Co-Production and Health System Reform – From Re-Imagining To Re-Making

There is growing interest in the application of citizen participation within all areas of public sector service development, where it is increasingly promoted as a significant strand of post-neoliberal policy concerned with re-imagining citizenship and more participatory forms of citizen/consumer engagement. The application of such a perspective within health services, via co-production, has both beneficial, but also problematic implications for the organisation of such services, for professional practice and education. Given the disappointing results in increasing consumer involvement in health services via 'choice' and 'voice' participation strategies, the question of how the more challenging approach of co-production will fare needs to be addressed. The article discusses the possibilities and challenges of system-wide co-production for health. It identifies the discourse and practice contours of co-production, differentiating co-production from other health consumer-led approaches. Finally, it identifies issues critically related to the successful implementation of co-production where additional theorisation and research are required.     

Re-slicing the Big Apple: New Immigrants and African-Americans in the New York Economy

The continuing convergence of immigrants on New York City is a puzzle. On the one hand, the decline of the city's manufacturing sector and the growth of advanced services appear to provide little demand for immigrant labor; on the other hand, the deep penetration of immigrants into the city's economy has been paralleled by a deteriorating employment situation among native blacks. This article, seeks to unravel this puzzk in the light of two conflicting perspectives, the restructuring and the replacement labor hypotheses. The paper assesses each perspective using data from the 1970 and 1980 Censuses of Population and merged sampks of the June 1986 and 1988 Current Population Surveys.     

Knowledge and attitudes about AIDS: A comparison of public high school students,incarcerated delinquents,and emotionally disturbed adolescents

This study compared AIDS knowledge and attitudes in public high school students (N=167), incarcerated delinquents (N=166), and emotionally disturbed (SED) adolescents (N=151). The response measure was a 50-item Acquired Immunodeficiency Syndrome (AIDS) questionnaire that was previously used by Bell et al., in their 1991 study of learning disabled adolescents. Although AIDS knowledge was moderately high in all three groups, widespread misunderstandings about disease transmission and awareness of high-risk groups and practices were noted. Knowledge scores were significantly higher in the public school sample than in the SED adolescents; moreover, they tended to be slightly higher (p<0.10) than the delinquent group as well. Teenagers with the severest emotional problems were by far the least informed. Age and race were also predictive of AIDS knowledge. Other results showed that delinquents were more permissive in their attitudes about sex, more inclined to disdain safe sex practices, and more likely to feel threatened by high-risk groups as well as powerless to protect themselves against AIDS. Generally speaking, the findings extend the work of other investigators on the needs for AIDS education in adolescents. The need is especially urgent in delinquent and emotionally disturbed youth who may require a more comprehensive intervention because of their greater knowledge deficits, propensity for high-risk practices, and tendency to deny or underestimate their own vulnerability.Received Ph.D. in clinical psychology from the University of Utah in Salt Lake City. Research interests include health behavior change and the treatment of anxiety and habit disorders. To whom correspondence should be addressed.Received M.A. degree in psychology from the University of the Pacific. Research interests include health behavior change and medical epidemiology.Received Ph.D. in psychology from the University of Auckland, Auckland, New Zealand. Research interests are in child and adolescent psychiatry and the delivery of mental health services.Received Ph.D. in biostatistics from the Medical College of Virginia. Research interests are in general linear models.     

On the political economy of state highway expenditures: Some evidence of the relative performance of alternative public choice models

This paper explores the extent to which the public demand for roads and/or power of special interest groups determines road expenditures at the state level using an extension of the methodology developed in Congleton and Shughart (1990). Reduced form models of median voter demand, special interest group equilibria, and a combined model are estimated using cross-sectional state data from the United States. We generally find support for the hypothesis that voting matters. The pure median voter models have a better fit than the pure special interest group models. Moreover, in our combined model, we find that variables from the median-voter model can not be dropped without significantly reducing the combined model's fit.