Health policy and the politics of research in the United States

During the past decade research has been more important to the health policy-making process in the United States than at any time in the past. This article describes and assesses three competing normative models for research on health affairs: economizing, social conflict, and collective welfare. The three models provide a context for the history of research bearing on health policy in the past half century, with particular pertinence to the years since 1980. The article concludes with a discussion of some of the consequences of the new legitimacy of research.     

The uncertain relationship between transparency and accountability

The concepts of transparency and accountability are closely linked: transparency is supposed to generate accountability. This article questions this widely held assumption. Transparency mobilises the power of shame, yet the shameless may not be vulnerable to public exposure. Truth often fails to lead to justice. After exploring different definitions and dimensions of the two ideas, the more relevant question turns out to be: what kinds of transparency lead to what kinds of accountability, and under what conditions? The article concludes by proposing that the concept can be unpacked in terms of two distinct variants. Transparency can be either ‘clear’ or ‘opaque’, while accountability can be either ‘soft’ or ‘hard’.     

First report from the Swedish National Forensic Psychiatric Register (SNFPR)

To the best of our knowledge, the present register is the only nationwide forensic psychiatric patient register in the world. The aim of this article is to describe the content of the Swedish National Forensic Psychiatric Register (SNFPR) for Swedish forensic patients for the year 2010. The subjects are individuals who, in connection with prosecution due to criminal acts, have been sentenced to compulsory forensic psychiatric treatment in Sweden. The results show that in 2010, 1476 Swedish forensic patients were assessed in the SNFPR; 1251 (85%) were males and 225 (15%) were females. Almost 60% of the patients had a diagnosis of schizophrenia, with a significantly higher frequency among males than females. As many as 70% of the patients had a previous history of outpatient psychiatric treatment before becoming a forensic psychiatric patient, with a mean age at first contact with psychiatric care of about 20 years old for both sexes. More than 63% of the patients had a history of addiction, with a higher proportion of males than females. Furthermore, as many as 38% of all patients committed crimes while under the influence of alcohol and/or illicit drugs. This was more often the case for men than for women. Both male and female patients were primarily sentenced for crimes related to life and death (e.g., murder, assault). However, there were more females than males in treatment for general dangerous crimes (e.g., arson), whereas men were more often prosecuted for crimes related to sex. In 2010, as many as 70% of all forensic patients in Sweden had a prior sentence for a criminal act, and males were prosecuted significantly more often than females. The most commonly prescribed pharmaceuticals for both genders were antipsychotics, although more women than men were prescribed other pharmaceuticals, such as antidepressants, antiepileptics, and anxiolytics. The result from the present study might give clinicians an opportunity to reflect upon and challenge their traditional treatment methods.     

‘The Woman was a Stranger’: childbirth and community in eighteenth-century England*

On 17 December 1766 James Field stood accused at the Old Bailey of the ‘wilful murder of a new born child, by casting it into a tub of water’. The case was exceptional in many ways—not only was the accused male but he and his family had removed themselves from the network of neighbourly interactions that characterised lower status life in this period. As a result, the court's deposition statements record ideas of belonging and community with unusual clarity. Using Field as a case study, this article explores the involvement of the local community in the experience of childbirth in the eighteenth century. It will argue that childbirth had an active role in the creation of neighbourhood, and momentarily captured shifting eighteenth-century understandings of community.     

