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PubMed1986

Why medical students will not practice in rural areas: evidence from a survey.

A survey of medical students was held in order to determine the reasons why they were not willing to set up practice in rural areas after graduation. The reasons they gave were quite typical: lack of facilities, lack of opportunities for themselves and their family, poor income, etc. We also discovered that not many were acquainted with rural health conditions and a very great percentage wanted to go to the West for specialisation. We have tried to set their responses in light of the socio-economic and political system prevalent in a typical capitalist UDC. The conclusion that we have reached is that it is the class system in these societies which has determined the responses of the students, and it is the main factor which causes a dearth of medical manpower in rural areas.

Attitude of Health Personnel↗
PubMed1995

Goods on which one loses: women and mental health in China.

This article is broadly divided into three sections. The first part deals with the traditional aspects of gender discrimination in China. Before the Communist government came to power in 1949, discrimination against women was institutionalized within all the usual structures of society: family, the economy, education, culture and the political system. It was one of the major policy initiatives of the Communist government to do away with unequal treatment of women. However, it is very easy to demonstrate that significant discrimination against women still exists. The Chinese government argues that this is because of 'remnants of feudal thinking'. Although this may be partly true, there are aspects of current Chinese society that encourage the continuation of this cultural tradition. The second part of the article examines what is known of the epidemiology of mental illness in China with particular reference to gender. As is the case in Western countries, depression and neurotic disorders are diagnosed more frequently in women than in men, although, overall, the prevalence rate is much lower than in Western countries. What is unusual is that schizophrenia, which is diagnosed at roughly equal rates for men and women in Western countries, is diagnosed more frequently in women in China. Despite this, women occupy fewer psychiatric hospital beds and generally receive fewer resources (e.g. health insurance) than men. Suicide rates are very much higher in China than, for instance, in America, and the suicide figures for young, rural women are particularly disturbing. The third part of the article is based on three interviews with women in a psychiatric clinic in Hubei province.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Violence in American cities: young black males is the answer, but what was the question?

Many Americans believe that the public health problem of violence can be addressed by focusing on young black males. We hypothesize that our economic and political systems have created marginal urban areas of undesirable land uses and unwanted people which breed violence. Using three medium-sized cities (Camden, Newark, Trenton) located in an extremely affluent state (New Jersey) as illustrations, we show that violent death rates from homicides, poisoning/drug abuse, falls, fires, and suicide in these areas are high for whites and Hispanics, as well as blacks; females, as well as males; and middle-aged and elderly populations, as well as young populations. We conclude that marginalization (e.g. concentration, ghettoization, segregation) of unwanted land uses and unwanted people must be addressed to reduce urban violence.

Adolescent↗
PubMed2005

Social science research in malaria prevention, management and control in the last two decades: an overview.

In the recent past, considerable progress has been made in understanding how human behavior and social organization, macro- and micro-level economic processes, and health and political systems affect responses to malaria at global, national, community, household, and individual levels. Advances in malaria-related social, behavioral, economic, evaluation, health systems, and policy (social science) research have resulted in improvements in the design and implementation of malaria prevention, management and control (PMC) strategies. Indeed, the past two decades chronicle dramatic advances in the implementation of evidence-based interventions, drawn not only from biomedical but also from social science research. Malaria awareness-raising, advocacy, case management, and prevention efforts have reaped the benefits of social science research and as a result, many programs are implemented and evaluated in a more effective manner than in the past. However, the pace at which findings from social science research are integrated into program and policy implementation is unsatisfactory. Additionally, examples remain of programs that fail to utilize findings from social science research and as a result, achieve minimal results. Furthermore, there is a sizeable body of knowledge that is underutilized and which, if assimilated into programs and policies, could accelerate progress in malaria PMC. Examples include information on meaningful community participation, gender, socio-economic status, and health systems. Regrettably, although social science input is necessary for almost all interventions for malaria management and control, the numbers of scientists working in this area are dismal in most of the key disciplines-medical anthropology; demography; geography and sociology; health economics and health policy; social psychology; social epidemiology; and behavior-change communication. Further, skills of program workers charged with implementation of interventions and strategies at country level are most often inadequate. The Special Program for Research and training in tropical diseases (TDR) and the multi-lateral initiative on malaria (MIM) have remained in the forefront of capacity building for this area of research, but additional efforts are needed to bring more applied social scientists into the fold. Their skills are necessary to ensure that social science findings get to program planners and implementers in a useful form that allows for more rapid and appropriate integration of the results into malaria PMC programs and policies. A re-thinking of the current focus within capacity building efforts is proposed.

