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PubMed2000

Going down to the local: incorporating social organisation and political culture into assessments of decentralised health care.

The social organisation and political culture of the society in which an organisation is embedded can have major effects on the way in which organisational policy is implemented and on how that organisation functions. Research on health sector reforms has paid scant attention to this aspect. If the claims made for decentralised management in the health sector are to be evaluated seriously, it is critical to develop concepts and methods to evaluate not only the formal organisation and the outputs of the health system, but also the aspects of local social organisation and political culture within which that local health system is embedded that may mediate their relationship. The paper explores three cases of district health systems in Northeast Brazil in order to identify aspects of local social organisation and political culture that appear to influence the implementation of the reforms and thereby potentially impact upon the quality of the care provided. The results of the study indicate the importance that aspects of local social organisation and political culture may exert on the operations of a decentralised health system. Key aspects identified are: the space for autonomy; the space for local voice in political life; personalized and institutionalised influences on autonomy and local voice; differences of involvement of health staff with the district; different spaces of acceptable practice and accountability. These factors are seen to moderate the intent of the health reforms at all stages in their implementation. Three possibilities are discussed for the nature of the interaction in terms of cause and effect between the formal organisation of the health system and its local context. Seeing this relationship as one of a dialogue offers some cautious optimism for the potential of the reform agenda. The paper closes with suggestions on how to take this line of research forward.

Brazil↗
PubMed2002

The politics of priority setting for reproductive health: breast and cervical cancer in Ghana.

Priority setting for reproductive health is affected by health sector reform policies, the often politically charged nature of issues such as abortion, decreasing funding for reproductive health activities and the broad agenda of the ICPD Programme of Action. This paper examines the influence of political and organizational factors on national priority setting for reproductive health and argues that existing priority setting tools such as disability-adjusted life years and cost-effectiveness analysis do not consider the influence of politics on the priority setting process or account for the interpretation of evidence in priority setting. It suggests that priority setting tools can be strengthened by incorporating empirical measures of political and organizational attention to an issue, and through a new measure--policy priority. The paper applied this new measure to a case study of attention to breast and cervical cancer in Ghana from 1990-97, illustrating how traditional priority setting methods cannot explain the priority given to breast cancer in Ghana. It demonstrates how local politics can trump scientific and economic evidence and suggests that the priority setting process can have unforeseen equity and social implications. It concludes by arguing that the policy priority measure provides a more complete picture of reproductive health priorities and is useful for better understanding the implications of the priority setting process for reproductive health.

Breast Neoplasms↗
PubMed1990

The political dimension in health care technology assessment programs.

This article considers technology assessment (TA) to be a comprehensive form of policy research. Technology assessment must then have a relation to policy-making; in the area of health care, TA must relate to such political decisions as resource allocation. Since policies are determined politically, i.e., by factors such as power and influence, technology assessment is, or should be, part of a political process. Technology assessment seems to be developing predominantly as a technical and professional activity, carried out in centers with no relation to the policy-making process. While the impact of technology on health, as well as such broader impacts as those on financial costs, is a key concern, political considerations and political decision-making must always be an important dimension in health care TA.

Communication↗
PubMed2000

Invisible enemies: bacteriology and the language of politics in imperial Germany.

The text analyzes the related semantics of bacteriology and politics in imperial Germany. The rapid success of bacteriology in the 1880s and 1890s was due not least to the fact that scientific concepts of bacteria as "the smallest but most dangerous enemies of mankind" (R. Koch) resonated with contemporary ideas about political enemies. Bacteriological hygiene was expected to provide answers to social and political problems. At the same time metaphors borrowed from bacteriological terminology were incorporated into the political language of the time. While the "high command of our doctors" (F.J. Cohn) fought diseases, some contemporaries were identified with members of the evil species of "bacillus communis odii." Both imperialistic politics and bacteriological science relied on images of inferior and invisible but potent enemies. Both were able to increase their prestige via a mutual interchange of their vocabularies.

Bacteria↗
PubMed2001

The sexual games of the body politic: fantasy and state violence in Northern Ireland.

This article analyzes the practice of strip searching women political prisoners in Northern Ireland as a violent technology of control aimed at breaking the political identity of prisoners. Focusing on a controversial case of a mass strip search carried out in 1992, the article examines the phantasmatic investements pervading this seemingly rational technology of control. Using a psychoanalytic notion of fantasy against the backdrop of a Foucaultian theory of power, this article argues that strip searches constitute a gendered form of political domination driven by, and performed within, a phantasmatic scenario of sexual violence. In this scenario both the political and gender identities of prisoners are re-inscribed with the power of a state acting as a male body politic. The article argues that the phantasmatic support of rational technologies of control betrays the contingent and shifting character of domination as well as its ambiguous effects.

Anecdotes as Topic↗
PubMed1996

Appraisal of self, social environment, and state authority as a possible mediator of posttraumatic stress disorder in tortured political activists.

