High-level political support for the United Nations Millennium Development Goals (MDGs) drew international attention to included causes at the turn of the century. Influences of this normative framework on national-level health agenda setting remain little investigated. This study investigates the agenda status of maternal survival against the backdrop of the MDGs in two countries in sub-Saharan Africa. Informed by replicative case studies conducted in Ghana and Tanzania, the study finds the MDGs played a significant role in the issue's increasing status in both countries by helping to align several factors that facilitate the agenda setting process, including: ideas concerning the severity of the problem and expectations for its redress; institutions that shape policies, programs and monitoring; and economic and political interests. The agenda setting process was similar in the countries but for two dynamics. HIV/AIDS dominated Tanzania's health policy agenda in the early 2000s, crowding out attention to maternal and other health issues. A network of concerned actors that expanded to form a broad political coalition later facilitated agenda setting in Tanzania, including securing some budgetary commitments. By contrast, Ghana's core maternal health network remained technically oriented and closed to broader political and civil society engagement, limiting its capacity to expand issue attention and budgetary commitments beyond the health sector.
This paper deals with ‘medical social engineering’, which is now required to solve health problems in developing countries. The first section presents an historical background for social scientists participation in the health field and explores their involvement in classical public health approaches, such as direct interventions, epidemiology and ecology. In a second section, more recent types of participation, associated with the health political model, are discussed in reference to community medicine, ethnomedicine and clinics. The third section examines three promising recent developments in medical social science: health planning and evaluation, population studies and emergence of an indigenous social science. Finally, an interface is proposed between social and bio-medical sciences, and a reconceptualization of health and disease is explored which fills the gaps between these sciences.
The regional variations in age/sex standardized rates of common surgical operations in three countries are examined. Large differences between these countries are noted and possible explanations are examined. In England and Wales the extent to which particular surgical rates are related to indices of medical supply by Regional Health Authority are examined in detail. Overall hospital sector funding, relative to norms of medical “need”, are seen to be strongly positively related to many operation rates indicating a dependence on supply factors. The role of manpower levels in explaining utilization rates is examined in some detail to compare with empirical observations made in North America. Generally in a National Health Service context numbers of surgeons or general practitioners are not as strongly related as in the United States.
The effect on the chief carer in 97 patients with fresh stroke has been observed for 4 years and compared with 19 stroke patients without identifiable chief carer—84% lived together and a further 5% saw each other daily. The largest group of chief carers were women, aged less than 60, and over one quarter of them had responsibility for other people. Deterioration in the chief carer's health was common during the first year and 14% of those in employment gave up their jobs because of the patient's stroke. By the end of one year post-stroke 27% of the patients they were looking after in the community were totally dependent (including personal care). The main problems they found were in relation to behaviour and the need for constant supervision. It is concluded that the vast majority of stroke survivors are living in the community and that their chief carers could be afforded more support by mobile “stroke teams” at an early stage, more involvement of relatives in rehabilitation and the continued development of stroke clubs.
Singapore's degree of government intervention into health policy can be seen as intermediate between the bureaucratic and market strategies which Alford delineates. In this approach, the government takes a quite tolerant if not directly encouraging approach to the several forms of traditional medicine of the several important ethnic groups in the country. To some extent this approach reflects a solution of sorts to the shortage of qualified medical personnel.
This paper presents a review and evaluation of efforts to control dental care costs in the United States. In general, health care costs have become a major concern in the United States; health spending has risen significantly faster than expenditures and prices for other goods and services. The same is not true for dentistry, however. The first section of this paper documents the moderate growth of dental care expenditures and summarizes some of the contributing factors such as increases in health care utilization, productivity, auxiliary utilization and prepayment.
An analysis of attitudes toward continuing medical education techniques between physicians within diverse educational cohorts. A sample of primary care physicians in three Boston area community hospitals is disaggregated by year of medical school graduation. The resulting analytical categories, generation units, demonstrate different attitudes toward continuing medical education approaches. Continuing medical education planners are asked to consider the diverse needs of generation units in their development of new programs.
This article examines some meanings, themes and approaches concerning regionalization. The conceptual framework provides an introduction to a report of a Dutch example. First of all, the social geography is described, then the parties in the health care field and the consultants' participation. Subsequently, an extensive analysis is offered of some salient observations during the process of organizing a regional federation. They are the ways the federation was founded and developed, and the problems concerning a policy program. The analysis is intended as a contribution in this field, particularly from an empirical rather than a normative perspective.
A distinction is made between the types of problems posed in preventing sickness and those faced in maintaining health. Preventing sickness has been based on analytic modes of inquiry, but concern with health requires integrative methods. A study of the investigations of a disease. Kuru, and a method of synthesising six types of evidence are used to illustrate the two approaches to knowledge. The conclusion is drawn that research findings would be more immediately applicable to the work of health development if the challenge of the integrative approach were accepted.
