Health-Care Reform, Managed Competition, and Subnational Politics

"Managed competition" is Congress' likely response to health-carereform. At the center of managed competition are regional healthinsurance cooperatives or alliances. In some states, these allianceswill face daunting numbers of uninsured and underinsured peopleand a hostile reception from business leaders and state governmentofficials. In other states, alliances may be welcomed as a logicalextension of current efforts to expand access to health care.Uneven support for alliances among the states will affect theimplementation of reform, as is typically the case in federallyorganized programs. However, the visibility, power, and financialresources of alliances will also affect state governments. Henceforth,American federalism may include three centers of power, notjust two, and the impact on state politics could be profound.     

Reviews

Scribe, Griot and Novelist: Narrative Interpreters of the Songhay Empire by Thomas A Hale. University of Florida Press, Gainesville (Florida, U.S.A.), 1990. xiv plus 313 pp. including notes, bibliography and index. £23.06. Hardback.

General History of Africa VII. Africa under Colonial Domination 1880–1935 (abridged edition) edited by A. Adu Boahenforthe UNESCO International Scientific Committee for the Drafting of a General History of Africa. UNESCO (Paris), University of California Press (Berkeley) and James Currey (London), 1990. xxi plus 387pp. including illustrations, bibliography and index. £4.95. Paperback.

South Africa: Constitutional Development ‐ A Multi‐disciplinary Approach by Donovan Marais. Southern Book Publishers, Johannesburg, 1989. 315pp. Notes and index. R37.50. Paperback.

Transport Planning for Third World Cities edited by Harry T. Dimitriou. Routledge, London, 1990. xxii plus 432pp. including figures, tables, notes, bibliography and index. £40.00. Hardback.

The Founder: Cecil Rhodes and the Pursuit of Power by Robert I. Rotberg with Miles F. Shore. Oxford University Press, New York, 1989. xxii plus 800pp. including maps, illustrations and bibliography. $35.00 and £25.00.

The Development of the Executive underthe Nigerian Constitutions, 1960–81 by J.D. Ojo. Ibadan University Press, Ibadan, 1985.189pp.

Cultural Forces in World Politics by Ali A. Mazrui. James Currey, London 1990.262pp. R46.60. Paperback.

Urban Markets ‐ Developing Informal Retailing by David Dewar and Vanessa Watson. Routledge, London, 1990. xii plus 154pp. £30.00. Hardback.

State‐Administered Rural Change: Agricultural Cooperatives in Kenya by Björn Gyllström. Routledge, London and New York, 1991. xvii plus 319pp. including figures, tables, appendices, notes, bibliography and index. Hardback.

The African Frontier: The Reproduction of Traditional African Societies. Edited and with an introduction by Igor Kopytoff. Indiana University Press, Bloomington and Indianapolis. 1987. vii plus 288pp. including maps, notes and index. R70.15. Hardback.

Studies in the Economic History of Southern Africa. Volume Two: South Africa, Lesotho and Swaziland edited by Z.A. Konczacki, Jane L Parpart and Timothy M. Shaw. Frank Cass & Co. Ltd., London, 1991. xvii plus 290pp. including maps, figures, tables, notes, bibliography and index. £35.00 Hardback. £19.50 Paperback.

Incentives and Agriculture in East Africa by Mats Lundahl. Routledge, London, 1990.223pp. Hardback.

African Agriculture: The Critical Choices edited by HA Amara and B. Founou‐Tchuigoua. UN University Press, Tokyo and Zed Books, London, 1990. 227 pp. Paperback.

A History of Agriculture in West Africa: A Guide to Information Sources by S.C. Saha. Studies in African Economic and Social Development, Volume 6, The Edwin Mellen Press, New York and Lampeter, Wales. 136pp. $49.95. Hardback.

Ethnographic Decision Tree Modelling by Christina H. Gladwin. Sage University Paper Series on Qualitative Research Methods Vol.9. Beverly Hills CALSage, 1989.96pp. $6.50. Paperback.

Samora Machel: A Biography by lain Christie. London: Panaf 1989. 181pp including photographs, bibliography and index. Paperback.

Mozambique: Norwegian Assistance in a Context of Crisis by Grete Brochmann & Arve Ofstad. Fantoft: Christian Michelsen Institute, 1990. vii plus 173pp. including tables, bibliography and index. Paperback.

Self‐Employment for Disabled People: Experiences from Africa and Asia by Malcolm Harper and Willi Momm. International Labour Office, Geneva, 1989. viii plus 85pp. Swiss Francs 15. Paperback.

Technology, Gender and Power in Africa by Patricia Stamp. Ottawa, Ontario, International Development Research Centre, 1989. x plus 185pp. Paperback.

The Devils are Among Us: The War for Namibia by Denis Herbstein and John Evenson. Zed Books Ltd., London, 1989. ix plus 202pp. including maps, photographs, bibliography, glossary and index. Paperback.

Zimbabwe: A Model for Namibia? A Comparison of Events in Zimbabwe‐Rhodesia 1979–1980 with the Situation in SWA in 1989by Ted Sutton‐Pryce. Academica, Pretoria, 1989. vii plus 77pp. including photographs and acknowledgements. R12.50 plus VAT. Hardback.

