long-term care policy were interviewed. The role occupants are key people involved in long-term care policy formulation for the organizations for which they work. The organizations' long-term care position papers were obtained. Using a process of structural analysis, the position papers and interview transcripts were analyzed to identify vital interests. An analysis of linguistic elements such as metaphors and other figures of speech, justifications, preferred meanings, and recurrent terms was conducted. In addition, content analysis was carried out with the aid of a computer program. The vital interests identified through these analyses served as the basis for the development of a strategy to shape the national long-term care policy debate. / Ph. D.

Breast and prostate cancers are the most commonly diagnosed forms of cancer in women and men in the United States. The federal government has played an active role in dedicating resources toward breast and prostate cancers since the early 1990s, when policy actors successfully lobbied Congress to adopt policies that increased awareness and spending. Using theories of social construction, I argue that the key to their success was the ability of these policy actors to socially construct the illnesses of breast and prostate cancers into politically attractive public issues that appealed to federal policymakers. Through the use of embedded collective case study and content analysis of newspaper coverage and congressional data, this dissertation demonstrates how the social constructions of these illnesses impacted the way that breast and prostate cancers were treated as they moved through the policy process. The way in which social construction influenced the types of policies that were adopted to deal with these illnesses is also examined. Because social construction is a multidimensional and dynamic process, several different elements of this process were examined in this dissertation: the ways that policy actors attracted attention to these illnesses, how gender influenced advocacy efforts, the symbolic aspects of these illnesses, and the way the illnesses were defined on systemic and institutional agendas. Since this dissertation examines two different policy issues, the similarities and differences in breast and prostate cancer policymaking were analyzed. I found that discussing breast and prostate cancers in relation to their social constructions provides support for the importance of symbolism and non-rational policy-making processes. / by Jocilyn Martinez. / Thesis (Ph.D.)--Florida Atlantic University, 2010. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.

This thesis investigates if and how poor, mostly minority citizens can be mobilized by a campaign whose principal policy objective would materially enhance their lives by including them in a major public program. The question is put to the test through a multi-dimensional study of voter mobilization in Alabama during the 2014 election for Governor. At stake in the election was whether Alabama would expand Medicaid through the Affordable Care Act in Alabama, an issue emblematic of "submergedness" (Mettler, 2011). In order to understand the extent to which the policy was submerged - measured by knowledge and awareness of the policy, along with its key provisions - I distributed a survey to 868 Alabamians weeks before the election. The survey used the experimental design of conjoint analysis to test which aspects of the policy were most persuasive among the target population. Additionally, I performed a randomized field experiment across the four major metropolitan areas of Alabama, micro-targeting 6,021 registered voters living in the "Coverage Gap," citizens who could gain health insurance if Medicaid were expanded. The campaign yielded negligible effects on voter turnout among subjects in the Coverage Gap, even though the interventions shifted voter knowledge, 'surfacing' the policy. In addition to the survey and field experiments, this research benefits from qualitative insights gathered in 22 semi-structured interviews conducted among poor Alabamians, many of whom were uninsured. From these interviews, it became clear that the political disengagement of the poor is deeply entrenched, prohibitive of policy-based mobilization. Disengagement is driven by a complex mix of barriers to registration and perceptions of political inefficacy based on interpretations of extant policy designs. These results have important implications for our understanding of the limitations of policy-based mobilization, suggesting that more attention must be paid to how current policies shape predispositions for mobilization.

In 1993, a group of unionized bedside nurses took control of their state nursing association. In 1995, they disenfranchised themselves from the American Nurses Association, which historically had billed itself as - THE voice of the profession of nursing. This study utilizes a case study format to look at who they are, what their intentions are, and what their vision is for the future of the profession. Twenty questions were submitted to key participants identified by the California Nurses Association (CNA). The questions were organized into three main areas: the period leading up to the disenfranchisement, the period of growth after the takeover up until the historic passage of the ratio laws and whistle blower protection, and the period after the passage of the laws wherein the association began a national movement. This movement continues to evolve, and in December, 2009, the CNA (now the National Nurses United) became the largest nursing organization in the country. As the title of the study implies, one intention of the study is to look at the implications for the profession of nursing and the inevitable political implications for the national healthcare debate. Another purpose is to introduce this group to the academic and professional nursing communities, which until now have largely ignored them. Still another purpose is to lay out a blueprint for other state nursing associations who may wish to empower themselves, to analyze the process by which this group has grown to political prominence. No other nursing association has been able to duplicate their political success. Finally, the study raises many crucial questions which nursing academics and nursing leaders must address if nursing is going to able to utilize our only real political power, the power of numbers. Uniting the field, or at least growing the association to significant numerical strength, is the only way nursing can become an equal partner in the national healthcare debate. / by John Silver. / Thesis (Ph.D.)--Florida Atlantic University, 2010 / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2010. Mode of access: World Wide Web.

