Although rural households in Kenya rely on agricultural production for their livelihood, attaining food security is challenging in areas experiencing harsh agro-ecological conditions. We utilized mixed methods research to examine the effect of agricultural production, including that of traditional foods, on household food insecurity in Seme sub-County of Kenya. Study participants believed that traditional foods protected against hunger. However, production of these foods, with the exception of traditional vegetables, was low. Poultry-keeping; cereal/grain, any vegetable and traditional vegetable production; and crop diversity were significantly associated with lower household food insecurity. Vegetable production maintained statistical significance after controlling for other variables.

Disparities in outcomes are evident in emergency management interactions, in acute circumstances, like hurricanes or natural disasters, or routine interactions involving first responders, such as traffic stops or patient transport. Women and people of color are disproportionately represented in experiencing adverse effects. In light of observed inequities, this analysis investigates whether codes of ethics articulate the value of equity as a guiding principle. After presenting background evidence on the manifestation of inequities, we reviewed literature on the general nature of codes of ethics and their context in Public Administration and Emergency Management, giving consideration to social vulnerability and cultural competence. The purpose of this inquiry was to examine codes of ethics in various professions comprising the broad field of emergency management and first response within the United States—including that of the American Society for Public Administration—to determine whether they take race and gender into account. As disparities in outcomes are broadly observed, we hypothesized that the terms would be underrepresented. We found that only a small minority of codes make explicit mention of race or gender, and the majority do not mention equity. We also discovered a stronger emphasis on professionalism than on outcomes within the populations served.

Social media can be a hostile environment for women, where threats of sexual assault and violence proliferate (Locke, Lawtom, and Lyons 2018; Jane 2014). Yet, social media sites like Twitter provide a platform for advocacy organizations seeking to influence public opinion and policy outcomes aimed at reducing gender-based violence (GBV). Using anti-GBV groups, this study follows research by Merry (2011, 2014) and Guo and Saxton (2018), to examine whether advocacy organizations effectively use Twitter to mobilize support and influence political communication and policy outcomes, where effectiveness is taken to be synonymous with more interactive communication. Interactivity among groups and the reach of their messaging (i.e., amount of attention received) are assessed to consider their effectiveness and potential mechanisms for broadening that reach. While empirical evidence of effectiveness based on the communicative quality of tweets is not advanced in this analysis, the quantity of tweets is affirmed as a mechanism of attention getting.

This editorial considers the persisting importance of rhetoric and equity in health policy analysis, implementation, and outcomes. It argues that employing social determinants of health, and intersectional and rhetorical frames, can improve life and health outcomes, as measured by morbidity and mortality. The pertinence of these frames with regard to the crises brought on by the COVID‐19 pandemic is discussed, and the plan for a special issue on disparties and COVID‐19 is announced.

This article reports on a rhetorical analysis of media reports on campus sexual assault informed by the Narrative Policy Framework (NPF). The analysis reveals patterns of narrative construction wherein those accused of campus sexual assault remain absent from reporting while universities and accusers are burdened with responsibility. Consequently, the "disappearing accused" contributes to public uncertainties about how to respond to the problem of campus sexual assault and complicates how governing policies, particularly Title IX, are perceived, wherein Title IX's equity framework does not match expectations of justice in response to violence.

The COVID‐19 pandemic has had disproportionately negative impacts on socially disadvantaged and underserved populations around the world. Inequality and the related social determinants that impact certain groups are directly related to the adverse health outcomes of vulnerable populations during the pandemic. People in disadvantaged communities are generally more prone to occupational exposure to the virus and tend to have limited access to health care and higher rates of comorbidities. Outcomes related to widespread school closures are also of particular concern for underserved communities. Additionally, these populations are more susceptible to the negative economic outcomes of the pandemic. There is an urgent need for research and policy solutions regarding the impact of the COVID‐19, with particular attention to the needs of disadvantaged and vulnerable populations, a foundation for which is offered in this discussion.

