Parallel Systems and Human Resource Management in India's Public Health Services: A View from the Front Lines

There is building evidence in India that the delivery of health services suffers both from an actual shortfall in trained health professionals and from unsatisfactory results of existing service providers working in the public and private sectors. This study focuses on the public sector and examines de facto institutional and governance arrangements that may give rise to well‐documented provider behaviors such as absenteeism that can adversely affect service delivery processes and outcomes. We analyze four human resource management (HRM) subsystems: postings, transfers, promotions and disciplinary practices from the perspective of front‐line workers—physicians working in rural healthcare facilities operated by two state governments. We sampled physicians in one “post‐reform” state that has instituted HRM reforms and one “pre‐reform” state that has not. The findings are based on both quantitative and qualitative measurements. The results show that formal rules are undermined by a parallel modus operandi in which desirable posts are often determined by political connections and side payments. The evidence suggests an institutional environment in which formal rules of accountability are trumped by a parallel set of accountabilities. These systems appear so entrenched that reforms have borne no significant effect. Copyright © 2015 John Wiley & Sons, Ltd.     

Residential Aged Care Policy in Australia – Are We Learning from Evidence?

The residential aged care industry in Australia will expand rapidly over the next 10 years leading to substantial increases in government expenditure. Recent and future reforms are likely leading to changes in the structure of the industry with a potential impact on quality of care. The purpose of this paper is to stimulate broader public debate, based on the available evidence, about the preferred structure of this important industry. It examines the literature on the impact structure has on the quality of services and compares this with a fresh analysis of current trends. The paper argues that future policy should be evidence based and explicit about the structure of the industry that will emerge from current policy reforms.     

Is governance democratic?

This paper argues that governance can engender undemocratic inequality, exclusion and populism. It does so by analysing the concept of governance, and unearthing three theoretical justifications for it: one libertarian, one radical and one republican. These justifications are in turn refuted by showing how they respectively undermine a process-view of democracy, neglect structural avenues for accountability and encourage elites to wield power.     

Peddling a semiotics of fear: a critical examination of scare tactics and commercial strategies in public health promotion

In this study, we critically examine the ways in which a nationwide health promotion campaign – the 2013 Diabetes UK/Tesco diabetes campaign, the largest of its kind in the UK – seeks to raise the general public's awareness of Type 2 diabetes. We subject a series of six campaign images (including their layout and accompanying text) to a multimodal discourse analysis, identifying the presence of a range of fear-inducing, stigmatising and commercial strategies, through which the campaign emphasises the dangers of diabetes and advocates personal responsibility for assessing both individual and others' risk of the disease. Specifically, we describe, in multi-semiotic detail, three discursive techniques deployed in the campaign to achieve these ends: (1) the depiction of grief and amplification of diabetes-related danger, (2) the promotion of diabetes risk and localisation of individuals' responsibility for their health and (3) the commercial branding and framing of the Diabetes UK/Tesco partnership – including the promotion of goods and services – as a means of diabetes prevention and management. Our findings raise concerns about the moral legitimacy of using fear-inducing and commercial strategies in order to (effectively) raise public awareness of and responses to Type 2 diabetes, strategies which do little to address the environmental factors which are associated with increasing rates of the disease.     

Community-based forensic child and adolescent mental health services in England,Scotland and Wales: a national mapping exercise

Aim: We sought to ascertain the current nature of specialist community mental health provision for young people presenting with risk of harm to others or involvement with the youth justice system in England, Wales and Scotland. Methods: Questionnaire-based survey. Results: Fifty-five services were contacted, 48 responded and 35 of these were found to be providing some form of community mental health provision to high-risk young people. Thirteen services provided comprehensive community forensic child and adolescent mental health (FCAMH) services, whilst the remainder offered more ad hoc clinical input. Amongst the comprehensive FCAMH services, staffing, function, commissioning arrangements and population served varied widely. Conclusions: There is patchy geographical provision of comprehensive community FCAMH services across England, Scotland and Wales with heterogeneous commissioning arrangements, staffing and function. Development of a national commissioning strategy for community FCAMH services is required to ensure that the complex needs of high-risk young people are adequately addressed.     