This thesis presents qualitative research conducted in summer 2017 at the Finger Lakes Free Clinic, which provides free medical and holistic care to people without insurance in upstate New York. The primary goal of this research was to strengthen the relationship between a free clinic and its donors by gathering donor concerns and perceptions regarding federal healthcare policy. Data from 32 interviews with donors, staff, board members, and volunteers, along with 100 hours of participant observation revealed that donors to this clinic were concerned about the potential impact of Congressional healthcare reform yet did not consider federal policy a strong influence on their donations. Rather, donors cited dedication to local giving and personal connections with the clinic as their primary motivations. These motivations suggest the value of viewing the clinic-donor relationship as a relationship of reciprocity. From this framework, the research identifies opportunities for the clinic to reciprocate donor generosity while expanding services in response to a growing need. Insights from the research will guide the clinic's response to federal policy changes and support the clinic's vision of becoming a national model for integrative care.

The issue of national health care has actively plagued the 20th century political spectrum in both the U.S. and the United Kingdom. It has been an issue of astounding resilience and vexation, alluding almost all simple-quick answers while consuming an ever increasing amount of public resources. There have been three principal time periods when both the United States and Great Britain have actively addressed universal coverage: the 1910s; the 194Os; and the 1990s. This dissertation extends John Kingdon's theory on policy agenda formation by examining the aforementioned debates. The conclusions that come from this study are four fold. (1) Contemporaneous interactions can occur between nations. (2) Century-long longitudinal development of a single policy area is possible and is illustrated. (3) Kingdon's policy streams approach can be utilized to conduct a comparative analysis of the policy agenda formation process. (4) Kingdon's conceptual model is more accurate at depicting the policy agenda formation process of the British parliamentary system than it is for the divided government structure of the U.S. / Ph. D.

This study explored the work of nursing and the social influences of eugenic policies established during the Progressive Era (1890-1930) on the writing and passage of the Social Security Act of 1935. The research questions: "Did eugenic philosophy and practice influence the Social Security Act of 1935 in relation to Maternal Health Policy?" and 'What was nursing's influence on the Social Security Act of 1935?" required the social history research method. Data were evaluated with the conclusion that eugenic policies did influence the writing and passage of the Social Security Act. Also, that nurses, and other women, played a specific, important and constructive role in developing the Act. During the late 1800s and early 1900s prominent leaders of business, science, philanthropy, and social reform supported the eugenic agenda to assure the wellbeing of hard working "Anglo-Saxon" American citizens. Industrialization and scientific advances in medicine gave Americans the impression that the "production" of healthy, intelligent children could be controlled, efficient, and predictable. Better breeding as a means for social improvement, which fueled the eugenics movement's use of science to solve social problems through governmental involvement, had two sides. Positive eugenics increased information on health and illness prevention, and established well baby clinics; however, negative eugenics advocated controlled reproduction through sterilization of persons considered "unfit." By 1935, twenty-eight states had eugenic sterilization laws. Noted reformers during this time (Lillian Wald, Jane Addams, and Florence Kelley) worked with Presidents Theodore Roosevelt and Woodrow Wilson to establish the Federal Children's Bureau. The Bureau had a direct influence on the maternal and child health policy established by the Social Security Act of 1935. / This legacy continues today in the continued fight for women and children's social and economic rights.The Social Security Act's intention, economic security for all citizens, was not realized. Sections of the Act focused on maternalistic social views and sought to maintain a patriarchal family structure. The language of the Social Security Act created barriers to benefits for the most vulnerable. In fact, it seems reasonable to conclude that institutionalized health care disparities laid their roots in America through this legislation. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

Indiana University-Purdue University Indianapolis (IUPUI) / Oral health is crucial to overall health and a focus of the U.S. Health Center program, which provides preventive dental services in medically underserved communities. Dental hygiene is an oral health profession whose practice is focused on dental disease prevention and oral health promotion. Variations in the practice and regulation of dental hygiene has been demonstrated to influence access to dental care at a state level; restrictive policies are associated lower rates of access to care. Understanding whether and to what extent policy variations affect availability and access to dental care and the oral health of medically underserved communities served by grantees of the U.S. Health Center program is the focus of this study. This longitudinal study examines dental service utilization at 1,135 health center grantees that received community health center funding from 2004 to 2011. The Dental Hygiene Professional Practice Index (DHPPI) was used as an indicator of the state policy environment. The influence of grantee and state level characteristics are also considered. Mixed effects models were used to account for correlations introduced by the multiple hierarchical structure of the data. Key findings of this study demonstrate that state policy environment is a predictor of the availability and access to dental care and the oral health status of medically underserved communities that received care at a grantee of the U.S. Health Center program. Grantees located in states with highly restrictive policy environments were 73% less likely to deliver dental services and, those that do, provided care to 7% fewer patients than those grantees located in states with the most supportive policy environments. Population’s served by grantees from the most restrictive states received less preventive care and had greater restorative and emergency dental care needs. State policy environment is a predictor of availability and access to dental care and the oral health status of medically underserved communities. This study has important implications for policy at the federal, state, and local levels. Findings demonstrate the need for policy and advocacy efforts at all levels, especially within states with restrictive policy environments.