PUBLICS,PATIENTS, CITIZENS,CONSUMERS? POWER AND DECISION MAKING IN PRIMARY HEALTH CARE

This article uses theoretical approaches to the discussion of power in order to consider the role of public and patient participation in primary health care organizations in the UK. There is considerable evidence to suggest that, despite major national initiatives to extend participation in health services, the role of participation in decision making remains underdeveloped. The primary purpose of this article is to understand how and why this should be the case. Using findings from qualitative research that explored approaches taken by the dominant professional groups on primary care groups (PCGs) to involving patients and the public, we consider how these approaches reflect the exercise of different forms and levels of power. The explanation combines Lukes’ categorization of three forms of power with Bourdieu’s dynamic conceptualization of the relations of habitus and field. It is argued that the models observed represent different opportunities for the operation of power with implications for the role that participation can play.     

GROWTH AND QUALITY OF U.S. PRIVATE PRISONS: EVIDENCE FROM A NATIONAL SURVEY*

Research Summary: Private prisons incarcerate 5.3% of the sentenced, adult population in the United States. The present study presents selected results from a 1999 survey of administrators who monitored private prisons in the United States (or U.S. territories). Among the findings of interest, the private sector experienced significant problems with staff turnover, escapes, and drug use. Where possible, private prison operations were compared with those of the Federal Bureau of Prisons. Policy Implications: Given the issues raised here with public safety, public sector agencies contracting for private prisons need to develop incentives or other means to ensure that private sector operators retain experienced custody staff.     

CONTRIBUTIONS OF FAMILIES AND PEERS TO DELINQUENCY*

A model is presented that explains the contribution of parents and peers to adolescent delinquent behavior. It is hypothesized that during adolescence a failure in Parent Monitoring and deficits in Social Skills increase the likelihood that a youngster associates with Deviant Peers. Poor Parent Monitoring Deviant Peers, and low levels of Academic Skills are hypothesized to contribute directly to an adolescent's engagement in delinquent behavior, The present model was tested on a sample of 136 seventh and tenth grade male adolescents by using the structural modeling approach in the LISREL IV analysis program (Jöreskog & Sörbom, 1978). The major revision of the model was that the correlation between Academic Skills and Parent Monitoring was set to zero. A chi square goodness-of-fit test for the revised model showed adequate agreement between the hypothesized model and the observed covariance structure of the data. It was suggested that a number of requirements be completed before accepting the above model: (1) replication of this model on a new set of data, (2) longitudinal analyses showing the hypothesized relations through time, and (3) experimental testing by manipulation of one or more independent variables, as is possible in clinical intervention studies.