Suicide rates and mental health services in modern China

Suicide rates in China have in the past been reported to be very low for a variety of historical and political reasons. In recent years, however, the reported suicide rates in China have increased alarmingly among certain age groups. This article reviews reports of the national rural suicide rates in China for 1992, gathered from the Annal of Chinese Public Health, which has previously never been reported publicly. The highest suicide rates occur in the rural areas and among young women and men over 60 years. These data reveal that suicide in China may have some unique characteristic associated with a variety of socio-cultural variables, such as traditional culture, social class, economic status, health care levels, and interpersonal problems. The author shows that lack of mental health services in rural areas in China may be considered one of associated reasons to the high rural suicide rate in China.     

Performance measurement and financial incentives for community behavioral health services provision

This article analyzes the uses of performance measures in contracting for behavioral health services. A flexible performance measurement methodology, called Data Envelopment Analysis (DEA),is used to measure cost efficiency and cost effectiveness. The use of measures in controlling costs, allocating program funds and administrating performance-based contracting is demonstated.     

Consequences of increased third-party payments for health care services.

The growth of third-party programs to pay the costs of health care has occurred in an unplanned manner. As a result, the country presently is faced with a number of uncoordinated payment programs that sometimes work against each other. While the expansion of health insurance programs has provided the financing necessary to keep our health care system up-to-date, and while such programs doubtlessly have reduced the financial barriers to seeking health care for some population segments, health insurance also has produced some problems. Generally, the contribution of health insurance to these problems is subtle and cannot be quantified. Yet, policymakers increasingly are recognizing that there are factors at work in our health care system that, if continued unabated, will exacerbate the country's health care cost problem. Many of these factors owe their existence to the socially unacceptable incentives provided by most health insurance programs. This article focuses on some of the adverse consequences of health insurance programs and indicates that the future of private health insurance depends upon how these problems are addressed.     

New Labour's modernization in the public sector: a neo-Durkheimian approach and the case of mental health services

Five accounts of New Labour's style of public management reform can be identified in the recent academic literature. Although each has merits, none is wholly convincing. After a discussion of their scope and limits, this article offers a distinctive account, grounded in wider social theory, which also synthesizes the most valuable elements in the five mainstream accounts. The article then uses the case of New Labour's reforms of the mental health system to support this account, showing how it exemplifies each of the 15 major strands of reform activity that have together been the hallmark of what in practice New Labour has meant by 'modernization'. This provides the basis for a critique of the limits and dangers of the New Labour style.     

The personal social services

The Future of London's Government: Research and Consultation Project by the Greater London Council, GLC, March 1986, pp.240. (Free ‐ available from Room 708, London Strategic Policy unit,. Middlesex House, 20 Vauxhall Bridge Road, London SW1V 2SB.)

Welfare Rights Work in Social Services, Geoff Fimister, Macmillan, 1986, pp.166, £15.00 hardback, £5.95 paperback.

The Structure of Local Government in the European Community and The Structure of Local Government in 20 Arab Countries, compiled by Eileen Martin Harloff, WLA, The Hague, 1986, pp.74 and 64 respectively, each $6.00 IULA members; $10,000 others.

Decentralized Economic Development Activities and their Implications for In‐Service Training, Andrew Coulson, Local Government Training Board, 1986, pp.10, £6.00 (£3.00 for local authorities).

Council Non‐Manual Workers and Low Pay, Nasreen Rahman, Low Pay Pamphlet No. 41, Low Pay Unit, June 1986, £3.00.     

The administration of human services.

Human service programs have gone from a period of rapid growth in the 1960s and early 1970s to a period of retrenchment in the 1980s. The changing political and economic context has forced these programs to undergo major organizational transformations and to adopt different administrative strategies. These include degovernmentalization of social services, reliance on cutback management, and deprofessionalization of human-service workers. The article explores the implications of these developments on the delivery of services to the public.     