AbstractSocial media campaigns on Twitter are one of their primary strategies used by organizations aiming to mitigate the global problem of gender‐based violence (GBV). Social media has been touted as a transformative force in social movements, affecting the influence and interplay of actors in advocacy networks, and their entrepreneurship in shaping policy. We examine the social media campaigns of three anti‐GBV organizations operating at the local, national, and global levels to assess the nature and extent of their effectiveness.

Policy scholarship can improve the policy process by approaching it from varying vantage points. Evaluative studies examine existing policies and consider whether and how they might be mitigating the targeted problem. Other studies consider the policy context, using theoretical frames and empirical evidence to explain what factors might account for observed outcomes. Still others can be prescriptive, offering recommendations of novel approaches based on evolving scientific evidence, or lessons from historical precedent. In this first issue of a new decade, World Medical & Health Policy offers a selection of articles from all of these persuasions, in policy contexts from the Philippines, Iran, and Nigeria to U.S. state houses and college campuses. Chen et al. consider whether benchmark prices set by the Department of Health are being followed by local government units in the Philippines, and find that the majority are likely not compliant, with implications for both the public seeking essential medicines, as well as drug-procuring agencies. Feizi and Moeindarbari take a look at the heterogeneity of market structures in Iran's unique organ transplant landscape, and the accomplishment of the world's shortest waiting list for organs, while considering some safeguards built into the model to address concerns about undue inducement in the market among poorer populations. And, in a commentary, Enabulele identifies challenges and offers recommendations to address the shortcomings of Nigeria's National Health Insurance scheme, which covers no more than 4 percent of the population almost 15 years after its formal launch. De Soto and Tajalli seek to address a deficit in the literature regarding gendered patterns of drug use on campuses in the United States by considering two theories of human behavior, as means to potentially improve understanding of the factors that influence adverse substance use outcomes. And O'Mahen and Petersen offer an institutional frame to explain how varying state structures can lead to different outcomes on Medicaid expansion decisions, which affects health-care equity and access. Two articles in this issue (De Soto and Tajalli and Ovissi and Hagaman) have their origin in a 2018 World Medical & Health Policy Call for Papers on Eradicating Addiction. Ovissi and Hagaman also presented their “Trauma Informed Educational Program for Teens as a Tool for Addiction Prevention” at the Policy Studies Organization's 11th Annual Dupont Summit in Washington, DC, where World Medical & Health Policy put on two panels. Giesbrect, Bosma, and Reisdorfer's “Reducing Harm Through Evidence-Based Alcohol Policies: Challenges and Options” (2019), presented at the same Dupont Summit, was published in fall 2019. Feizi and Moeindarbari's piece on the “Iranian Model of Kidney Transplantation” follows a thread of articles on the topic of transplantation in World Medical & Health Policy, before and after a related Call for Papers and Workshop held at the Schar School of Policy and Government in Arlington, Virginia, in 2017. Papers presented at the Workshop and subsequently published include Nayebpour and Koizumi's “The Social Stigma of Selling Kidneys in Iran as a Barrier to Entry: A Social Determinant of Health,” (2018); Fry-Revere et al.'s “Introducing an Exploitation/Fair Dealings Scale for Evaluating Living Organ Donor Policies Using Iran as the Test Case” (2018); Elias, Lacetera, and Macis's “Understanding Repugnance: Implications for Public Policy” (2017); and McSorely et al.'s “Dialysis Providers’ Perceptions of Barriers to Transplant for Black and Low-Income Patients: A Mixed Methods Analysis Guided by the Socio-Ecological Model for Transplant” (2017). Earlier transplant work published in our pages include “Geographical Disparity in Access to Organ Transplant” by Koizumi, and Akhtar and Bari's (2012) consideration of kidney selling in Pakistan. Finally, this issue features Popescu's timely review of Stefan Elbe's Pandemics, Pills and Politics, which focuses on medical countermeasures in the face of pandemic flu. Our new Book Review Editor, Cynthia Golembeski of Rutgers School of Public Affairs and Administration, is developing a steady stream of reviews to roll out in the year ahead, as we both believe that book reviews are an important avenue for sharing emerging work and encouraging collaboration among health policy scholars and practitioners.

