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.     

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.     

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.     

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.     

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.     

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.     

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.     

Crime and punishment in Russia and the United States: 1990–1998

Since the collapse of the Soviet Union in 1991, dramatic sociopolitical changes have affected the ability of the Russian criminal justice system to effectively process violent crimes. This paper compares the police and court processing of selected violent crimes in Russia and the United States during the period 1990–1998. Using data from the Russian Ministry of Internal Affairs and the U.S. Bureau of Justice Statistics, we examine the disposition of homicide, rape, robbery, and aggravated assault (i.e., serious bodily injury) cases in both countries during this period. Our findings indicate that while arrests and rates of homicide, robbery and aggravated assault decreased in the U.S. during this period, they increased in Russia. On the other hand, rape rates and arrests decreased in both countries during this period. Conviction rates as well as the percentage of defendants sentenced to prison in Russia were both higher than in the U.S. for each of the offenses studied during this period. We discuss implications of the findings and suggest additional research.     

When death is the sanction—United States and worldwide perspectives

Conclusion Gross and Mauro are probably correct in concluding that in the United States McCleskey ... certainly seems to represent a final decision to give up any pretense that the death penalty can be tamed.8 Current attempts at judicial oversight in the United States have proved as ineffective in bridling the discretion of capital case decision makers as were prior attempts at legislative and gubernatorial oversight. The historical lesson appears to be unmistakable: the nation must either abolish the death penalty or suffer its improper application and imposition. The worldwide pattern documented by Hood reinforces this conclusion; when the death penalty is on a country's statute books, it will be used—but, sooner or later, improperly so. No attempts at judicial or other forms of vigilance have proved this prediction to be incorrect—no matter how few cases have been permitted to flow through the system and no matter how principled have been the system and its officials.B.A., Queens College 1969; M. A., University of Pennsylvania 1973; Ph.D., University of Pennsylvania 1978.     

European human rights law and the United Kingdom—A note

This article asserts that established concerns about access to, and widening participation in higher education, are now reflected in interest around retention. Those law schools with inclusive admissions policies and widening participation practices face a number of challenges around the financial and human costs of poor retention. Most of these law schools fall within the “new university” sector.

This article argues that poor retention among first‐year law students often reflects a lack of engagement. This lack of engagement exists in two key relationships; first that of between students and the teaching and learning structures of their law school and university, and second between first year law students and many of the staff who teach them. It is argued that this lack of engagement reflects a clash of cultures, first between the requirements and structures of the law school and the everyday life experience of our students, and second between ourselves as teachers and our students.

The utilisation of aspects of the Oxbridge tutorial model of higher education together with an appropriate use of new technology is suggested as a response to this cultural clash and as a way of increasing engagement with our students.

In support of these arguments, the article refers extensively to the evidence presented to the House of Commons Education and Employment Committee hearings on retention in higher education, and to the Committee's conclusions.     

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.     

Mental health law and the EU: the next new regulatory frontier?

Over the last decade the EU's engagement with health law and policy has rapidly increased and there is now a growing body of literature highlighting this evolution and the impact of legal and regulatory structures in this area. In contrast the specific impact of EU law and policy in relation to the area of mental health remains the subject of comparatively little engagement. The aim of this paper is to examine whether mental health law and policy will become a major site for EU policy and law in the future. It examines the development of EU policy in this area. It sets this in the context of related legal developments such as the Charter of Fundamental Rights and the new EU Patients Rights Directives. It suggests that while it might be at present premature to envisage that a single body of EU mental health law itself may be unlikely that nonetheless the EU presents what is a potentially very influential site for regulation, law and policy in this area in the years to come.     

Harassment and stalking of Members of the United Kingdom Parliament: associations and consequences

A survey concerning intrusive/aggressive behaviours towards MPs was administered at Westminster, and in Queensland, New Zealand and Norway. Follow-up interviews were conducted with a sample at Westminster. This paper examines the experiences and associations of the 239 Westminster responders, of whom 81% had experienced intrusive/aggressive behaviours, 18% been subject to attack/attempted attack, and 53% stalked or harassed. Being stalked and subject to certain types of intrusive/aggressive behaviour were associated with younger age and being in the Commons five years or less, but serious incidents were more common in those who had been MPs for longer. There were no associations with brief periods of harassment. Some differences with party and constituency type emerged. Mental illness was prominent amongst perpetrators. Motives predominantly concerned personal grievances. Significant proportions of MPs suffered psychological ill-effects, necessitating inconvenient behaviour changes. Internal consistencies in these results and similarities to other sites are explored, and their implications discussed.     

Acquisitive Crime and Inflation in the United States: 1960–2012

Objectives

Inflation is conspicuous by its absence from recent research on crime and the economy. We argue that price inflation increases the rate of crimes committed for monetary gain by fueling demand for cheap stolen goods.

Methods

The study includes inflation along with indicators of unemployment, GDP, income, consumer sentiment, and controls in error correction models of acquisitive crime covering the period from 1960 to 2012. Both short- and long-run effects of the predictors are estimated.

Results

Among the economic indicators, only inflation has consistent and robust short- and long-run effects on year-over-year change in the offense types under consideration. Low inflation helps to explain why acquisitive crime did not increase during the 2008–2009 recession. Imprisonment rates also have robust long-run effects on change in acquisitive crime rates.

Conclusions

Incorporating inflation into studies of crime and the economy can help to reduce the theoretical and empirical uncertainty that has long characterized this important research area in criminology.

     

Violent crime in Russia and the United States: 1990–1996

In spite of significant press attention to the dimensions of the crime problem in Russia during the 1990s, the scholarly literature on crime in Russia remains limited. In an attempt to address this limitation, this paper examines trends in violent crime in Russia during the period 1990–1996. To place the data in a comparative framework, we also examine data on reported violent crime in the United States during this period. Findings indicate the persistence of dramatically higher homicide rates in Russia, dramatic increases in reported robbery and aggravated assault rates, yet declines in rape rates. With the exception of homicide, violent crime rates remained below those in the U.S. We discuss implications of the findings and suggest additional research.     

Citizens’ knowledge and perceptions of legislatures in Canada,Britain and the United States

This study has two major parts. The first uses survey data to reveal what citizens in Britain, Canada and the United States know about their national legislatures and what factors ‐ including cognitive ability, opportunity, motivation and media exposure ‐ affect that knowledge. We find that US citizens are the least knowledgeable. The second part of the study looks at whether the level of knowledge in each country has any importance for understanding levels of public support for the national legislature. In the United States, the more knowledgeable citizens are less likely to support Congress, in sharp contrast to the tendency of knowledgeable Canadian citizens to be more supportive of their parliament. Knowledge is not a significant predictor of support in the British model. Some implications of the findings are discussed.     

The fox and the grapes: is real reform beyond reach in the United States?

As the challenges of maintaining (or, in the US case, attaining) affordable universal coverage multiply, the debate about what constitutes "real" reform intensifies in Western health care systems. The reality of reform, however, lies in the eyes of myriad beholders who variously enshrine consumer responsibility, changes in payment systems, reorganization, and other strategies -- or some encompassing combination of all of the above -- as the essential ingredient(s). This debate, increasingly informed by the agendas of health services researchers and health policy analysts, arguably serves as much or more to becloud as to clarify the practical options policy makers face and remains severely imbalanced with respect to the institutional sectors on which it concentrates, the fields of knowledge on which it draws, and the roles it envisions for markets and the state.