The Failure of the Centralised State: Institutions of Self‐Governance in Africa edited by James S. Wunsch and Dele Olowu. Westview Press, Boulder, San Francisco and Oxford, 1990. viii plus 334pp. including tables, notes, bibliography and index. Paperback.     

The Responsible Administrator Has The Ethics Edge

Books reviewed:
Terry L. Cooper, The Responsible Administrator: An Approach to Ethics for the Administrative Role
Evan M. Berman, Jonathan P. West, Stephen J. Bonczek, eds., The Ethics Edge     

The Death of Freddie Gray and Its Impact on Homicides in Baltimore and Maryland

This study evaluated the impact that Freddie Gray’s death on April, 19, 2015, had on homicides within Baltimore, Prince George’s County, and the rest of Maryland. The numbers of these deaths were compared in the 2 years prior and after his death. The average number of homicide per month in Baltimore and Prince George’s County, but not the rest of Maryland, showed a statistically significant increase in the 2 years after his death, with a sudden spike in homicides in Baltimore immediately following his death. Spatial density (“heat”) maps of homicides showed an increase in clustering of deaths after Freddie Gray’s demise in portions of Baltimore, particularly near his arrest site. Hot spot maps showed a massive expansion of statistically significant clusters of homicides in areas of West and East Baltimore after his death. An emerging hot spot analysis revealed consecutive hot spots in large areas of West Baltimore with new hot spots prominent along the southern edge of this area. A review of the history of Baltimore, as well as discussions with Baltimore homicide detectives, revealed that prior socioeconomic and political trends likely primed Baltimore for the protests and violence that occurred after Freddie Gray’s death. It is probable that a perceived “overcharging” of officers involved in his death by the State’s Attorney resulted in a “pullback” from policing that directly led to increased homicides in Baltimore.     

WaSH as a maternal health issue: three perspectives from rural Uganda

Inadequate water, sanitation, and hygiene (WaSH) knowledge and practices affect maternal and newborn morbidity and mortality. This article describes postpartum knowledge, resources, and practices in three rural Ugandan hospitals. A lack of WaSH resources was problematic for both staff and newly-birthed mothers who demonstrated a lack of knowledge about the appropriate use of WaSH resources and the links between WaSH and health protection. These results suggest that in addition to increasing the availability of medical interventions, basic preventative public health practices should be reflected in policy and practice integrated across the spaces inhabited by pregnant women to achieve improved maternal and newborn outcomes.     

Mum's the Word: the cycling career of Beryl Burton, 1956–1986

The English cyclist, Beryl Burton, was one of the few women athletes whose performances matched and sometimes surpassed those of men. Despite the potential threat to hegemonic gender relations thus posed, Burton was, with the important exception of a well‐publicised disagreement with her fellow‐cyclist daughter, Denise, an uncontroversial figure and much respected within the male sporting community. While many personal and sporting factors contributed, this was largely the result of her highly public performance of her roles as wife and mother. However, those roles were also skilfully constructed so as to generate the maximum space for her development as an elite athlete. As a woman and as an amateur, she received less media attention than she deserved in her lifetime and, despite being one of the greatest athletes of all time, has received little serious scholarly or wider public attention since her death.     

The Moderating Role of Spirituality in the Association between Stress and Substance Use among Adolescents: Differences by Gender

Adolescents are exposed to various stressors that may increase the risk for substance use. Due to the detrimental, and potentially long-lasting, effects related to substance use, it is necessary to explore more optimal coping strategies. This study explored the association between substance use and stress among male and female high school students in relation to spirituality as a moderator. To examine these relationships, the study used cross-sectional data collected from 27,874 high school students (Male?=?50.7%, Female?=?49.3%) across 58 high schools in Maryland that included an ethnically diverse sample (49% Caucasian, 30% African American) with an average age of 16 years old. Bivariate results showed differences in substance use, stress, and spirituality between male and female students. Higher rates of substance use were generally found among male students compared to female students; rates tended to be higher among female students for stress and spirituality compared to their male counterparts. Multilevel analyses indicated a positive association between stress and substance use among male and female students after adjusting for demographic and school-level factors. Both male and female students who reported turning to spiritual beliefs when experiencing problems were less likely to use substances. However, the interaction between stress and spirituality was significant for males only. These findings suggest that stress may increase the propensity for substance use and that spirituality might be a viable coping mechanism useful for helping high school students adapt to stressful circumstances and situations.     

School Climate for Transgender Youth: A Mixed Method Investigation of Student Experiences and School Responses

Transgender youth experience negative school environments and may not benefit directly from interventions defined to support Lesbian, Gay and Bisexual (LGB) youth. This study utilized a multi-method approach to consider the issues that transgender students encounter in school environments. Using data from two studies, survey data (total n = 2260, 68 transgender youth) from study 1 and focus groups (n = 35) from study 2, we examine transgender youth’s experience of school harassment, school strategies implemented to reduce harassment, the protective role of supportive school personnel, and individual responses to harassment, including dropping out and changing schools. In both studies, we found that school harassment due to transgender identity was pervasive, and this harassment was negatively associated with feelings of safety. When schools took action to reduce harassment, students reported greater connections to school personnel. Those connections were associated with greater feelings of safety. The indirect effects of school strategies to reduce harassment on feelings of safety through connection to adults were also significant. Focus group data illuminate specific processes schools can engage in to benefit youth, and how the youth experience those interventions.