At first glance, Formerly Known As Food by Kristin Lawless seems like it might cover mostly familiar terrain for those concerned with healthful eating. But what starts with a close up look at our d...

This analysis examines the literature on gendered media coverage of women candidates for higher office, and considers how biases in the treatment of candidates based on gender may be evident in or exacerbated by the promulgation of fake news. Using the 2016 Presidential election cycle in the United States as a case study, two fake news stories are investigated, which, like most fake news stories at the time, exhibited coverage in favor of the candidacy of Donald Trump and demonized or denigrated his opponent, Hillary Clinton. Findings suggest that the Pizzagate and Hillary Health Scare stories evince gendered narratives supporting stereotypes of women as unfit for leadership positions, and either villainize or trivialize women, depending on their perceived degree of power. Using a dataset of news articles and tweets from the months surrounding the 2016 election, evidence is offered of more negative coverage of the female versus male contender, in keeping with the findings of the literature, though the presence of potentially confounding factors, including personality and party, is acknowledged.

Rhetoric and policy are in many ways complementary disciplines. Rhetoric, as the art of civic discourse, is inherently concerned with the questions and disputes of the public sphere. Rooted in deliberative, democratic traditions of the classical era, rhetoric is, at its origin, the practice of understanding how language makes change in the world—arguing for and against new laws, shaping outcomes of public debates, and articulating cultural values and mores. The subdiscipline of the rhetorics of health and medicine (RHM), then, follows questions about language use as it relates to medical spaces, health practices, and related decision making. RHM is most succinctly defined by Amy Reed, who describes it as work that “examines language about health and medicine as produced by rhetors with limited agency; used by particular audiences, who may or may not share the intentions, values, beliefs, or practices of the rhetor; and reflecting and constituting ideology” (Reed, 2018, p. 191). Following from this definition, RHM work has a long tradition of studying a wide range of public communication tools and practices as a way of understanding how language mediates health and medical experiences. Work in this field has studied how medical practices and discourses characterize and shape physicians' perceptions of their patients and their diseases (Keränen, 2010; Scott, 2014; Segal, 2008); how communication practices shape patient knowledge about diagnosis and prognosis (Barton, 2004; Teston, 2017); the roles that medical practices at various historic moments (from lobotomy to genetic testing) play in patient lives and society (Happe, 2016; Johnson, 2015; Pender, 2018); and how public controversies impact medicine, health, and science (Ceccarelli, 2011; Kolodziejski, 2014; Lawrence, Hausman, & Dannenberg, 2014). Methodologically and theoretically, RHM relies primarily on qualitative research and hermeneutic, interpretative approaches to the texts, discourses, and artifacts under study. Scholarship in policy pairs productively with the ends of RHM, potentially extending rhetorical analyses into real-world acts and implications. Goals of research in policy include establishing and assessing the social and material effects of policies as they impact populations; understanding historic precedents and trajectories of policy interventions; and examining how policies may create inequitable outcomes for particular groups, all with a goal of improving health outcomes and the public's health. As a direct linkage between policy's capacity for social action and rhetoric's aims to understand how people use language to make change, exploring the synergies between scholarship across these disciplines offers scholars in both disciplines insight into other mechanisms for knowledge making, possibilities for understanding, and new routes for creating positive change in the world. As scholars in policy (Stabile) and rhetoric (Lawrence), we originally began our collaboration more than 5 years ago at a forum designed to encourage multidisciplinary collaboration at our university. Through that collaboration, we have found our methods, approaches, and social goals to offer complementary ways of engaging with public problems and how scholarship might help to resolve them. Our study of media constructions of campus sexual assault argues that how we talk about the problem of campus sexual assault constrains what we might do to resolve it. A rhetorical analysis of media reports revealed recurring narrative and discursive patterns in how the media describe what campus sexual assault is, demonstrating both macro- and micro-level problems in public understanding of the problem (Lawrence, Fernandez, Lussos, Stabile, & Broeckelman-Post, 2019). We also find gaps in the articulation of policy interventions in this problem as well. Public actors and advocates demand “justice” and “punishment” for perpetrators of sexual assaults on campus, words that can be incongruent with a context of campus policies oriented toward “equitable” treatment through Title IX and other governing policies that are bound to protect perpetrators and victims alike. In these analyses, we see how rhetoric and policy shape and are shaped by a context of real, material, lived consequences and health outcomes for those who seek justice. Exploring more possibilities of such a collaboration between policy and rhetoric motivated the creation of a space through this special issue for working through the particular consequences of rhetoric in health and medical policy. The goals of this issue extend from our own collaborative goals, to see the ways in which language shapes public understanding of problems, the stakes of those problems for the people experiencing them, and the