The Russian health crisis and the economy

Russia experienced a severe health crisis in the 1990s, as reflected by a drop in life expectancy. It has been suggested in literature that this poor state of health is likely to endure and will significantly retard economic growth in the country. This paper uses evidence from other former Communist countries and studies of income–health relationship across economies to evaluate these claims. It concludes that the mortality increases of 1988–94 and 1999–2000 were the effects, rather than causes, of the economic recession. The state of health is unlikely to put a brake on future economic growth.     

The relationship between competition and efficiency of waste-collection services in the Czech Republic

This paper examines the role of the competition on the waste-collection market. Based on the case study of the Czech Republic, we evaluate the influence of competition intensity on supply side of the market on efficiency of waste-collection services. The rate of competition was approximated by the number of submitted bids to public tenders and efficiency was measured by per capita expenditures for municipal waste-collection services. We developed two regression models – the first model verified a competitive effect on the public procurement market for the provision of waste-collection services; the second model identified factors that affected municipal expenditures for waste-collection services per capita. We concluded that the competition in the waste-collection market increases by organising open tenders for suppliers at regular intervals, by adapting the duration of contracts to economic life of fixed assets, by sustaining pressure on service providers through a change in suppliers or the distribution of contracts among jurisdictions.     

The world population situation

Population experts appear to be reaching a consensus that there has been a perceptible decline over the last decade in the growth of the world's population. The decline is accounted for by the "new demographic transition" in the less developed countries (LDCs). The decline in fertility rates began in the 1950s in some LDCs and became more widespread during the 1970s. The process has not yet begun in many of the LDCs. During the 1960s it was observed that the declines in birth rates (to levels of 30 of less per 1000) were occurring mostly in small countries. Many of these countries were islands with levels of social and economic development above the developing country average. The key question is whether the recent downward trend in fertility in LDCs will continue, stabilize at the current level, or rise again. A primary concern about the future is that the poorer and less developed countries will end up with an increasing share of the world's population, with the share of the developed countries declining from 34% to 22% over the 1950-2000 period. Considerable differential exists in demographic growth patterns among various regions. The 12 largest LDCs (China, India, Indonesia, Brazil, Bangladesh, Pakistan, Nigeria, Mexico, Vietnam, Philippines, Thailand, Turkey) contain 55% of the current world population, and the fertility decline of these nations is expected to have the maximum impact. 7 of these countries have had fertility declines of 14-35%. The force of the "population momentum" must also be considered. Most developing country populations have a young age distribution with considerable potential for population growth even after the fertility level reaches a replacement level and the net reproduction rate equals 1.     

The public valuation of religion in global health governance: spiritual health and the faith factor

ABSTRACT

This article explores how the role of religion is evaluated in global health institutions, focusing on policy debates in the World Health Organization (WHO) and the World Bank. Drawing on Luc Boltanski and Laurent Thévenot’s pragmatist approach to justification, I suggest that religious values are creative and worldly performances. The public value of religion is established through a two-pronged justification process, combining generalizing arguments with particularizing empirical tests. To substantiate the claim that abstraction alone does not suffice to create religious values in global public health, I compare the futile attempts of the 1980s to add ‘spiritual health’ to the WHO’s mandate with the more recent creation of a ‘faith factor’ in public health. While the vague reference to some ‘Factor X’ inhibited the acceptance of spiritual health in the first case, in the second case, ‘compassion’ became a measurable and recognized religious value.     

The health care state in the information age

The computerization of the medical record has important implications for the governance of health care, and the importance of health care means that changes wrought there are indicative of changes in government as a whole. This paper draws on work in public policy, medical sociology and studies of science and technology, as well as on cross–national empirical research in Britain and France. It describes the recent development of information policy in health care as an exercise in state–building, realized specifically in the governance of the health professions. The paper concludes with a discussion of what is both new and not so new in the form and extent of state power which emerges.