Does racism affect health? Evidence from the United States and the United Kingdom

Blacks have worse overall health than whites in both the United States and the United Kingdom. However, the relative difference in health between the two groups within each cultural context differs between each context. In this article, we attempt to glean insights into these health disparities. We do so by first examining what is currently known about differences in morbidity and mortality for blacks and whites in the United States and the United Kingdom. We then turn to medical examination data by race and country of birth in an attempt to further untangle the complex interplay of socioeconomic status (SES), race, and racism as determinants of health in the United States and the United Kingdom. We find that (1) longer exposure of blacks to the recipient country is a risk for mortality in the United States but not in the United Kingdom; (2) adjustment for SES matters a good deal for mortality in the United States, but less so in the United Kingdom; (3) morbidity indicators do not paint a clear picture of black disadvantage relative to whites in either context; and (4) were one to consider medical examination data alone, differences between the two groups exist only in the United States. Taken together, we conclude that it is possible that the "less racist" United Kingdom provides a healthier environment for blacks than the United States. However, there remain many mysteries that escape simple explanation. Our findings raise more questions than they answer, and the health risks and health status of blacks in the United States are much more complex than previously thought.     

Why hasn't integrated health care developed widely in the United States and not at all in England?

There have been influential advocates for financing and organizing health care in the United States and England based on the model of integrated health care delivery systems (IHCDSs). Despite good evidence that a few IHCDSs provide high-quality health care economically, such organizations are rare and localized in a few market areas in the United States and are absent in the English National Health Service (NHS). The explanation of why this is so includes various contributory factors: the way the development of the medical profession in each country pursued specialization; the division in British medicine between general practitioners and specialists; and the characteristics that we identify of established successful IHCDSs, which created formidable barriers to entry for a new IHCDS. This explains why currently the most promising organizational developments in U.S. health care are hybrids resulting from vertical integration. In England government policies of an "internal market," as adopted in the 1990s and currently, were and are based on a purchaser-provider split with the objectives that providers would compete and be funded by a system in which "money follows the patient." These policies recognize the division in British medicine, which also means that it is difficult to implement a reorganized English NHS based on high-performing IHCDSs.     

Rational rejection? The ethical complications of assessing organ transplant candidates in the United Kingdom and the United States

The practice of allocating scarce organs in medicine is an ethical minefield. Due to the organ shortage, organ procurement agencies in both the United Kingdom and the United States are placed in the unenviable position of having to choose a limited number of patients to compete equally for life-saving treatment. They do this by composing multidisciplinary transplant teams, which must evaluate transplant candidates and their complex range of personal, medical, environmental, psychiatric and financial characteristics. During the candidate assessment process, such teams may often be torn between their moral duty to save those who are most in need, considerations of efficiency, and the battle against forming moral judgments about particular candidates. Several ethical approaches can be adopted by transplant teams during the decision-making process, but do these ideologies provide adequate justification for their sometimes controversial decisions? This article provides a detailed examination of the ethical principles available to transplant teams in the United Kingdom and the United States, and the effect that these principles have on assessment procedures, organ allocation protocols, transplant candidates and their prospects.     

Competition policy in the United States and the United Kingdom ‐ A look at underlying forces*

Summer schools in law are a common feature of Irish legal education today. Originating in the US, summer schools are now an international phenomenon. In 2005, the eLaw Summer Institute (or ELSI), was established at University College Cork as a four-week international summer school. In this article, we reflect on the design and development of ELSI, with reference to three key aspects of this summer school. First, we address issues arising from the intensive teaching aspect of ELSI, including the use of technology as part of a blended learning experience. Second, we explore the challenges posed by the international audience in ELSI. Lastly, we critically examine the comparative elements of the school in terms of curriculum design and delivery of the programme. Our analysis builds upon existing literature in the areas of curriculum design and delivery, intensive teaching, the international classroom and comparative legal studies; and is informed by empirical data in the form of anonymous student questionnaires. The aim of the article is to engage with others involved in summer programmes, to share our experiences and critical analysis and to provide an insight for those not involved in summer school programmes into the challenges and the rewards for students, staff and the institutions involved.     

A technocratic fix to the "legitimacy problem"? The Blair government and health care rationing in the United Kingdom

The work of the National Institute for Clinical Excellence, an agency which has recently been created by Tony Blair's Labour government to provide guidance on best clinical practice to the National Health Service, has generated considerable controversy in the United Kingdom. It has been argued that the role which the institute plays in appraising cost effectiveness, especially of expensive new health technologies, constitutes explicit, national rationing. Although the employment of scientific and evidence-based criteria as the basis of decisions might have been expected to secure legitimacy for the institute--even when its recommendations have the effect of denying access to a particular treatment--the reaction to much of its work so far indicates that this goal has not been fully achieved. While alterations to structure and procedure may be considered as possible means of addressing the agency's difficulties, such proposals are not without problems. Consequently, in the final analysis, the British example may serve as a demonstration that the inherently political nature of priority-setting in health care precludes any easy technocratic solution.     