This study examined appraisal of self and others, as measured by semantic differential ratings of Police, State, Society, Family, Friend, Myself as a Man/Woman, and Myself as a Political Person, in 55 tortured political activists in Turkey, 55 nontortured political activists, and 55 nontortured, politically noninvolved controls. There were no remarkable differences between tortured and nontortured political activists; both groups differed from controls in having a more negative appraisal of the police and the state and stronger perceptions of danger, mistrust, and injustice in relation to state authority. Lack of beliefs concerning a "benevolent state" may have protected the survivors from the traumatic effects of state-perpetrated torture. Further research into the possible protective role of belief systems in posttraumatic stress disorder is needed.

Adult↗
PubMed1996

Identified and introjected forms of political internalization: extending self-determination theory.

Canadian voters' reasons for following political events were assessed prior to the 1992 Constitutional Referendum and the 1993 federal election. Results showed that reasons reflecting identification were endorsed more frequently than those reflecting introjection, and distinctive patterns of cognitions, emotions, and actions were associated with the 2 types of internalization. Identification was associated with actively seeking information about political events, possessing a complex set of political attitudes, and being more likely to actually vote. Introjection was associated with relying on the influence of important others, experiencing conflicted emotions about political outcomes, and vulnerability to persuasion. The study also provided evidence that identification and introjection toward politics are distinguishable from intrinsic motivation and amotivation.

Affect↗
PubMed2006

Placing perceptions of politics in the context of the feedback environment, employee attitudes, and job performance.

The authors proposed a model suggesting that organizational environments supporting high levels of informal supervisor and coworker feedback are associated with lower employee perceptions of organizational politics. Furthermore, these lowered perceptions of politics were proposed to result in higher employee morale (as reflected in job satisfaction and affective commitment) and, through morale, to higher levels of task performance and organizational citizenship. The proposed mediational model was supported with empirical results from 150 subordinate-supervisor dyads sampled across a variety of organizations. Higher quality feedback environments were associated with lower perceptions of organizational politics, and morale mediated the relationships between organizational politics and various aspects of work performance. These findings suggest that when employees have greater access to information regarding behaviors that are acceptable and desired at work, perceptions of politics are reduced and work outcomes are enhanced.

Adult↗
PubMed2007

The impact of political skill on impression management effectiveness.

In this study, the authors investigated the effect of an individual's political skill on the relationships between 5 different impression management tactics (intimidation, exemplification, ingratiation, self-promotion, and supplication) and supervisor evaluations of performance. To test these relationships, the authors used a matched sample of 173 supervisor-subordinate dyads who worked full time in a state agency. Findings showed that individuals who used high levels of any of the tactics and who were politically skilled achieved more desirable supervisor ratings than did those who used the tactics but were not politically skilled. Opposite results were found when impression management usage was low. That is, individuals who were not politically skilled created a more desirable image in their supervisors' eyes than did their politically skilled counterparts when they did not use these tactics. Practical and research implications for the findings as well as directions for future research are offered.

Adult↗
PubMed2005

Political skill: an antidote in the role overload-strain relationship.

Political skill is characterized by social perceptiveness and the ability to adjust one's behavior to different and changing situational needs to influence others. The authors argue that politically skilled individuals enjoy a sense of personal security that allows them to perceive interpersonal control over the process and outcomes of interpersonal interactions within organizations. The authors examine the buffering effects of political skill on the perceived role overload-strain relationship, with strain operationalized as job tension, job (dis)satisfaction, and general anxiety. Results support the hypothesized moderating effects of political skill such that greater political skill reduces the negative effects of role overload on all types of strain. The contributions and limitations of the study are discussed, as are directions for future research.

Adult↗
PubMed2003

Political economy of youth smoking regulation.

This paper considers the political economy of tobacco regulation-that is, the interplay between politics and markets in tobacco regulation. In surveying the interest-group politics of tobacco control, it describes political advantages held by a profitable and concentrated industry engaged in tobacco production. It also considers reasons for the surprising political success of tobacco control advocates over the past decade. The paper considers challenges faced by tobacco control advocates, who face their own obstacles to collective action in promoting effective tobacco regulation. Both public officials and tobacco control advocates face stronger incentives to advocate new legislation than they do to ensure effective implementation of existing regulatory measures. The essay concludes by considering the Master Settlement Agreement, whose detailed implementation remains uncertain after the election of the Bush administration.

Adolescent↗
PubMed1995

Politics and nursing: an elective experience.

The case for enhancing the political awareness of nurses is reviewed, examining the need for the inclusion of political issues in nurse education programmes. A brief review of the available literature from North America reveals that some schools of nursing have made progress in including aspects of politics in nursing curricula, either as part of a course on health policy or as a separate elective course. Topics addressed in these courses, and experiences offered, aim to raise awareness and equip nurses with the knowledge and skills necessary to engage in politics at a variety of levels. An account is offered of the experience of running a 4-week theoretical elective course entitled 'Politics and nursing' as part of the Common Foundation Programme of a Project 2000 course in a college of nursing based in North London, England.

Curriculum↗
PubMed2001

The influence of liberal political ideology on nursing science.

