Books received

This paper is concerned with the role of education as a determinant of health care choices. The central premise of the paper is that utilisation of health services is determined not solely by an individual's own education, but rather by a notion of effective education, which incorporates the educational attainment of other household members. The paper sets out a general framework for representing intra-household education externalities, and proposes a number of specific hypotheses concerning the way in which the education of different household members affects health care choices. These hypotheses are tested on data from Mozambique, focusing on maternity services, child immunisations, and child malnutrition. We draw four major conclusions from the analysis. First, while maternal education seems to be the education variable of primary importance for the health service and malnutrition variables under consideration, the education of other household members does have a significant and sometimes large effect. This is true not only for the spouse, but also the education of other individuals residing in the household. Second, the analysis suggests that while the education of the person (non-spouse) in the household with the highest level of education is important, the level of education of additional household members does not, as a rule, affect the use of services or child health outcomes. Third, the data provide no evidence of a gender difference in education externalities. Fourth, we examine the merits of two alternative representations of the education externality, but are unable to conclude unambiguously in favour of one specification over the other.     

Participation and independence of consumers in a health systems agency

Health Systems Agencies (HSAs) were mandated to include representation of the community, broadly conceived. The implicit intention of the law was to include consumers as important and co-equal participants with providers in health planning. This paper is an examination of consumer participation in one ESA. Contrary to expectations derived from the literature, citizens in this HSA exercised independent judgment regarding the major issue to confront them. We conclude his was a function of the following: talents and skills of the consumer members; natural interest in health care policy by consumer board members, sympathetic and supportive provider board members; and the homogenous character of the population in the region served.     

Views of public health leaders in English local authorities – changing perspectives following the transfer of responsibilities from the National Health Service to local government

This paper reports on the findings of a research project that examined the changes to the public health system in England introduced in 2013. Drawing on case study research and two national surveys the findings explore the impact of organisational change on the composition and role of public health teams. Views and experiences were obtained from public health leaders involved in the transfer of staff and functions from the National Health Service in England to local authorities. National surveys at two points in time aimed to compare and contrast views on the evolving changes. The new organisational and managerial arrangements had enabled public health professionals to widen their work and influence, and public health skills and budgets were welcomed by those in local government. Initially, in some areas, directors of public health were less certain of the benefits of the transfer to local government compared to high levels of confidence expressed by elected members, but perspectives changed over time and moved closer together. National headline figures were found to mask high levels of turbulence and churn being experienced by individual authorities identified in the case study research, and the trend of reducing capacity through cuts to staff, budget and services was a cause for serious concern.     

Establishing a health promoting setting: an experience in an albanian polyclinic

A “health promoting polyclinic” based on the “health promoting setting concept” has been developed in Tirana, the capital of Albania. This paper discusses the implementation and intervention of the project, whereas the final evaluation results will be presented in another article. An important aspect of the whole program is the training of the administrators and staff members in the necessary skills relating to their allocated roles, such as creating a healthy environment, health education, outreach activities and total quality management. In this approach the International Relief Organization (IRO) acting as an external agent took the initiative of enabling, mediating and advocating, as well as providing support for the polyclinic's staff and its clients. The model appears to be effective in promoting health at the secondary health care level (the polyclinic). This may encourage health planners to adopt a similar concept at other settings i.e. general or specialized hospitals.     

MEMBERSHIP OF THE ‘NEW STYLE’ HEALTH AUTHORITIES: CONTINUITY OR CHANGE?

The 1989 White Paper 'Working for Patients' continued the process begun by Griffiths of managerial reform and the introduction of private sector concepts into the NHS. One of the new proposals was to change the composition and constitution of health authorities, both to avoid the assumed weaknesses of the existing format and to emulate the pattern found in the private sector.
The essence of the change was the removal of the representational elements on authorities, both of medical professionals and nominees from the local authority. The health authorities were reduced in size to just eleven members and for the first time executives were included. Previous attempts at reform within the NHS have been judged to have resulted in more continuity than change. This article examines in detail who the new members are and assesses the balance between continuity and change.
Despite a high level of continuity of membership, there are signs of more fundamental change. There is a significant increase in the proportion of non-executive members from the private sector and with the inclusion of executives, a stronger managerial role is emerging. The article concludes by assessing what the implications of these changes maybe.     

