Block grants and state discretion: A study of the implementation of the partnership for health act in three states

This article examines the use of federal funds provided to state health departments under a grant consolidation of eight previously categorical health programs in Michigan, Pennsylvania, and Alabama in a comparative context. The primary question addressed is why the three states chose to describe their allocations of funds within the total health department budget differently, and what political, administrative, and bureaucratic factors explained the differences. Although certain factors were found to be at work in all states (e.g. each had an incentive to concentrate the reported use of federal funds to simplify federal audits) these factors combined with circumstances unique to each state to produce different expenditure patterns. After examining the experience of three states, general hypotheses are developed. For example, it is hypothesized that more volatile changes in allocations will result from grant consolidations in policy areas which do not address basic service needs. Finally the decision-making process with respect to block grant funds is characterized as one in which a small group of professionals determined allocations autonomously with relatively little input from interest groups or other actors within state government; nevertheless, the external political and administrative environment severely limited the possibilities of realistic choice in each of the three states studied.I wish to thank the National Center for Health Services Research which supported this study under grant HS 01495. I am indebted to the state health department officials in Alabama, Michigan, and Pennsylvania who made this research possible. I would also like to thank Leonard Robins, Janet Shikles, William Schmalzreid, Bruce Vladeck, John Kingdon and Robert Baitty for comments on an earlier draft. Of course the views expressed are my own and in no way reflect the positions of the Department of Health and Human Services.     

Executive Succession and the Performance of Public Organizations

A theoretical framework is developed for the analysis of the impact of executive succession in public organizations. The central concepts in the model are the motives of chief executives, the means at their disposal and the opportunities available for influencing performance. The main hypothesis that flows from the model is that the effect of executive succession is likely to be small but significant. Furthermore, the strength of the impact of succession is contingent on a variety of external and internal circumstances. Seventeen testable hypotheses concerning these contingency effects are presented as a research agenda for studies of top management change in the public sector. The theoretical arguments are illustrated with reference to UK local government.     

Genotyping the future: scientists' expectations about race/ ethnicity after BiDil

The ongoing debate about the FDA approval of BiDil in 2005 demonstrates how the first racially/ethnically licensed drug is entangled in both Utopian and dystopian future visions about the continued saliency of race/ethnicity in science and medicine. Drawing on the sociology of expectations, this paper analyzes how scientists in the field of pharmacogenetics are constructing certain visions of the future with respect to the use of social categories of race/ethnicity and the impact of high-throughput genotyping technologies that promise to transform scientific practices.     

Comparative urban social indicators: Problems and prospects

The increasing availability of urban social indicators offers the possibility of an overall quality of life measure which can be used to compare cities. Several solutions to the problem of combining the individual indicators into an overall comparative measure are considered in this article. The most promising results were obtained by grouping cities according to the similarity of their profiles on the social indicators. Yet the value of the comparisons remains speculative because of serious limitations in the indicators. While a number of improvements are possible, the resulting indicators will still only be adequate for use in gross comparisons of metropolitan areas.     

Political Parties and Democratic Consolidation in Africa

With the collapse of the Soviet bloc it was widely assumed that Cuba would be the next domino to fall. But now over ten years has passed since the demise of communism and the Castro regime is still in power with no signs of capitulation. However most analysts of contemporary Cuba still assume it is only a matter of time before the island succumbs to the forces of the market and the politics of liberal democracy. Indeed, for the regime to have resisted for so long is seen as illogical and counterproductive. Contrary to such mainstream views, this article argues that the encouragement of popular involvement in the revolution, especially through the mechanism of participation, has given the regime hidden strengths which may not only have secured its survival under extreme duress but could also offer a route through which it might emerge from the crisis. In this context the most important issue at stake in Cuba is not how quickly it can integrate with the global market or how long it can hang on to the remnants of Soviet‐style central planning, but rather how popular participative democratic practices can be channelled into an alternative development model aimed at satisfying basic needs and promoting selective engagement with the world market on terms decided by a politically engaged population.