Communication↗
PubMed2006

The resistance to changing guidelines--what are the challenges and how to meet them.

Bridging the gap between scientific evidence and its practical application is of the utmost importance in improving the quality of care and increasing patient safety. Guidelines based on evidenced-based medicine (EBM) have led to improved performances and better outcomes. However, even though scientific data are available, resistance to adopting evidence-based guidelines is still enormous. Significant barriers hinder the introduction of best medical practice into the daily clinical routine. The barriers to implementing change are complex, multifunctional, and influenced on many levels by various interests both inside and outside the health-care system. Political, organizational, financial, cultural and scientific interests are regarded as being as important as the perception of patients and health workers. Strategies need to be planned which take account of the multidimensional character of quality of care and incorporate it at the various levels. The conclusion, therefore, is that we need to combine methods and tools to tailor our interventions to the patient's needs.

Evidence-Based Medicine↗
PubMed2004

Did an epidemic of tularemia in Ancient Egypt affect the course of world history?

The dynamics of the spreading, and the identity of a virulent epidemic, similar to bubonic plague or typhus, which hit Ancient Egypt in the middle of the Bronze Age, are hereby presented. Documented in medical papyri as well as archaeological findings, and re-echoed in biblical texts, a plague entered Egypt's main harbor, Avaris, around 1715 BC. As a result, the country was severely weakened at a time when it was already facing serious sociopolitical issues: crumbling central government, immigration, foreign influence, and the rise in power of the army and of warlords. The Hebrews, one of the ethnic groups within the Avaris area, appeared immune amidst the devastation of the plague. This immunity was key to identify the etiological agent of the epidemic: Francisella tularensis, the Gram-negative bacterium passed by ticks, and that causes tularemia. The disease manifests itself as either an ulceroglandular or a typhoid syndrome, accounting for its similarity with bubonic plague and typhus. Cellular immunity provides the main defense against F. tularensis, and is achieved through continuous contact with avirulent strains of the bacterium. Urban dwellers of Avaris, who had a limited contact to animals, would have been defenseless against the virulent strains, unlike the Hebrews, who lived off sheep and other animals. Attempting to consolidate Egypt's central government in the aftermath of the tularemia epidemic, led among others to the internment of the Hebrews in labor camps. The repressive measures against the Hebrews left traces in the subsequent archaeological layer (stratum F) at Avaris. As a corollary, the enslavement would set the stage for the exodus of the Hebrew community from Egypt at a later time.

Communicable Diseases↗
PubMed2005

Geographies of inequality: child pedestrian injury and walking school buses in Auckland, New Zealand.

In the face of mounting concern at traffic congestion in the vicinity of schools and the associated risks of child pedestrian injury, the 'walking school bus' (WSB) idea has been rapidly adopted within metropolitan Auckland. WSBs involve volunteers guiding children to and from school in an orderly manner following established walking routes. This paper reports on a survey of the 34 Auckland primary schools which had adopted the scheme by November 2002. Despite rates of child pedestrian injury being highest in areas of socio-economic deprivation, our survey found WSB developments highly concentrated in low deprivation neighbourhoods. The inequitable socio-spatial distribution of WSBs in Auckland suggests that the ability to respond to road safety issues is closely correlated with socio-economic privilege. While our respondents identified a number of individual and community health benefits accruing from WSBs, we conclude that the initiative has a limited ability to address public health challenges originating within an inequitable and car-dominated urban political system.

Accidents, Traffic↗
PubMed2005

Decolonization and the movement for institutionalization of Chinese medicine in Hong Kong: a political process perspective.

This paper focuses on the question of why the social and political acceptance of Chinese medicine has grown in the former British colony of Hong Kong since the late 1980s. To supplement the conventional explanations for the institutionalization of alternative medicines, we propose a political process perspective that highlights the effects of political changes amidst the decolonization process in Hong Kong. During the late 1980s and early 1990s, the weakening of the political position of the established elite, the opening up of political space for previously excluded groups, and the competition for support among the new political elite, all stimulated the indigenous Chinese medicine organizations to mobilize for the institutionalization of Chinese medicine. By the mid-1990s academics from leading tertiary institutions began to take over the leadership of the movement and in doing so carried it to a higher level. In the conclusion, we briefly consider the implications of this movement for the future development of alternative medicine in Hong Kong and other societies.