A pilot study of the suicide victim's last contact with a health professional

Suicide victims frequently have contact with health care professionals in the months before death. The primary aims of this pilot psychological autopsy study were to determine the feasibility of undertaking a full study and to describe the characteristics of the last health care professional contacts with suicide victims aged > 34 years. We interviewed the informants of 52 suicides. Interviews were obtained from 37 health care professionals who had contact with 28 of the suicides during the 3 months before death. The primary reasons for the last contact with the health care professional were mental health (62%), physical health (22%), and social (14%). 87% of health care professional contacts occurred within 1 month of death. Symptoms of depression were noted in 49% of health care professional contacts. Consensus psychological autopsy diagnoses of depression were made in 64% of suicide victims. Overall suicide risk was assessed by 38% of health care professionals during their last contact. This was more likely to occur when the deceased presented as depressed, was aged < 60 years or seen by a psychiatrist. None was assessed to be suicidal. The family informants regarded nine of the suicide victims to have been suicidal before death but informed a health care professional in only one third of the cases. Critical information that might have altered the management is not often accessed from family members.     

Mental Health Intervention with Hispanic Immigrants

Abstract

The underutilization of mental health services by Hispanic immigrants has been well documented in the literature. Hispanic immigrants encounter numerous obstacles which prevent them from successfully navigating through the mental health system. This reality is further compounded by the fact that research appears to suggest an increased rate of mental health disorders among Hispanics. This article underscores the importance of understanding the influence of a Hispanic client's worldview, language, and religion on the provision of mental health services. A case vignette is presented as a means of illustrating key conceptual points. Practice principles or conclusions drawn from this article should be used as a general guide by mental health practitioners.     

China's provincial diplomacy to Africa: applications to health cooperation

There is a prevailing view of China as a unitary actor in its relationships with African countries. This view is incomplete: on the contrary, China is a collection of provinces, autonomous regions and municipalities with myriad strategic ties to African countries, with decentralization shaping the current form of Chinese government and its level of efficiency. In this paper, factors have been explored for why Chinese provinces have played a role in foreign cooperation in health of African countries, in addition to trade and foreign direct investment. Incentives and disincentives for Chinese provinces to engage internationally in foreign cooperation and health assistance have been identified. The concept of paradiplomacy for health has been presented and this typology has been applied to the example of Chinese medical teams. Finally, we draw linkages between China and other members of Brazil, Russia, India, China, and South Africa.     

Sense of control: potentials for intervention.

A substantial amount of research has demonstrated that the sense of control is associated with numerous positive outcomes, including good health. Many aspects of the personal and social conditions of old age influence the control-health relationship. Environmental events associated with old age often place limits on the range of outcomes that are attainable by older people. Moreover, the association between control and indicators of health status may be altered by old age. Finally, old age may influence the relationship between control and various health maintenance behaviors. Aspects of the sense of control can be altered with small interventions that can enhance health specifically and the quality of aging in general. Given the relationship between control and health in old age, several possible factors may help explain or mediate this relationship including mechanisms of behavioral and cognitive change, and physiological adaptations. Despite the largely positive outcomes associated with increased sense of control, negative outcomes are also possible, especially when control is not desired or entails too much responsibility or other demands.     

Strategies used by Health Scrutiny Committees to Influence Decision-makers

The scrutiny function, designed to enhance and provide a counterbalance to executive decision-making, is a key element in the modernisation of public service delivery in England. Early research expressed concerns about the effectiveness of scrutiny however, with lack of responsiveness by local decision-makers being suggested as one of the main difficulties. This paper applies a model of political influence strategies drawn from the business sector to analyse the strategies which health scrutiny committees in eight local authorities adopted in order to influence decision-makers. The relevance of the model to health scrutiny is assessed, and possible implications for enhancing health scrutiny in the future are discussed.     

