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The science and politics of targeting: who gets what, when, and how.

Targeting has been defined as a method by which goods, services, or other programmatic actions are delivered to groups or individuals who have specific characteristics. Similarly, politics refers to the social processes that determine who gets what, when, and how. This similarity suggests there may be utility in undertaking an explicit analysis of how the science and the politics of targeting relate to one another. Accordingly, this article outlines a technical/scientific framework regarding targeting and, using one element of this framework [sensitivity and specificity analysis], demonstrates that recent shifts in politics and policy in the United States can be more clearly understood when viewed from this angle. Then, the article outlines a basic framework on politics and uses it to demonstrate that one of the most fundamental features of our training, practices, and outlook (specialization) holds obvious benefits for advancing research but has three undesirable effects in the realm of policy: 1) it directly or indirectly encourages narrow, partial solutions to complex problems, some of which may have unintended effects on health or well-being for the very people we seek to help; 2) it creates a cumulative demand for research dollars, specialized interventions, and policy attention that far exceeds available resources and capabilities; and 3) it often prevents us from developing and advancing the common agendas and mutual support required to be effective in political and policy realms. The article concludes that more explicit analysis along these lines could strengthen our effectiveness in the policy realm.

Delivery of Health Care↗

Predictors and effectiveness of coping with political violence among Palestinian children.

Relationships between exposure to political hardships, social-economic status and mother's psychological responses, and children's coping modes, were analysed among 66 Palestinian boys and girls aged 8-14 who lived in the West Bank and the Gaza Strip. The effectiveness of children's coping modes in protecting their mental health from the negative impact of political hardships was also analysed. The coping modes were assessed on the intentional (passive-active), cognitive (defensive-purposive), and emotional (helpless-courageous) levels. The results showed that the more children were exposed to political hardships, the more they employed active and courageous coping modes. Furthermore, the more mothers showed psychological symptoms the more their children used active coping modes. The more political activity the mothers used as a coping mode, the more their children used purposive coping. Exposure to political hardships increased children's psychological symptoms, and none of the children's psychological coping modes were effective in mitigating this relationship.

Adaptation, Psychological↗

The gender gap: differences in political attitudes and social dominance orientation.

Survey data over recent decades show men to differ from women on a number of political attitudes and on political party identification. We provide evidence that many such differences can be attributed to individual differences in Social Dominance Orientation (SDO)--preference for inequality among social groups--that are sex linked. Results from a US college student sample (N = 463) and a US 1992 voter sample (N = 478) replicate previous findings of more male support of conservative ideology, military programmes, and punitive policies and more female support of social programmes and equal rights. Consistent with our hypotheses, men were more social dominance oriented than women, and SDO accounted for much of the sex-linked variability in political attitudes, SDO was also a significant predictor of candidate choice in the US 1992 presidential election through its influence on policy attitudes and political ideology. Implications of these results for theories of gender and politics are discussed.

Adolescent↗

The politics of public health policy.

Politics, for better or worse, plays a critical role in health affairs. The purpose of this article is to articulate a role for political analysis of public health issues, ranging from injury and disease prevention to health care reform. It begins by examining how health problems make it onto the policy agenda. Perceptions regarding the severity of the problem, responsibility for the problem, and affected populations all influence governmental responses. Next, it considers how bounded rationality, fragmented political institutions, resistance from concentrated interests, and fiscal constraints usually lead political leaders to adopt incremental policy changes rather than comprehensive reforms even when faced with serious public health problems. It then identifies conditions under which larger-scale transformation of health policy can occur, focusing on critical junctures in policy development and the role of policy entrepreneurs in seizing opportunities for innovation. Finally, it reviews the challenges confronting officials and agencies who are responsible for implementing and administering health policies. Public health professionals who understand the political dimensions of health policy can conduct more realistic research and evaluation, better anticipate opportunities as well as constraints on governmental action, and design more effective policies and programs.

Government Agencies↗

Psychological effects of torture: a comparison of tortured with nontortured political activists in Turkey.

OBJECTIVE: The aim of the study was to investigate the long-term effects of torture in a group of former political prisoners. METHOD: The study was carried out in Istanbul, Turkey, where 55 Turkish political activists who had been tortured were compared with a closely matched group of 55 activists who had not been tortured. The Structured Clinical Interview for DSM-III-R, the Semistructured Interview for Survivors of Torture, and other self-rated and assessor-rated measures of anxiety, depression, and posttraumatic stress disorder (PTSD) were used. The tortured and the nontortured activists were similar in age, sex, marital and socioeconomic status, political ideology, political involvement, stressful life events other than torture, and other features. RESULTS: The torture survivors reported an average of 291 exposures to a mean of 23 forms of torture. The mean length of their imprisonment was 47 months. The survivors of torture had significantly more symptoms of PTSD and anxiety/depression than the nontortured comparison subjects, although their PTSD symptoms were only moderately severe and their general mood was normal. Despite the severity of their torture experiences, the survivors had only a moderate level of psychopathology. CONCLUSIONS: The results suggest that torture has long-term psychological effects independent of those related to uprooting, refugee status, and other traumatic life events in a politically repressive environment. Prior knowledge of and preparedness for torture, strong commitment to a cause, immunization against traumatic stress as a result of repeated exposure, and strong social supports appear to have protective value against PTSD in survivors of torture.