History, 20th Century↗
PubMedDate not supplied

Incorporating political socialization theory into baccalaureate nursing education.

Political socialization theory explains how an individual develops a political belief system. As the health care system undergoes dramatic changes, nursing faculty should use political socialization theory to enhance the education of student nurses. A political thread can be woven through the nursing curricula, and students can be socialized to the political role. The new generation of nurses must incorporate a political component into their professional role identity. Political socialization theory can guide nursing faculty as knowledge of the political system and political skills are incorporated into nursing curricula.

Curriculum↗
PubMed1987

The determinants and structure of adolescents' beliefs about the economy.

Although it is of both practical and theoretical importance very little work has been done on adolescents' knowledge of, and beliefs about, the economy. Two studies are reported in this paper--the first concerns the determinants of economic values in a population of 16-17 year old British schoolchildren, and the second concerns economic preferences and knowledge in a larger group of slightly older adolescents. By-and-large the pattern of results is not dissimilar from other studies done on older children. The results are discussed in terms of the literature on economic socialization.

Adolescent↗
PubMed2006

Politics and health outcomes.

The aim of this study was to examine the complex interactions between political traditions, policies, and public health outcomes, and to find out whether different political traditions have been associated with systematic patterns in population health over time. We analysed a number of political, economic, social, and health variables over a 50-year period, in a set of wealthy countries belonging to the Organisation for Economic Co-operation and Development (OECD). Our findings support the hypothesis that the political ideologies of governing parties affect some indicators of population health. Our analysis makes an empirical link between politics and policy, by showing that political parties with egalitarian ideologies tend to implement redistributive policies. An important finding of our research is that policies aimed at reducing social inequalities, such as welfare state and labour market policies, do seem to have a salutary effect on the selected health indicators, infant mortality and life expectancy at birth.

Canada↗
PubMed1998

Growth of civil society in developing countries: implications for health.

Owing to changes in political systems, the number of non-governmental organisations worldwide has increased substantially since 1980. The influence of civil society on health and health care depends on the recognition of its role as a partner in primary health care, on its success in the scaling up of activities, on its cooperation with the State and business sector, and on networking. In the event of health-sector reforms, civil society should focus on equity and justice, and advocate health as a public responsibility. The impact on health would increase if medical personnel joined forces with civil society and if medical schools added public speaking, networking, and lobbying to their agenda. The trend is that an increasing number of agents are getting involved in the promotion of health.

Africa↗
PubMedDate not supplied

[Public policy analysis].

This article presents to public health professionals concepts and perspectives from political science relevant for creating a healthier public policy. Currently, there is no uniform vision of what constitutes public interest and the decisions of public administrations tend to be based on compromise. In public debate, what is paramount is the capacity to persuade. From the perspective of public policy analysis, the crucial issue is definition: the final decision depends on the definition of the problem that has emerged triumphant in the public debate among competing actors with different definitions of the problem. From a policy analysis perspective, the problems entering the agenda of public administration does not necessarily correspond to their severity, as competing actors try to impose their point of view. Because of its historical evolution, the Spanish political system has specific traits. The relatively weak democratic tradition tends to make the decision process less visibles, with strong technocratic elements and weaker social articulation. Both the juridical tradition and liberal rhetoric portray lobbying as contrary to public interest, when in fact it is constantly performed by powerful vested interest groups, through both personal contacts and economic connections. Regulatory policies, with concentrated costs and diffuse benefits, seem to be moving from Spain to the European Union. To promote healthier public policies, the development of civil society initiatives and the building of coalitions will play an increasingly greater role in the future.

Public Policy↗
PubMed2001

The political context of social inequalities and health.