Health in the United States.

On the whole, the American people consider themselves healthy and, according to the major health indicators, they are becoming healthier all the time. The expectation of life at birth is one and one-half times what it was at the beginning of the century. Many of the leading causes of death have experienced significant declines in rates in the last decade. Nevertheless, the minority populations frequently lag behind the white population with respect to health indicators. Prevention in the health field is being stressed through immunization programs and programs to influence individuals to change their habits. Nutrition is playing a larger role in public life; considerable publicity has been given to dietary goals for promotion of good health. The health service industry has grown rapidly. Health care has expanded and its costs have trebled since 1970. In the 1980s, interest will undoubtedly focus on minority populations and health, on how the economically disadvantaged may better be served, on the effects of an aging population on the health care system, and on how life-styles which undermine health care can be changed. The U.S. Surgeon General has established national health goals for the 1980s that will improve the nation's health if they are achieved.     

Whom Do They Recruit?: Profiling and Recruitment in the PKK/KCK

Terrorist organizations use a proactive strategy in identifying potential candidates for recruitment. In such a strategy, miscellaneous vulnerabilities, grievances, and feeling destitute, inter alia, render certain individuals perfect candidates for terrorist organizations. It is therefore crucial to have an integrative approach to understand the interplay between the profiles of terrorists and their reasons to join terrorist groups on the one hand and processes of recruitment on the other. Proceeding from such a fulcrum, this article provides a general profile of the Kurdistan Workers’ Party [PKK]/Kurdistan Communities Union [KCK] members and various recruitment techniques used by this group. To this end, records of 2,270 group members were content analyzed, in addition to face-to-face interviews with 42 group members and a range of individuals from public and private institutions. Our findings suggest that a variety of individual and organizational factors influence individual paths toward terrorism.     

Pathological Teasing and Bullying Turned Deadly: Shooters and Suicide

Bullying, a form of interpersonal violence, has emerged in the 21st century as an important public health issue. Bullying during childhood and adolescence is a common problem and occurs almost universally. It may be viewed on a continuum as a relationship problem in which power and aggression are inflicted on a vulnerable person to cause distress. However, teasing and bullying can turn deadly. A deeply troubled youth, after years of chronic bullying, may decide he has no alternative but suicide. The Daniel Scruggs case is one such example. Alternatively, the troubled youth may be attracted to the violent hero presented in the media that demonstrates his power via weapons as in the cases of school shootings.

Why does bullying continue? Some of the problem is the belief that bullying is simply a part of growing up; adults who believe this are often unwilling to intervene. Bullies are not always easy to identify, as they are adept at concealing bullying behavior. Anti-bullying school programs have shown promise in reducing unacceptable behaviors. The next step is to educate teachers, law enforcement, and mental health staff members to identify the red flags of teasing and bullying that indicate an at-risk youth for either suicide or homicide.     

Healthcare,Policy Implementation,and Culture: What Cultural Values Influence Unpaid Primary Caregivers to Provide Care to Older Adults?

This research examines home healthcare programs implemented in Puerto Rico and Indiana. Puerto Rico is primarily a Hispanic territory of the United States, while Indiana is a culturally Anglo Midwestern state. This study explores the cultural values that influence unpaid care of older adults in these two settings. I hypothesize that dissimilar cultural values will influence care of unpaid primary caregivers (UPCs) in both jurisdictions. Results supported the hypothesis: UPCs emphasized different cultural values in caregiving. The study recommends that the federal government support families with essential services to enable them render badly-needed care to their elderly family members.     

Post-Accra: is there space for country ownership in global health?