Adult↗

Americans' political participation in the 1993-94 national health care reform debate.

The health politics and policy communities are still struggling with the question of "what went wrong" in the 1993-94 health care reform effort. Here I identify which Americans were politically active and inactive during the health care reform debate to explore the role political participation may have had in determining the outcome of the debate. Using data from a national and California random-sample telephone surveys, and controlling for other demographic attributes, I found that those who engaged in political activity specifically related to health care reform were disproportionately more likely to be self-identified conservatives, less likely to favor an employer mandate plan, more likely to be fifty to sixty-four years old, more likely to be men, and more likely to have greater interest in and knowledge of the health care issue. Even in California, where a single-payer proposal was on the November ballot, self-identified liberals were no more likely to engage in political activity on health care reform than were moderates or conservatives. I consider implications for the reform outcome given that liberals, the elderly, and those favoring the employer mandate proposal were all disproportionately "silent" during this debate, and finally I discuss the potential for mobilization during future debates.

Adult↗

"Man's words" and manly comradeship: language, politics, and homosexuality in Walt Whitman's works.

Critical assessments of Walt Whitman's works either emphasize his sexual themes while ignoring his political ideas or they focus on the poet's politics but ignore his poetics of corporeality. Recent studies that do discuss both politics and sexuality in Whitman's works do not devote much attention if any to the poet's theory of language as it appears in his An American Primer. This essay explores the complex intersections among sexuality, politics, and language in Whitman's works, illustrating how the poet consistently correlated his linguistic, sexual, and political metaphors, constantly relating the health and the sexual potency of the male body with the power of language, the efficacy of literature, and the strength of the states in the United States. Underlying these multiple metaphors and poetic intentions is the poet's homosexual vision. It constitutes the basis of his linguistic theory, his hope of an ideal democratic union, and his plea for sexual equality. To Whitman, America needed male-to-male friendships to free it from materialistic vulgarities and to ensure its perpetuation.

Gender Identity↗

Leftist sexual politics and homosexuality: a historical overview.

For almost a full century now, the revolutionary prospect of socialism has fuelled opening forays first of the homosexual emancipation and later of the gay liberation movements, both in Europe and in North America. It inspired Edward Carpenter and Magnus Hirschfeld at the turn of the century; André Gide and Richard Linsert in the post-World War I years; Harry Hay and Jim Kepner in the post-World War II era; and the British and American Gay Liberation Front, the Italian Fuori!, the French FHAR, the German "Rotzschwule," and the Dutch Red Faggots following the Stonewall rebellion. While the official socialist parties of Northwestern Europe may have made only limited contributions to homosexual emancipation, they certainly have a better record than conservative and Christian parties and even the liberals, who have consistently, if contradictorily, underlined the freedom of private life. Even so, parties across the entire political spectrum have gradually come to endorse at least some of the movement's goals. As it has advanced, the gay movement has changed as well, and it now finds itself pulled in divergent directions. Gay leftists who still subscribe to the ideals expressed in Marxist and utopian socialist writings now find themselves at demonstrations shoulder-to-shoulder with members of ACT UP and Queer Nation, to say nothing of gay conservatives and gay Christians. The successes achieved by the contemporary gay movement despite or precisely because of its diversity support Foucault's argument that "there is no single locus of great Refusal, no soul of revolt, source of all rebellions, or pure law of the revolutionary. Instead there is a plurality of resistances, each of them a special case...." At the close of the twentieth century, the welfare state has reached its apogee in Northwestern Europe. As blue-collar workers historically committed to class struggle have become relatively well-to-do and minoritarian, socialist parties have increasingly lost their traditional base of support and been forced into the defensive. Depending only on the socialists would mean relying on an ineffectual partner, for nowhere are they in a stable position of power. Long before the collapse of "really existing socialism" in Eastern Europe and the former Soviet Union, gay and lesbian movements began developing their own autonomous politics independent of parties. They moved in this direction in part because the coalition with leftism so frequently led to disappointment, particularly when gays and lesbians working within socialist parties were called upon to subordinate or abandon their own goals in favor of party platforms. In other cases the gay-left coalition failed to yield results because a single-minded reliance on one party placed limits on lobbying other parties and entering compromises. We have reached a time when inherited ideologies are no longer capable of laying claim to the undivided loyalty of the gay movement, if indeed they ever were. As it has developed autonomous theories and practices, the gay movement's choice of coalition partners has increasingly come to be based on pragmatism and success in advancing the gay agenda. Indeed, the roles of the gay movement and political parties have undergone a notable switch in recent years, with parties currying the support of the gay movement rather than vice versa. This signals a shift from the desire for politics to a politics of desire, going far beyond traditional socialist ideologies.