The sick-role model of Parsons, with its professionalist bias, and with its underlying notion of illness as deviance, has been vulnerable to sustained criticism for its failure to take into account the lay's participation in the illness process. Accordingly, the model does not really apply to situations of the chronically ill and the permanently handicapped, in which the resumption of the patient's independence depends more on the resources at his/her disposal than on medical intervention. This study of 430 women affiliated with Israel's largest comprehensive health care deals with variations between the sick-roles in acute and chronic conditions, focusing on those behavioral expectations of Parsons' model which have implications for the extent of dependency granted to the ill. As expected, the extent of dependency which the respondents would allow, was indeed found to rest largely upon the prospects implied by medical diagnosis. But Parsons' supposition that the professionals would have a dominant role in caring for the ill and in defining their sick-role expectations has not been confirmed. A sequence of cluster analyses revealed two distinct sets of expectations corresponding to the sick-roles for acutely and for chronically ill. Although the chronically ill were allowed less dependency than the acutely ill, a more crucial role in their treatment was assigned to the lay significant others than to professionals. Moreover, the contribution of the lay was found to be the most prominent dimension in the cognitive process by which the lay respondents formed the behavioral expectations of the ill. Accordingly, it was the concern about the care and support of lay others rather than about medical care which was found to provide the best criterion for differentiating between the revealed clusters.
This paper examines the assumptions underlying the practice of antenatal education. It traces the ideological basis of past attempts to educate pregnant women and their teachers, and to assess the effects of these attempts. It also charts the conflicts and alliances resulting from the contrasting ideologies, and concludes that the content, purpose and results of antenatal education must be reexamined in the light of an adequate study of the experience of childbearing. The requirements for such a study are outlined.
This paper summarizes findings from a Durango, Mexico sample which lend support to some earlier findings by Hoppe and Heller [1]. Contrary to conventional wisdom in the literature, Hoppe and Heller, in a study of Mexican-Americans living in San Antonio, Texas, hypothesized, that familism was not a deterrent to the utilization of health service by members of this lower class, ethnic population.
Health in developing countries is poor. Historically the trend towards ill health was initiated with the advent of slave trade and accelerated later by the colonial expansion of Europe. Dental health is no exception to this. There are many oral conditions which are functions of the poverty and undernutrition which are currently prevalent in developing countries. There are few human or physical resources available to meet these health needs. In most developing countries the dentist to population ratios are of the order of one dentist to 100,000 people or worse. In establishing dental health services in developing countries, there is a danger that attempts will be made to establish the same patterns of organization and to use the same technologies as those used in industrial nations. Because such organizations and technologies are often specific to certain social, political and economic situations their direct transfer for use under totally different circumstances frequently meets with failure. This caveat is particularly critical since there are clear differences between industrialized and developing countries in their patterns of dental disease.
The discipline of geriatrics derives its knowledge base from gerontology and clinical medicine. The former supports a belief in biological life and natural death while the latter presents the notions of pathological life and pathological death. These theories are incompatible and the continuing debate on the status of geriatrics as well as a coherent policy towards health care for the elderly rests on this cognitive contradiction.
The influence of psychosocial factors in the general aetiology of disease is examined with particular reference to the notions of vulnerability and susceptibility. Cultural definitions are considered as well as cultural variations in help-seeking behaviour. Analysis concludes by looking at eight patterns of help-seeking behaviour.
Pre-scientific medicines are immensely widespread involving about 80% of the world's population. This is a consequence of the connection between many pre-scientific medicines and religion, whereby many people resort to personal, domestic and popular medicines initially, because of the lack of any suitably scientifically trained staff. The environment, soil and climate, diversifies the various systems of pre-scientific medicine so that it is necessary to distinguish between those in arid zones, equatorial forests, cold climates and at great heights.
The need to improve the design and application of tropical disease control measures has led to the establishment of a Social and Economic Research Scientific Working Group in the UNDP/World Bank WHO Special Programme for Research and Training in Tropical Diseases. This group will support research to increase the effectiveness of disease control activities and to improve the bases for research resource allocation decisions.
In interviews with a sample of laypersons about how they manage their health, we found that the way an individual feels is a prime criterion of health, illness, and recovery, as well as a feature of health interactions. In this paper, we describe the place of feeling in illness and its importance in the social organization of health care, both lay and professional. While other criteria of illness are certainly employed, the problems which the criterion of feeling poses for the social legitimation of illness permit us to begin to specify how these legitimation processes work. Based on interview data, we show that the use of feelings as a criterion generates the problem of proving that one is ill. The structure of knowledge on which physicians draw in their diagnoses is specifically suited to solving this problem of the patient. and thus provides one reason for the patient to consult or to avoid the doctor.