The fundamental law that shapes the United States health care system: is universal health care realistic within the established paradigm?

In this article, the author draws from his own experience as a doctor in describing the issues the uninsured patient population faces. Pointing out that neither the U.S. Constitution nor case law provides a positive right to health care, the author describes the parameters of federal health care funding and ultimately concludes that universal health care cannot be fully achieved in the U.S.     

Is health care different? Popular support of federal health and social policies

Over the past several years there has been a striking increase in policy-makers' attention to health care reform. This paper explores whether there has been a corresponding shift in popular attitudes and identifies factors that may have changed these attitudes. The first part of the analysis relies on survey data collected between 1975 and 1989 to estimate a set of regression models, relating support for federal involvement in health care, antipoverty programs, and general domestic policies to a set of sociodemographic characteristics.... The second part of this study explores motivations that might account for these patterns. We identify a half dozen ways in which health care may be viewed as "different," that is, more or less appropriate for federal action. Analysis of survey data from 1987 suggests that there are relatively small differences in the attitudes and perceptions that motivate support for federal health initiatives, relative to federal domestic policies in general. However, there are more striking differences between health programs and more overtly redistributive policies.... We suggest that the growing support for federal intervention in health care, relative to other social policies, is in part an inadvertent by-product of ideological positions popularized during the Reagan and Bush administrations. We draw from these results some predictions about the course of the ongoing debate over federal health policies.     

Convergence or path dependency in policies to foster the creation of university spin-off firms? A comparison of France and the United Kingdom

This paper examines attempts by French and UK governments to fill the gap between the US and Europe with respect to the creation of academic spin-offs. Analysis of the contrasting cases of the UK and France, shows that there is no convergence of national policies to foster the creation of firms by academics. Rather, the two countries demonstrate different rationales and approaches to policy in this area. In UK, the rationale for spin-off policy is mainly to develop a third stream of financing. Spin-offs are a part of a policy to commercialize technology and knowledge created by universities. Policy is at the university level, leading to the creation of diverse structures. Public schemes bring public money directly to universities. In France, the rationale for policy towards the creation of new ventures by academics is the development of high technology new ventures as part of a technological entrepreneurship policy. The notion of a third stream of financing for universities is an argument that is never advanced. The UK has placed the universities at the heart of policies aimed at the creation of spin-offs, this is not the case in France.     

Condliff v North Staffordshire Primary Care Trust: can human rights redress inequities in United Kingdom and Australian cost-containment-driven health care reforms?

A recent case from the English Court of Appeal (R (on the application of Condliff) v North Staffordshire Primary Care Trust [2011] EWCA Civ 910, concerning denial by a regional health care rationing committee of laparoscopic gastric bypass surgery for morbid obesity) demonstrates the problems of attempting to rely post hoc on human rights protections to ameliorate inequities in health care reforms that emphasise institutional budgets rather than universal access. This column analyses the complexities of such an approach in relation to recent policy debates and legislative reform of the health systems in the United Kingdom and Australia. Enforceable human rights, such as those available in the United Kingdom to the patient Tom Condliff, appear insufficient to adequately redress issues of inequity promoted by such "reforms". Equity may fare even worse under Australian cost-containment health care reforms, given the absence of relevant enforceable human rights in that jurisdiction.     

The conflict between the ethics of th individual and the ethics governing public health: practical sustainability of health care in jeopardy?

The "health rights movement" has reconstructed the clinical relationship between health care workers and patients by simultaneously demanding more from traditional medical care and challenging the perceived power differential between doctors and patients by rejecting the paternalistic medical model in favour of an individual patients' rights model. However, the growth in individual expectations of a right to health care creates a potential conflict with the ethics that prioritise public health and guide the rationing of its limited financial and human capital resources. This, in turn, creates a practical dilemma which requires public health institutions to become service orientated while sacrificing their integral role in training and educating the medical workforce and potentially compromising the practical sustainable delivery of public health in Australia. However, the law can play a role in resolving this conflict through legislation, regulations, codes, administrative law and common law in an effort to ensure the quality and future sustainability of public health in Australia.     

Catalyst or Cause? Legislation and the Demise of Machine Politics in Britain and the United States

In the nineteenth century, British and American parties competed by hiring electoral agents to bribe and treat voters. British parties abruptly abandoned this practice in the 1880s. The conventional explanation is that legislation put an end to agent‐mediated distribution. But this explanation leaves many questions unanswered. Why did the parties use agents for decades, even though they imposed great expense on candidates and were viewed as untrustworthy? And why, after decades of half‐hearted reforms, did the House of Commons pass effective antibribery reforms only in 1883? In our formal model, parties hire agents to solve information problems, but agent‐mediated distribution can be collectively suboptimal. Legislation can serve as a credibility device for shifting to less costly strategies.     