Europe↗

The politics of health reform: why do bad things happen to good plans?

This paper examines political feasibility and its implications for health reform. I discuss the political obstacles to health reform in the United States, disentangling perennial barriers from contemporary constraints. I then explore major reform options and their political prospects. I argue that while incremental reform now appears to be the most feasible option, the political climate may change in a way that permits a bolder vision. Moreover, incremental reform may not be sustainable in the long run, for the same reason that makes it politically popular now: It does not change the status quo in the health system.

Cost Control↗

The tobacco industry, state politics, and tobacco education in California.

OBJECTIVES: Proposition 99 added 25 cents to the California state cigarette tax and mandated that 20% of the new revenues be spent on tobacco education and prevention programs. This paper examines the implementation of these programs and the tobacco industry's response to Proposition 99. METHODS: Political expenditure data for twelve tobacco firms and associations were gathered from California's Fair Political Practices Commission and secretary of state's Political Reform Division. Tobacco education expenditure data were collected from Governor's Budgets and the Department of Finance. RESULTS: Since Proposition 99 passed, tobacco industry political expenditures in California have risen 10-fold, from $790,050 in the 1985-1986 election to $7,615,091 in the 1991-1992 election. The tobacco industry is contributing more heavily to the California legislature than to Congress. A statistical analysis of data on campaign contributions indicates that California legislators' policy-making is influenced by campaign contributions from the tobacco industry. Since fiscal year 1989-1990, the state has ignored the voters' mandate and spent only 14.7% of the new revenues to tobacco education. Medical care programs received more money than permitted by the voters. CONCLUSIONS: The tobacco industry has become politically active in California following the passage of Proposition 99. One result may be that the state has underfunded tobacco education by $174.7 million through the 1993-1994 fiscal year. The estimated redirection of funds to medical care would essentially eliminate the tobacco education campaign by the year 2000.

California↗

Social class and political involvement in age graded and non-age graded associations.

This paper examines the relationship between social class and political involvement after retirement and seeks to determine whether this relationship is differentially mediated by participation in non-age graded and age graded associational contexts. Controlling for the age structure of association memberships, the relationships between social class and political activity and several measures of political interest are examined for 304 retired people. Strong and moderate relationships were found for individuals without memberships and those with non-age graded memberships exclusively. No relationships were found for members of age graded associations only. The absence of a relationship between social class and political involvement for those individuals who confine their formal associational activity to age peers is explained by positing the existence of a generational community which insulates lower class older people from class related cross-pressures and invidious distinctions which depress political involvement in other contexts.

Age Factors↗

What's inside the black box: a case study of allocative politics in the Hill-Burton program.

This paper explores the political and bureaucratic determinants of grant allocations within the Hospital Survey and Construction Act of 1946 (the Hill-Burton Act), which established the major hospital construction subsidy program in the United States. Resource allocation within the Hill-Burton Program was neither purely a function of external political forces impinging on the state nor purely a result of internal organizational factors. Instead, as shown in the analysis which follows, external political forces shaped program structure, operating routines, and rules and regulations at the time of the Program's formation. Rules and regulations depoliticized the grant allocation process while institutionalizing the interests of hospitals and other producers into the program structure. Consumer interests and influence are excluded from program decision making. Once established, the rules and regulations and a set of bureaucratic behaviors play a critical role in determining resource allocation. Rules and regulations facilitate distributing divisible benefits to producer interests in a politically predi-table way. Yet rules and regulations must also regulate the supply of hospital beds in accordance with local and national market conditions. The mode of operations required for distributing benefits in a politically predictable way limited the Program's ability to regulate hospital bed supply. This was a critical factor which led the Hill-Burton Program to subsidize excess capacity in the U.S. hospital system and is a useful way of explaning many similar dysfunctions within allocative programs such as Hill-Burton.

Facility Regulation and Control↗

The importance of the political and the social in explaining mortality differentials among the countries of the OECD, 1950-1998.