possibilities for policy-related solutions. The results of these disciplines intersecting are reflected in the articles in this special issue. Across this issue, the scholarship represented here examines a wide range of medical sites and spaces, professionals and patients in context, and community-based problems affecting and affected by policy. Kirk St. Amant's commentary articulates the stakes for rhetoric in an international context for health and medicine, arguing for a new framework for understanding and responding to culture in context. St. Amant's perspectives set the stage for the issues in rhetoric and their connections to policy raised across the issue. Each article, through a different study of rhetoric, text, and language use, analyzes a different component of the health system and how policy impacts or is impacted by different rhetors and rhetorical situations. Some of this work focuses on institutions and their responses to policy constraints. Liz Hutter’s analysis of promotional materials for Grady Hospital points to the very particular needs for health systems and governing policies that shape how care is dispensed and operates. Christina Puntasecca, E. Ashley Hall, and Jennifer Ware’s study of lesbian, gay, bisexual, and trans-gender (LGBT) veterans and their treatment at VA hospitals, “point[s] to a need to better understand LGBT veteran experiences and how the VA’s new Strategic Plan will affect LGBT veterans seeking VA resources” through an analysis of websites and other textual materials. Dawn Opel's work examines the impact of the Affordable Care Act (ACA) on community-based organizations (CBOs), whose responsibilities expanded, yet remain constrained, as the larger policy environment around health care has changed. Exploring a different, yet critical, component of health and medicine, David Lee’s analysis examines constructions of medicine and science in a museum exhibit, considering how such a created space configures possibilities and needs for policy through public communication about science. Other articles focus on specific, lived experiences of individuals in health systems and policy contexts. Skye de St. Felix examines the difficulties undocumented immigrants can have obtaining reproductive health services, such as abortion, upon arriving in the United States. This work considers how cultural contexts, discursive restraints, and xenophobia shape rhetorics that individual agents must use to seek the resources of health and medicine in an environment highly constrained by a range of policy objectives. David Gruber and Jason Kalin study the growing rhetorics concerning the microbiome—and what they term “gut rhetorics”—and how they interact with policy-informing mechanisms such as questionnaires. This work challenges how instruments shape understanding of the nature and scope of a phenomenon and impact public understanding of science and science-related policies. Finally, Susan Rauch analyzes the stigmatizing effects of mental health policies, specifically as they impact nurses with bipolar 1 and 2 disorders. Through an analysis of forum responses and related policies, Rauch argues that the nurses resist the medicalization of their conditions and self-advocate within a system designed to pathologize their bodies, minds, and treatment options. Problems at the intersection of health, medicine, and immigration policy are further considered in a book review of Jay Dolmage's Disabled Upon Arrival, written by Norma Smith. The work in this special issue raises important questions about how policy and rhetoric work in medicine and health—how policy changes are operationalized and experienced by real people, how public understanding of science and medicine shapes and is shaped by policies, and how the language we use configures our framing of problems and their solutions. In so doing, the work in this special issue accomplishes and extends the goals we set for the issue at its outset and the possibilities for our own and future collaborations between scholars in rhetoric and policy. A final goal of this issue is for these articles to encourage further questions and possibilities for connections across rhetoric and policy, such as the development of new theories and methodologies for research, new instruments for measuring and understanding social practices, and sites for interdisciplinary study. We hope that the cross-disciplinary audience reading this issue will see and seek out these possibilities in future scholarship. Creating this special issue has been no small task. Our authors and reviewers have been brave, bold, and kind with us as they tested their ideas among scholars with a range of backgrounds and expectations and tried to see the productivity in meeting the aims of an interdisciplinary readership. For that, we thank them. As co-editors, we have been challenged to see how each discipline's ideas and paradigms might productively engage with and challenge the other to produce novel approaches that remained relatable and appropriate to our scholarly goals. We are excited and hopeful at the prospects that this work reflects, and we look forward to seeing where the conversations that begin here might take both of our fields through future scholarship, collaborations, and real-world social action. Heidi Y. Lawrence, is an assistant professor of English at the George Mason University, and the director of the Master in English, Professional Writing and Rhetoric (PWR) concentration. Her book on vaccine controversy, Vaccine Rhetorics, will be available from The Ohio State University Press in Spring 2020. Bonnie Stabile, is an associate professor in the Schar School of Policy and Government, and the director of the Master of Public Policy Program, and the Gender and Policy Center at the Schar School, in addition to serving as editor in chief of World Medical & Health Policy. [Article updated on January 6, 2020: Language was updated to correctly attribute an article to Christina Puntasecca, E. Ashley Hall, and Jennifer Ware, rather than only to Jennifer Ware.]