Final position arbitration

Abstract. The tremendous upsurge in public-sector collective bargaining in the last decade has prompted a search for new types of dispute settlement, particularly in so-called essential services. The right to strike for public employees has not been accepted in many jurisdictions, particularly in the United States. Compulsory arbitration is rejected widely by both union and management representatives hecausc it fails to take into account the dynamics of the negotiating process, stultifying rather than encouraging bargaining. Final offer Selection is presented as a possible alternative to strikes and arbitration. The process has been utilized effectively in the United States, particularly in Michigan and Wisconsin. It has not received popular acceptance thus far in Canada, although the committee established to propose new labour legislation in hlanitoba has recommended it. The University of Alberta has used it for determination of faculty disputes and the Ontario Hydro Engineers have also used it. The Finkelinan Report on suggested changes in the federal public service legislatioii refers to it as a possible dispute-settling device. There are many variations of final offer arbitration but, in general, it requires that after negotiations have reached an impasse, an arbitrator, upon hearing the final positions of the parties, would select the ‘most reasonable’ offer. The arbitrator would not be free to compromise hut would be required to accept one pusition or the other in toto. The attractiveness of the process stems from the impetus given to reach agreement on as many issues as possible so that the gamble of convincing the arbitrator is lessened and he has fewer items to consider when making his choice. Thus, the theory stresses the importance of the parties being ‘reasonable’ in their demands. Critics of the system believe that it turns the adjudication process into a poker game and have referred to it as ‘industrial relations roulette.’ With all its disadvantages, to an organization like Michigan Firefighters Union, which cannot countenance a strike, or to the public, which must endure the inconvenience and expenses of strikes in the public service, final position arbitration has much to be said in its favour. Sommaire. L'énorme multiplication des négociations collectives dans le secteur public au cours de la dernière déennie a suscité des recherches pour trouver de nouveaux moyens de resoudre les différends, surtout en ce qui concerned les services dits ‘essentiels.’ De nombreuses juridictions, en particulier aux Etats- Unis, ont refusé le droit de grève aux employés du secteur public. L'arbitrage obligatoire est trés souvent rejeté par les syndicats comme par les employeurs, parce qu'il ne tient pas compte de la dynamique du processus de négociation et tend à restreindre les échanges plutôt qu'à les encourager. Le choix entre des offres définitives est considéré comme une possibilité par rapport à la gré ou à l'arbitrage. Ce processus a été utilisé efficacement aux Etats-Unis et plus particuliérement dans le Michigan et le Wisconsin. II n'a pas eu jusqu'à présent beaucoup de succès au Canada, bien qu'il ait été recom-niandé au Manitoba par la Commission chargée de proposer une nouvelle législation du travail. L'Université de I'Alberta s'en est servie pour résoudre des dif-férends avec le corps enseignant, mmme dailleurs les ingénieurs de l'Ontario Hydro. Le rapport Finkelman qui a proposé des modifications àA lég législation fédérale répissant la fonction publique le mentionne également comme un inoven possible de résoudre des différends II v a toutes sortes de variantes de l'arbitrage des offres définitives mais en général, cette méthode exige que l'arbitre, lorsque les parties àB la négociation se trouvent dans une impasse, et que leurs offres sont définitives, choisisse la ‘plus raisonnable.’ L'arbitre n'est pas libre de faire un compromis entre les deux, il doit accepter I'une ou l'autre des offres in toto. L'intérét de ce processus est qu'il incite les parties à faire tous les efforts pour arriver à un accord sur le plus de questions possibles de façon à réduire la discrétion de l'arbitre. Les parties ont ainsi intérêt àêtre ‘raisonnables’ dans leurs demands. Les critiques du système ont peur que ce genre d'arbitrage transforme le processus d'adjudication en une partie de poker et certains ont appelé l'arbitrage des positions définitives ‘la roulette des relations industrielles.’ Malgé tous ces inconvénients, l'arbitrage des offres définitives demeure attrayant pour le svndicat des pompiers du Michigan qui ne peut pas envisager la grève et pour le public qui doit supporter les désagréments et !es coûts des gréves dans le service public.     

The efficacy of foot patrol in violent places

Objectives

This study examines the effectiveness of foot patrol in violent micro-places. A large urban police department deployed foot patrol in micro-places (hot spots) for a period of 90 days for two shifts each day. Our objective is to determine whether this activity impacted violent crime in these hot spots and whether spatial displacement of crime occurred.

Methods

Eight eligible foot beat locations were set by examining crime rates for previous years in order to identify micro-places of high criminal activity. We employed a quasi-experimental design comparing the four treatment to the four control areas, estimating panel-specific autoregressive models for 30 weeks prior to and 40 weeks after the treatment.

Results

Time series models revealed statistically significant reductions in violent crime in the micro-places receiving foot patrol treatment, while no such reductions were observed in the control areas. The deterrent effect, however, was short and dissipated quickly. Control areas did not experience any crime prevention benefit during this time period. No evidence of crime displacement to spatially contiguous areas was detected.

Conclusions

This contributes to the growing body of knowledge that focused police strategies within hot spots impact violent crime. Specifically, the implementation of foot patrol in high crime hot spots led to measurable reductions in aggravated assaults and robberies, without displacing crime to contiguous areas.