This article analyzes (within the conceptual frame defined in the previous article) the impact of political variables such as time of government by political parties (social democratic, Christian democratic or conservative, liberal, and ex-dictatorial that have governed the OECD countries during the 1950-1998 period) and their electoral support on (1) redistributional policies in the labor market and in the welfare state; (2) the income inequalities measured by Theil and Gini indexes; and (3) health indicators, such as infant mortality and life expectancy. This analysis is carried out statistically by a bivariate and a multivariate analysis (a pooled cross-sectional study). Both analyses show that political variables play an important role in defining how public and social policies determine the levels of inequalities and affect the level of infant mortality. In general, political parties more committed to redistributional policies, such as social democratic parties, are the most successful in reducing inequalities and improving infant mortality. Less evidence exists, however, on effects on life expectancy. The article also quantifies statistically the relationship between the political and the policy variables and between these variables and the dependent variables--that is, the health indicators.

Developed Countries↗

Developing power and political skills.

One characteristic of power is the ability to influence others; managers cannot be effective without it. Politics is the network of interactions by which power is acquired, transferred, and exercised; it is a fact of health-care life. Like the money in our economy, politics is the medium of exchange in an organization. Managers must be political beings to meet their objectives. This article helps you to assess your political behavior and describes specific methods to increase power and develop political skills. Using these techniques can result in getting what you want and having things done your way, resulting in better job performance and career advancement.

Administrative Personnel↗

Politics and personal pursuits: the experience of mothers of children with severe disabilities.

This study concerns the political nature of the work of mothers of children with disabilities who extended their caregiving responsibilities to social action in the public domain. Conversations were held with twenty-one women to determine, from the women's personal points of view, the meaning of their politically oriented work. The women who participated in the study were actively engaged in developing educational programs, initiating parent support groups, educating professionals in health, education, and social services and serving on various committees and boards of directors. The research adopted a feminist frame of reference to understand the women's experience of political activism. As such, the research recognized the integrative aspects of women's lives: commonplace and routine tasks of caregiving took on political aspects as the women sought assistance and services for their children with disabilities and their families. Their work often occurred spontaneously and without prior planning due to the urgency of their family's personal needs. In fact, many of the women did not consider their work political at all for it simply coincided with the job of caring for their children. The women's achievements could be attributed in part to the intensity of their personal missions and their remarkable abilities to persuade influential officials and administrators.

Caregivers↗

Developing your political skills. Be more effective and successful.

Organizational political skills have been generally neglected in management literature. This is unfortunate because managers who lack the requisite political skills inevitably run into difficulties on the job that reasoning and experience alone won't solve. Because politics are endemic to hospital life, laboratory managers must establish routines to deal with them. This article briefly reviews the origin of organizational political behavior and describes the political style and skills a manager needs to be effective.

Health Facility Administrators↗

A primer on politics.

In the preceding discussion "politics" was defined as the pursuit of power, and that pursuit of power was examined in the context of the local political scene. With this information, EMTs and paramedics may be better able to make sense of the complexities of local EMS politics and thereby relieve some of the frustration that all of us must feel as we look at a system that appears to be unresponsive and unmoving. John Naisbitt in his book Megatrends and Alvin Toffler in The Third Wave both discuss the decentralization of political power in the U.S. and the movement of power away from the federal government to state and local governments. There will probably be more opportunities, not less, for EMTs and paramedics to participate in local government decisions concerning the provision of emergency medical services in their community. Using the questions in each of the models will provide EMTS and paramedics a great deal of insight into the local political process. This will enable EMTs and paramedics to do themselves and their patients a great service by influencing the decisions made by local politicians, which will have a great impact on the quality of care that patients receive.

Emergency Medical Services↗

Political economy of tobacco control in low-income and middle-income countries: lessons from Thailand and Zimbabwe. Global Analysis Project Team.

Crucial to the success of the proposed Framework Convention on Tobacco Control will be an understanding of the political and economic context for tobacco control policies, particularly in low-income and middle-income countries. Policy studies in Thailand and Zimbabwe employed the analytical perspective of political economy and a research strategy that used political mapping, a technique for characterizing and evaluating the political environment surrounding a policy issue, and stakeholder analysis, which seeks to identify key actors and to determine their capacity to shape policy outcomes. These policy studies clearly revealed how tobacco control in low-income and middle-income countries is also being shaped by developments in the global and regional political economy. Hence efforts to strengthen national control policies need to be set within the context of globalization and the international context. Besides the transnational tobacco companies, international tobacco groups and foreign governments, international agencies and nongovernmental organizations are also playing influential roles. It cannot be assumed, therefore, that the tobacco control strategies being implemented in industrialized countries will be just as effective and appropriate when implemented in developing countries. There is an urgent need to expand the number of such tobacco policy studies, particularly in low-income and middle-income countries. Comprehensive guidelines for tobacco policy analysis and research are required to support this process, as is a broader international strategy to coordinate further tobacco policy research studies at country, regional and global levels.

Developing Countries↗