Prospects for health impact assessment in the United States: new and improved environmental impact assessment or something different?

Health impact assessment (HIA) has been advanced as a means of bringing potential health impacts to the attention of policy makers, particularly in sectors where health impacts may not otherwise be considered. This article examines lessons for HIA in the United States from the related and relatively well-developed field of environmental impact assessment (EIA). We reviewed the EIA literature and conducted twenty phone interviews with EIA professionals. Successes of EIA cited by respondents included integration of environmental goals into decision making, improved planning, and greater transparency and public involvement. Reported shortcomings included the length and complexity of EIA documents, limited and adversarial public participation, and an emphasis on procedure over substance. Presently, EIAs consider few, if any, health outcomes. Respondents differed on the prospects for HIA. Most agreed that HIA could contribute to EIA in several areas, including assessment of cumulative impacts and impacts to environmental justice. Reasons given for not incorporating HIA into EIA were uncertainties about interpreting estimated health impacts, that EIA documents would become even longer and more complicated, and that HIA would gain little from the procedural and legal emphasis in EIA. We conclude that for HIA to advance, whether as part of or separate from EIA, well-formulated methodologies need to be developed and tested in real-world situations. When possible, HIA should build on the methods that have been utilized successfully in EIA. The most fruitful avenue is demonstration projects that test, refine, and demonstrate different methods and models to maximize their utility and acceptance.     

How do college students in Ukraine and the United States view criminal offenders?

This paper introduces an original data set that provides insight into how Ukrainian and US college students would punish criminal offenders. Students on four campuses in Ukraine and four in the United States completed surveys that help us better understand these differences. In general, Ukrainian students are more likely than American students to be crime victims than are American students and they are consistently more fearful of being victimised. Ukrainian students are more punitive than American students for some types of crimes (e.g., drug possession) while Americans are more punitive on other crimes (e.g., burglary).     

Discolouring Democracy? Policing,Sensitive Evidence,and Contentious Deaths in the United Kingdom

This article examines recent United Kingdom government proposals for secret inquests, which, it is argued, are part of a general push for secrecy discernible across common law jurisdictions, and which include developments such as increased recourse to sensitive evidence in forensic settings and the normalization of intelligence‐led policing. While the push for secrecy is justified by national security claims, the article shows that in cases of contentious death involving police, the issue is less about national security and more about the use of intercept evidence, covert surveillance, and intelligence‐led policing, all of which have implications for police trust, accountability, and reputation management.     

Capital punishment politics and policies in the States, 1977–1997

Since the U.S. Supreme Court ruled the death penalty constitutionalin 1976, thirty-eight states have readopted new capital punishmentstatutes consistent with Supreme Court decisions on procedural guidelines. While much of the literature about capital punishmentaddresses the legal aspects of the issue, this essay examines thepolitics of the major institutions of state government in the formulation of capital punishment policies. In some states, thereis agreement between key officials in the institutions on the desirability of, or opposition to, capital punishment. However, inmost other states, the debate over the appropriateness of deathpenalty policies is vigorously waged between the executive, legislative and judicial branches. Overall, 432 felons were executedin 30 states between 1977 and 1997. However, no executions haveoccurred in nine of these states. Twelve states have no provisionsfor the death penalty. The majority of executions since 1977 havetaken place in just six states. In addition to the abolitioniststates, the others can be categorized as (1) aggressive executioners,(2) occasional executioners, (3) reluctant executioners, and (4)nonusers where the death penalty has been restored for politicalpurposes but no executions have been carried out in over two decadesand none are likely to be in the immediate future given the minisculenumber of inmates on death row.     

Do school disciplinary policies have positive social impacts? Examining the attenuating effects of school policies on the relationship between personal and peer delinquency

Purpose

Empirical research has yet to demonstrate that strict school disciplinary policies deter student misconduct. However, underlying the null and negative effects observed in prior research may be competing social impacts. What is missing from prior research is an acknowledgement that the deviance amplification effects of criminogenic risk factors may be partially offset by the general deterrence effects of strict school sanctions.

Methods

Using data from the school administrator questionnaire, the in-school interview, and the in-home interview from the National Longitudinal Study of Adolescent Health, this study employs logistic hierarchical models to investigate whether strict school sanctions condition the relationship between personal and peer smoking, drinking, and fighting.

Results

Results indicate that the effects of peer smoking, drinking, and fighting on corresponding respondent delinquency are attenuated in schools with strict sanction policies for these behaviors.

Conclusions

Results suggest that school policies can aid in preventing crime in unanticipated ways, for example, by reducing the crime-inducing effects of having delinquent peers. Prior research may therefore be unintentionally discounting the general deterrence effects of school disciplinary policies by neglecting the moderating mechanisms through which these policies operate.