Abstract

On 4 September 2008 the Accra Agenda for Action, which emphasised that country ownership over health must be strengthened, was agreed upon. While the Agenda for Action, which builds on the 2005 Paris Declaration, is a major step forward, there are still structural factors that impede developing country ownership in health. This paper outlines the key issues in the governance and resourcing of public health in low- and middle-income countries focusing on three major structural challenges for developing countries: the proliferation of initiatives, donor influence on priority setting and donors' lack of accountability, and the sustainability of current levels and types of external financing. How can these structural obstacles be overcome? Three avenues hold considerable promise: creating new mechanisms to hold donors to account, developing national plans and strengthening national leadership in health, and building South–South collaborative networks through bilateral, multilateral and plurilateral relations.     

Managing policy‐making in the local climate governance landscape: The role of network administrative organizations and member cities

Trans‐municipal networks (TMNs) have reshaped the landscape around local government action on global climate policy. Past research has focused on why cities join TMNs and the impact that membership has on local action. This study considers a potential reverse effect: namely, that cities' membership choices position them to influence TMNs' overall priorities. In considering this, we emphasize the role of network administrative organizations (NAOs) and posit that the multiple climate‐related networks, which share members and operate in overlapping geographic and issue spaces, are bound together as part of a meta‐network. We utilize social network analysis and data on membership in four climate‐related TMNs to examine the factors that shape how cities can influence meta‐network priorities. We find that cities with local vulnerabilities tend to be located in network positions that enable them to influence the meta‐network's overall priorities.     

THE ROLE OF POLITICIANS AND ADMINISTRATORS IN DEPARTMENTAL REORGANIZATION: THE CASE OF THE DEPARTMENT OF THE ENVIRONMENT

This article examines the history of the Department of the Environment from its creation in 1970 to the formation of the Department of Transport in 1976. Its main approach is an analysis of the roles of the Permanent Secretary and the Secretary of State in the development of the organization. The strong organizational relationship between these senior members of the department is an important factor in structural change both at the time of the initial reforms and throughout this period.
The influence of different personalities and their approaches to policy and management is considered as a determining factor in the evolution of the department. Additionally, the attempts at reorganization and reform are to be seen as largely developing within a traditional Whitehall framework, based on this relationship, which restricted its effectiveness.     

Reforms to enhance accountability and citizen involvement: a case study of the hong kong hospital authority

The article begins by examining current issues in thinking about accountability, citizen involvement and empowerment. The discussion then moves to the particular context of Hong Kong. Recent reforms to public hospital services are reviewed in the light of the territory's traditional values of paternalistic bureaucracy and minimal citizen involvement. It is shown that despite good intentions to enhance public accountability and cgitizen involvement, in practice there has been little substantive change in the distribution of power between the ruling elite, health care professionals, and the actual service users. Whilst more information about service performance may now be available, opportunities for citizen involvement and representation continue to be carefully managed by the administration. The net result is that only a very few members of the lay public have been appointed to the new bodies that are now responsible for the governance of the public hospitals. Nearly all of those appointed to such bodies are unrepresentative of the normal service users being drawn, instead, from members of the mostly non-public hospital users - namely Hong Kong's very wealthy professional and business elites. For most of the general public, therefore, the reforms have been less about empowerment and involvement and more about informing them of the changes that have been introduced or of educating them so that abuses of the system can be reduced, or their help enlisted in locally organized fund-raising functions. The article concludes that however well-meaning the reformers might have been in terms of endeavouring to enhance accountability and citizen involvement, the impact of such efforts are likely to be seriously limited whenever underlying administrative or social values conflict with those that ostensibly guide the reforms.     

DEVELOPMENTS IN THE PURCHASING PROCESS IN THE NHS: TOWARDS AN EXPLICIT POLITICS OF RATIONING?

The introduction of the internal market to the National Health Service in Britain marks a major change in the form of provision of health care interventions. This article reports the findings of independent research into the development of the purchasing process in eight purchasing authorities (which collectively purchase health care for 5 per cent of the population of Britain), and considers the extent to which this has led to an explicit politics of rationing in British health care. The structure and organization of purchasing organizations is described, along with their relationship with providers of health care. The ability of purchasing organizations to assess the health needs of the populations for which they purchase health care services, and their ability to influence change in the nature of the services provided, is also examined.