Female serial killers in the United States: means,motives, and makings

Most studies that have focused on female serial killers (FSKs), although informative, have examined limited sample sizes. We consulted mass media reports of demographics, motives, methods, mental health, and victim characteristics of 64 FSKs who committed their crimes in the US from 1821 to 2008. Consistent with other studies, our data showed that FSKs were typically White, educated, have been married, and held a caregiving role (e.g. mother, health care worker). Nearly 40% of FSKs in this sample experienced some form of mental illness. Their most common motive for murder was financial gain, and their most common method of killing was poisoning. FSKs knew all or most of their victims, and most were related to their victims. In all cases, FSKs targeted at least one victim who was a child, elderly, or infirm – those who had little chance of fighting back. We interpret these killers’ behaviors from clinical and evolutionary angles.     

Blood and bone: body mass,gender and health inequality in nineteenth-century British families

In mid-nineteenth-century Britain, a new institution emerged: the modern prison. Some prisons invested in scales. Upon entry, prisoners were measured and personal details documented. These meticulously compiled records afford a new vantage point from which we can peer into the dynamics of the household. Body measurements – height, weight, and body mass (weight adjusted for height) – connect to both patterns of consumption and health risk. Prison data thus speak to both gender and health inequality in the past. The paper juxtaposes a service economy (Wandsworth near London) with a modern manufacturing sector (Paisley near Glasgow) in order to contrast how economic form and opportunities in the market sector shaped relations and outcomes in the household sector. We find that families bargained over the allocation of resources; that bargaining position was influenced by economic value, mediated by maternal sacrifice; that this was an earner bias rather than gender bias; and that new industrial work for women and children supported a more egalitarian distribution that improved everyone's health status via superior heights and heavier weights. We examine Irish immigrants to assess cultural differences in family behaviour. Finally, the paper offers, for the first time, a detailed interpolation of Waaler's health risk for women.     

China’s Response to the Ebola Virus Disease in West Africa

This article examines the Chinese response to the Ebola outbreak in West Africa, first surveying Chinese interests in Guinea, Liberia and Sierra Leone. Many Chinese workers have been evacuated and projects postponed. For the first time, China has extended humanitarian aid to countries facing a public health emergency. China is under pressure to ‘do something’ but faces its own developmental challenges as well as problems of logistics. Chinese knowledge of Africa is still relatively weak and uninformed. Although China’s assistance dwarves that from the other BRICS, the Ebola crisis has revealed problems in Sino-African relations, not least the gap between rhetoric and reality.     

South Africa as an emerging power: from label to ‘status consistency’?

South Africa proudly wears the label ‘emerging power’, with its membership of the BRICS and G20 probably the most visible signs of this conferred status. This paper explores the concept of the emerging powers within the context of current global power shifts and locates South Africa within this group. It discusses the criteria for and characteristics of emerging powers, and then turns to some of the constraints and challenges faced by these states. Specific attention is paid to the ‘how’ of these states' recognition and inclusion in global institutions and the impact of domestic conditions and regional politics on their positions, focusing particularly on South Africa. It concludes that these factors will continue to challenge South Africa's ability to rise above the semblance of importance conferred by its inclusion in the category of emerging powers to a position in which it exercises this status to its own advantage, including its idealistic objectives of promoting greater global equality and recognition for Africa and the global South. Although other emerging powers face similar challenges, South Africa's domestic constraints and related lack of regional and global reach, politically and economically, threaten its ‘status consistency’ as an emerging power.     

Comparing Electronic News Media Reports of Potential Bioterrorism-Related Incidents Involving Unknown White Powder to Reports Received by the United States Centers for Disease Control and Prevention and the Federal Bureau of Investigation: U.S.A., 2009–2011

There have been periodic electronic news media reports of potential bioterrorism-related incidents involving unknown substances (often referred to as “white powder”) since the 2001 intentional dissemination of Bacillus anthracis through the U.S. Postal System. This study reviewed the number of unknown “white powder” incidents reported online by the electronic news media and compared them with unknown “white powder” incidents reported to the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Federal Bureau of Investigation (FBI) during a 2-year period from June 1, 2009 and May 31, 2011. Results identified 297 electronic news media reports, 538 CDC reports, and 384 FBI reports of unknown “white powder.” This study showed different unknown “white powder” incidents captured by each of the three sources. However, the authors could not determine the public health implications of this discordance.