The primary goal of policy analysis is to improve the lives of the populations studied. Sometimes this is accomplished by incisive examination of specific policies, while at other times, whole classes of policy, or the broader policy context, are considered. In this issue, Haeder examines the very particular case of network design and access to percutaneous coronary intervention (PCI or angioplasty with stent) in the Medicare Advantage and Affordable Care Act's insurance marketplaces. In so doing, he draws some potentially useful conclusions about their implications for quality and access to care. Segelman, Intrator, Li, Mukama, and Temkin-Greener consider whether those enrolled in Medicaid home and community-based services experience differences in rates of hospitalization and they outline implications about eligibility criteria for enrollees based on their findings. In the field of substance use policy, two long-term themes in our pages reappear in this issue, including work by some returning authors. Giesbrecht, Bosma, and Reisdorfer focus on the challenges faced in the implementation of alcohol policies and offer some approaches to be tried in response. This work expands upon an earlier investigation on the topic of “Implementing and Sustaining Effective Alcohol-Related Policies at the Local Level” by Giebrecht, Bosma, Juras, and Quadri (2014). In the current issue, Ferraiolo turns her attention to “Messaging and Advocacy in U.S. Tobacco Control Policy, 2009–19” while in 2014 her focus was on “Morality Framing in U.S. Drug Control Policy” in the case of marijuana decriminalization (Ferraiolo, 2014). In both cases, she considers the importance and tangible outcomes associated with how policy is written and talked about. Both current pieces on substance use policy—involving either alcohol or tobacco—bring to mind Cairney and Studlar's 2014 piece on health policy in the United Kingdom, which wondered, after the “War on Tobacco” whether a “War on Alcohol” was brewing. In her commentary on Cuban maternity care policy, Pettit Bruns, Pawlowski, and Robinson decry the inexcusably high infant mortality rate in the United States, particularly in rural areas, and look abroad for lessons of models that might ameliorate this regrettable condition. Earlier in 2019, Piane reviewed the literature on maternal mortality in Nigeria, pointing to the need for some, perhaps obvious, upgrades in supplies, equipment, and staff (Piane, 2019). Pham makes a contribution to the theoretical literature by developing a model to examine how income segregation affects communicable disease transmission. Whether focusing on communicable or noncommunicable disease, or the origins of other adverse health consequences, the work of all of the authors in this issue holds the real potential to positively influence policy prescriptions through their illumination of various facets of policy and practice.