This analysis reflects on the importance of political parties, and the policies they implement when in government, in determining the level of equalities/inequalities in a society, the extent of the welfare state (including the level of health care coverage by the state), the employment/unemployment rate, and the level of population health. The study looks at the impact of the major political traditions in the advanced OECD countries during the golden years of capitalism (1945-1980) -- social democratic, Christian democratic, liberal, and ex-fascist -- in four areas: (1) the main determinants of income inequalities, such as the overall distribution of income derived from capital versus labor, wage dispersion in the labor force, the redistributive effect of the welfare state, and the levels and types of employment/ unemployment; (2) levels of public expenditures and health care benefits coverage; (3) public support of services to families, such as child care and domiciliary care; and (4) the level of population health as measured by infant mortality rates. The results indicate that political traditions more committed to redistributive policies (both economic and social) and full-employment policies, such as the social democratic parties, were generally more successful in improving the health of populations, such as reducing infant mortality. The erroneous assumption of a conflict between social equity and economic efficiency, as in the liberal tradition, is also discussed. The study aims at filling a void in the growing health and social inequalities literature, which rarely touches on the importance of political forces in influencing inequalities. The data used in the study are largely from OECD health data for 1997 and 1998; the OECD statistical services; the comparative welfare state data set assembled by Huber, Ragin and Stephens; and the US Bureau of Labor Statistics.

Adolescent↗
PubMed2004

Beyond the income inequality hypothesis: class, neo-liberalism, and health inequalities.

This paper describes and critiques the income inequality approach to health inequalities. It then presents an alternative class-based model through a focus on the causes and not only the consequences of income inequalities. In this model, the relationship between income inequality and health appears as a special case within a broader causal chain. It is argued that global and national socio-political-economic trends have increased the power of business classes and lowered that of working classes. The neo-liberal policies accompanying these trends led to increased income inequality but also poverty and unequal access to many other health-relevant resources. But international pressures towards neo-liberal doctrines and policies are differentially resisted by various nations because of historically embedded variation in class and institutional structures. Data presented indicates that neo-liberalism is associated with greater poverty and income inequalities, and greater health inequalities within nations. Furthermore, countries with Social Democratic forms of welfare regimes (i.e., those that are less neo-liberal) have better health than do those that are more neo-liberal. The paper concludes with discussion of what further steps are needed to "go beyond" the income inequality hypothesis towards consideration of a broader set of the social determinants of health.

Adolescent↗
PubMed1998

Cardiovascular disease prevention in eastern Europe.

During the last 30 y the region of highest premature cardiovascular mortality has shifted from the US and Finland to Central and Eastern Europe. Present male cardiovascular mortality in Latvia, Estonia, the Russian Federation, and Hungary has overtaken the maximum cardiovascular mortality reached in the US in the 1960s. This epidemic is only partially explainable by the high prevalence of the three traditional risk factors, i.e., hypercholesterolemia, hypertension, and smoking. The international WHO project MONICA, Finnish/Russian/Estonian, Swedish/Lithuanian, and US/Russian surveys have shown that there were no substantial differences between Eastern Europe and democratic countries regarding the prevalence of traditional risk factors with the significant exception of male smokers. The number of female smokers and plasma lipid levels (total and HDL-cholesterol and triacylglycerols) were even more favorable in East European. The intake of antioxidants from domestic and imported fruits, vegetables, vegetable oils, and nuts in most East European countries was substantially lower than in the West. The failure of economical and political systems to satisfy material and psychosocial population needs was probably an important factor in the cardiovascular disease epidemic in Eastern Europe. Antioxidant deficiencies, alcoholism, and psychosocial stress could become "new" cardiovascular risk factors in Eastern Europe. Smoking and alcoholism are definitely important risk factors, but additional local risk factors in Eastern Europe need to be identified with more specific target-prevention programs in individual Eastern Europe countries. This region is a prospective arena for research on additional lesser known cardiovascular risk factors, e.g., oxidative stress, chronic marginal deficiency of antioxidant vitamins (vitamin C, tocopherols, carotenoids) and low intake of folic acid and flavonoids.

Cardiovascular Diseases↗
PubMed2004

Abortion law in Nepal: the road to reform.

In 2002 Nepal's parliament passed a liberal abortion law, after nearly three decades of reform efforts. This paper reviews the history of the movement for reform and the combination of factors that contributed to its success. These include sustained advocacy for reform; the dissemination of knowledge, information and evidence; adoption of the reform agenda by the public sector and its leadership in involving other stakeholders; the existence of work for safe motherhood as the context in which the initiative could gain support; an active women's rights movement and support from international and multilateral organisations; sustained involvement of local NGOs, civil society and professional organisations; the involvement of journalists and the media; the absence of significant opposition; courageous government officials and an enabling democratic political system. The overriding rationale for reforming the abortion law in Nepal has been to ensure safe motherhood and women's rights. The first government abortion services officially began in March 2004 at the Maternity Hospital in Kathmandu; services will be expanded gradually to other public and private hospitals and private clinics in the coming years.

Abortion, Induced↗