1993 health guide. Top 10 health stories to watch

A sea change seems likely in the way health care is delivered. In medicine, public health and nutrition, here's what else the year will bring.     

The economics of the women's movement

In recent years, the political process has seemed to become increasingly favorable to issues involving women, as shown by the relatively large number of states which have passed the Equal Rights Amendment. The economic theory of politics would imply that this result would occur if the interests of women in removing labor force sex discrimination had increased. We argue that most sex descrimination in hiring and pay of women is in the form of statistical discrimination where sex is used as a proxy for labor force attachment. If this is so, then, on net, sex discrimination in employment practices would pay in the sense that the gainers from such behavior would gain more than the losers would lose. Married women would share in such gains since they would be compensated for their lower earnings by the higher earnings of their husbands. Single women, however, would receive no such compensation. We therefore hypothesize that the recent increase in legislation benefitting women is related to marriage rates, not to female labor force participation. Using votes in the state legislatures on the ERA as a measure of success by state of the women's movement, we find that our results do hold — number of single women is significant in explaining such voting but female labor force participation is not significant.     

The state of nature and the evolution of political preferences

Analysis of governmental institutions often proceeds from ahypothetical 'state of nature', according to which humans areanalyzed as if they once existed as solitary individuals withno rules. Humans have never existed as humans in such an environmentbut have always been a group-living species. Rules have evolvedwith humans and were never 'created' de novo. Evolved ruleshave implications for contemporary governance. Human groupshave always been in conflict, and rules distinguish betweengroup members and outsiders. These rules have proved remarkablyflexible. Some rules regulate private conduct of group members.Although the desirability of these rules today is unclear, Iargue that a libertarian regime would have been unstable, whichmay explain why there are few persons with tastes for libertariangovernments. This analysis further explains why utility functionscontain elements of envy. Rules of property, contract, and hierarchyare well developed and universal among humans.     

Legal aid for coroners' inquests

Inquests held into deaths perform important functions, not only in determining the facts relevant to the death, but also in investigating and making recommendations on matters of public safety. Coronial legislation allows a number of parties to appear at inquests but a right of appearance without the possibility of legal representation is an illusory right. There are persuasive arguments for allocating funding for grants of legal aid to persons appearing at inquests and particularly to families. However, the demands on public legal aid funds are overwhelming and there are many competing needs. Historically, legal aid has not been available at inquests. Justifications for this are considered and whether government legal aid funding for advice and representation should be available to individuals involved in coroners' inquests and in what circumstances. The nature of the inquest process, indications of need for legal assistance, the level of assistance currently provided, defining what is the "public interest" for legal aid purposes in an inquest and the detriment suffered by individuals or the community if assistance is not available, are examined.     

Governing the multicultural city‐region

Abstract: This article reports on a study that identified the challenges posed by large immigrant populations for the governments of eleven Greater Toronto Area municipalities and the way those challenges were being addressed by municipal agencies that provided nine local services: government‐assisted housing, land‐use planning, policing, public education, public health, public libraries, public recreation, public transit, and social services. Many of the agencies were trying to accommodate their multicultural clienteles in a variety of ways. There were large differences in agency responses, however, not only among municipalities but also among agencies providing different services within the same municipality, and even among district offices of the same municipal agencies. Moreover, municipal agencies often found it difficult or impossible to adapt to new clienteles, even when they were seriously committed to doing so, in the face of provincial government indifference, cuts in provincial and local funding, and community ambivalence or antagonism. The study concluded that municipal agencies are unlikely to devote many resources to helping the immigrant settlement process without financial and legislative support from central governments. Sommaire: Le présent article porte sur une étude qui a cerné les défis que posent d'importantes populations d'immigrants aux gouvemements de ome municipalités de la Région du Grand Toronto, et sur la manière dont ces défis ont été relevés par des organismes municipaux assurant neuf services locaux: logement subventionné par le gouvernement, aménagement du territoire, services de police, enseignement public, santé publique, bibliothèques publiques, loisirs publics, transport en com‐mun et services sociaux. Un grand nombre de ces organismes ont essayé de répondre aux besoins de leurs clientèles multiculturelles par différents moyens. Cependant, les écarts étaient grands dans la manière d'y parvenir, non seulement parmi les municipalités mais également parmi les organismes foumissant différents services au sein de la même municipalité, et même parmi les bureaux de districts des mêmes organimes municipaux. En outre, les organismes municipaux trouvent souvent qu'il est difficile, voire même impossible, de s'adapter à de nouvelles clientèles, même lorsqu'ils se sont sérieusement engagés à le faire, face à l'indifférence du gouvemement provincial, aux compressions budgétaires à I'échelle provinciale et locale, et face à I'ambivalence ou à I'antagonisme de la colledivité. L'étude a conclu qu'il y avait de fortes chances que les organismes municipaux ne consacrent pas d'énormes ressources à I'aide au processus d'établissement des immigrants s'ils ne reçoivent pas un appui financier et législatif des gouvernements centraux.     

Altruism and Self Interest in Medical Decision Making

We seem to prefer that medicine and medical care be provided through altruistic motives. Even the pharmaceutical industry justifies its behavior in terms of altruistic purposes. But economists have known since Adam Smith that self-interested behavior can create large and growing social benefits. This is true for medical care as well as for other goods. First, I consider specifically the case of pharmaceutical promotion, both to physicians and to consumers. I argue that such promotion is highly beneficial to patients and leads to health improvements. I consider some criticisms of promotion, and show that they are misguided. I then provide some evolutionary explanations for our erroneous beliefs about medical care.     

Policy Design and Achieving Social Outcomes: A Comparative Analysis of Social Enterprise Policy

This article compares American, British, and Korean social enterprise policies to explore how government policy design shapes social enterprises and how “social benefit” and “public value” are defined. A social enterprise is defined as the legally structured organizational pursuit of blending social purpose and economic profit through business activities, and examples from each country are presented. Applying Bozeman's publicness theory, the authors demonstrate the wide range of roles that governments play in shaping social enterprises' ownership, funding, and control across the three countries using regulations, subsidies, and procurement policies. These roles may affect the impact of social enterprises in society. The case studies show that the U.S. approach to social enterprise policy is heavily market oriented, while the United Kingdom is in the middle of the market-to-publicness continuum, and South Korea is much closer to the publicness (government-dominated) end of the continuum.