This article reports on a mixed methods rhetorical analysis of a data set of news reports on campus sexual assault. A macro-level qualitative analysis of narratives combined with micro-level quantitative content analysis of verb voice offers insight into how news media shapes perceptions of power, blame, and agency in reporting. These findings offer implications for how public actors discuss campus sexual assault and implications for the teaching and practice of research methods in technical communication.

AbstractThis analysis investigates the presence of rape myths in the policy context, as reflected in social media, and considers how those myths might manifest in policy related to sexual assault in accordance with the social construction theory of target populations. Contested interpretations of Title IX between the Obama and Trump administrations serve as an example of how underlying assumptions about target populations based on rape myths might influence policy design. The rape myth that women routinely lie about rape is investigated through an examination of its prevalence on Twitter using a dataset collected over a period of 4 months. From the dataset, a typology of tweets was created that identifies emergent themes reflecting the social construction of target populations, including accusers and the accused. These message categories—accusational, validational and sensational—have potential policy relevance, as between 44% and 48% of the tweets are found to be accusational, meaning that they express doubts about or undermine accusers, and/or perpetuate the idea that women lie about rape.

Objective: To examine mothers' and young children's consumption of indigenous and traditional foods (ITF), assess mothers' perception of factors that influence ITF consumption, and examine the relationship between perceived factors and ITF consumption. Design: Longitudinal study design across two agricultural seasons. Seven-day FFQ utilized to assess dietary intake. Mothers interviewed to assess their beliefs about amounts of ITF that they or their young children consumed and on factors that influence ITF consumption levels. Setting: Seme sub-County, Kenya. Participants: Mothers with young children. Results: Less than 60 % of mothers and children consumed ITF at time of assessment. Over 50 % of the mothers reported that their ITF consumption amounts and those of their children were below levels that mothers would have liked for themselves or for their young children. High cost, non-availability and poor taste were top three reasons for low ITF consumption levels. Mothers who identified high cost or non-availability as a reason for low levels of ITF consumption had significantly lower odds of consuming all ITF except amaranth leaves. Mothers who identified poor taste had significantly lower odds of consuming all ITF except green grams and groundnuts. Similar relationships were noted for young children's ITF consumption levels. Conclusions: A majority of the mothers reported that they and their children did not consume as much ITF as the mothers would have liked. Further studies should examine strategies to improve availability and affordability of ITF, as well as develop recipes that are acceptable to mothers and children.

This study investigates the question of whether there are gender differences in the choice of specializations/concentrations by students enrolled in Master's Programs in Public Administration (MPA), and considers potential implications for MPA students and the broader field of public administration. We analyzed data provided by NASPAA-accredited MPA programs to identify if gender differences exist in students' concentration selections. After obtaining information on students' concentrations, we surveyed MPA directors, asking them if they, in their experience as program directors, noticed any variability in preferences for concentrations across genders. Our expectations, based on the literature, regarding the gendered nature of MPA specializations/concentrations were validated in the case of Budgeting/Finance, and City and State, which our analysis found to be statistically significantly skewed male, and in the case of Health, Nonprofit and Human Resources, which were found, to be overrepresented by women by the same measure of conferred degrees.

The recent surge in women reporting sexual assault and harassment (e.g., #metoo campaign) has highlighted a longstanding societal crisis. This injustice is partly due to a culture of discrediting women who report such crimes and also, rape myths (e.g., 'women lie about rape'). Social web can facilitate the further proliferation of deceptive beliefs and culture of rape myths through intentional messaging by malicious actors. This multidisciplinary study investigates Twitter posts related to sexual assaults and rape myths for characterizing the types of malicious intent, which leads to the beliefs on discrediting women and rape myths. Specifically, we first propose a novel malicious intent typology for social media using the guidance of social construction theory from policy literature that includes Accusational, Validational, or Sensational intent categories. We then present and evaluate a malicious intent classification model for a Twitter post using semantic features of the intent senses learned with the help of convolutional neural networks. Lastly, we analyze a Twitter dataset of four months using the intent classification model to study narrative contexts in which malicious intents are expressed and discuss their implications for gender violence policy design.