Previous notions of science as impartial and value-neutral have been refuted by contemporary views of science as influenced by social, political and ideological values. By locating nursing science in the dominant political ideology of liberalism, the author examines how nursing knowledge is influenced by liberal philosophical assumptions. The central tenets of liberal political philosophy - individualism, egalitarianism, freedom, tolerance, neutrality, and a free-market economy - are primarily manifested in relation to: (i) the individualistic focus of our science; (ii) our view of society as essentially egalitarian and equitable; (iii) our preference for politically neutral knowledge development, and (iv) an economy of knowledge development that supports rather than challenges the status quo. I argue that exposing, rather than ignoring, the liberal ideological values inherent in nursing science will render these assumptions open to debate, stimulate ongoing development of critically oriented knowledge, and increase our capacity to influence the social, political and economic determinants of health.

Democracy↗
PubMed2000

Nursing, politics and policy: a response to Clifford.

Political decisions and social policy initiatives have an impact on the practice of nursing and on the provision of health care. In this paper, we develop the argument that nurses, therefore, need to have political awareness. Developing a critical approach to politics and policy in nursing includes, first, developing an awareness of the range of structural and ideological factors underpinning the emergence of policies. This, we argue, is an essential backdrop to the analysis of the impact on nursing and health care of specific policy initiatives. To illustrate this approach, we present a brief analysis of health policy under the last government, and consider how this came to impact on nursing. We then go on to outline health policy emerging under the present government, and consider how this reflects a commitment to 'third way' politics. Having considered the possible impact of new health policy on nursing, we suggest, finally, approaches to the teaching of politics and policy in nurse education programmes.

Attitude of Health Personnel↗
PubMedDate not supplied

Intentions of burial: mourning, politics, and memorials following the massacre at Srebrenica.

In the aftermath of tragedy, memorials and grave sites are frequently constructed. Research needs to pay attention to the goals of mourners for such places. The 1995 massacre at Srebrenica in Bosnia-Herzegovina left over 7,000 Muslim men missing and presumed dead. Five years later, families fought to bury the remains that had been collected. Qualitative interviews with 67 people, including survivors and key informants were completed over the summer of 2000. This article examines the intentions of the burial from the perspective of two groups of family members who lost loved ones: survivors who remain politically isolated and those involved in advocacy or political organizations. For the politically isolated, burial was important in reshaping individual mourning after mass death and in the face of unidentified remains. For those involved in advocacy groups, burial was a means of recognizing the past massacre, understanding the massacre's impact on current political divisions, and shaping future directions. Both mourning and political functions are elaborated on in the setting of Bosnian culture and society.

Bosnia and Herzegovina↗
PubMedDate not supplied

Impact of political change on the psychological stress process among West Bank Palestinian women.

This article reports the relationships between political change, personal factors and the psychological stress process among 40 West Bank Palestinian women. The women were tested in spring 1982 and in autumn 1985. The stress process assessed consists of exposure to stressful life events, the way that women perceive the severity of stress (worry) and appraise their own resources to cope with it (locus of control), as well as actual coping modes, and mental health problems. The results show that the Palestinian women had more personal and political worries, and showed more personal helplessness (external locus of control) after the Lebanon war in 1985 than in 1982. The results further show that women employed less avoidance and retreat, and less denial as coping modes in 1985 than in 1982. No changes between these years were found in the women's mental health, their locus of control on the Palestinian issue, and coping modes of aggressive action and social-political activity. The results on the roles of personal factors in the stress process show that younger women expressed more political worries and initiative (internal locus of control) on the Palestinian issue. Furthermore, women who had many children had fewer political worries and more personal worries, and were less external in their locus of control on the Palestinian issue than women with few children.

Adaptation, Psychological↗
PubMedDate not supplied

Hindsight bias in political elections.

Two studies on political hindsight bias were conducted on the occasions of the German parliament election in 1998 and the Nordrhein-Westfalen state parliament election in 2000. In both studies, participants predicted the percentage of votes for several political parties and recalled these predictions after the election. The observed hindsight effects were stronger than those found in any prior study on political elections (using percentage of votes as the dependent variable). We argue that the length of the retention interval between original judgement and recollection is mainly responsible for this difference. In our second study, we investigated possible artifacts in political hindsight biases using a control-group design where half of the participants recalled their predictions shortly before or after the election. Hindsight bias was preserved, reinforcing the results of earlier studies with non-control-group designs. Finally, we discuss the possibility that the hindsight experience (in political judgement and in general) actually consists of three different, partly independent components.

Adult↗
PubMed1997

The politics of dependency estimates: Social Security Board statistics, 1935-1939.

State theorists maintain that Social Security Board (SSB) bureaucrats managed the evolution of public welfare. Institutional politics theory more readily accepts the influences of political interest groups. SSB archival records offer an opportunity to contrast these models and explore the early measurement of old age dependency. In reports designed to protect the 1935 Social Security Act, SSB staff exaggerated the extent of dependency among elderly persons. By 1939, Board statistics clearly showed that children were more impoverished than aged persons. SSB leadership did not repudiate prior estimates and they accepted rising transfers to aged persons, largely because of the political power of interest groups interested in flat pensions. While bureaucrats attempted to control events, an institutional politics approach better explains both the pivotal role of other, political actors and the solidification of the myth of old age impoverishment.

Activities of Daily Living↗