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PubMed1984

The political and administrative context of primary health care in the Third World.

Despite increasing knowledge about technical aspects of Primary Health Care (PHC), there has been as yet only limited research into political and administrative influences on the effectiveness of PHC programs. A three-stage model of the policy process is developed as a framework for organizing the relationships between elements of (1) the national political setting and PHC policy formulation; (2) the implementing agency and program administration; and (3) the community setting and service delivery. Drawing upon the literature on PHC and related programs, hypotheses are proposed for each of these stages as a basis for future study and practical application. Possible output indicators are suggested for each stage of the model. Several basic methodological issues must be addressed in the design of empirical research on political-administrative factors, including variable selection, identification of data sources, and choice of analytical approach. It is hoped that this review will encourage more systematic investigation in this area.

Community Health Services↗
PubMed1989

Children in political violence.

There is an urgent need to conduct research into the effects of political conflict on children growing up in South Africa. This paper discusses some international literature which may be relevant to researchers in this area. The first section briefly assesses the usefulness of the background literature on children in war and disaster situations. The second section outlines some of the clinical effects of political conflict on children. The third illustrates some of the ways in which intra-personal, inter-personal and contextual factors play a role in the stress process. The fourth section incorporates previous discussion into a model for understanding the effects of political conflict on children and offers a brief critique of some of the existing research. The final section explores the implications of the international literature for the South African researcher and examines the usefulness of conducting this kind of research.

Child↗
PubMed1991

Politics, power and poverty: health for all in 2000 in the Third World?

Health for All by 2000 could become a reality in the Third World countries. On present resource allocation, medical professional and political patterns and trends that is unlikely to happen in more than a few countries. For it to happen requires basic priority shifts to universal access primary health care (including preventative). The main obstacles to such a shift are not absolute resource constraints but medical professional conservatism together with its interaction with elite interests and with political priorities based partly on perceived demand and partly on (largely medical) professional advice. These obstacles are surmountable-as illustrated by divergent performances among countries--but only if education, promotion, efficiency in terms of lives saved and healthy years gained, community participation and political activism for Health for All are more carefully analytically based and pursued more seriously and widely than they have been to date.

Developing Countries↗
PubMed1995

The political economy of responsibility in health and illness.

This article addresses the question: to what extent do health care strategies in a given political economy increase people's perceptions of responsibility to take charge of their health, but do not structurally empower them to satisfy their health needs. In shaping health care policies, societies typically adopt one of three broad strategies, linking their larger political economy and modes of exercising power: a marketplace strategy, a state-managerial strategy or a national participatory strategy. Because of their different arrangements of structural power, these strategies result in three very different approaches to responsibility for health and illness. Changes in the political economy of health in Nicaragua during the Somoza, Sandinista and Chamorro periods illustrate the changing fields of choice within which care-seekers must make their health care decisions.

Health Behavior↗
PubMed2004

The tobacco industry's political efforts to derail the EPA report on ETS.

Previously secret tobacco industry documents detailed a multifaceted approach of political strategies aimed to derail the 1993 Environmental Protection Agency (EPA) risk assessment on environmental tobacco smoke (ETS). These pervasive strategies included the following: (1) lobbying the first Bush Administration to approve an executive order that would impose new risk assessment standards for federal agencies, thus delaying the release of the EPA report; (2) having the first Bush Administration transfer jurisdiction over ETS from the EPA to Occupational Safety and Health Administration (OSHA), thus obviating the need for the release of the EPA report; and (3) applying enormous political pressure directly by alleging improper procedure and policy at EPA. Although some of the attempted strategies failed, the political pressure from Congressman Thomas Bliley (R-VA) was a success. This is the first report showing how a single member of Congress in conjunction with his staff, tobacco industry attorneys, and executives worked very aggressively to do the tobacco industry's bidding. These tactics successfully delayed the EPA risk assessment and placed a cloud over its validity that was not fully vindicated until December 2002 when the U.S. 4th Circuit Court of Appeals overturned the tobacco industry's suit against the EPA. The documents show that the industry will expend whatever effort is necessary to protect itself from public health policy that would adversely affect consumption of cigarettes and, therefore, profit.

Humans↗
PubMed2005

Science, politics, and the GM debate in Europe.

Europe today stands at a crossroad, facing challenges but also opportunities. In its intent to make Europe a leading technology-based economy by 2010, the European Commission has identified biotechnology and genomics as fields for future growth, crucial for supporting the agricultural and food processing industry. Since first commercialization in 1996, GM crop areas have grown at double-digit rates, making this one of the most rapidly adopted technologies in agriculture. However, in contrast to other world areas and despite European Commission support, Europe has found itself 'bogged-down' in a polemic between opponents and supporters of plant biotechnology. As a result, planted areas have remained small. This stalemate is due to a lack of political leadership, especially at the Member State level, all the more surprising in light of European early development and competitive advantage with crop biotechnology. This situation proves once again that, for cutting-edge innovations, a solid science base alone is not sufficient. Acceptance or rejection of new technologies depends on interlinked political, economic, and societal factors that create a favorable or unfavorable situation at a given time. This article will look at GM crops in Europe and the role science and politics have played in the introduction of crop biotechnology.

Biotechnology↗
PubMed2002

Human rights, politics, and reviews of research ethics.

Although the human rights movement and the sphere of research ethics have overlapping principles and goals, there has been little attempt to incorporate external political and human rights contexts into research ethics codes or ethics reviews. Every element of a research ethics review--the balance of risks and benefits, the assurance of rights for individual participants, and the fair selection of research populations--can be affected by the political and human rights background in which a study is done. Research that at first seems to be low in risk may become high in risk if implemented in a country where the government might breach the confidentiality of study results or where results might be used to deport a refugee group. Researchers should determine whether research could or should be done by consulting human rights organisations and, when possible, a trusted colleague, to learn the background political context and human rights conditions of the settings in which they propose to do research.

Ethics↗
PubMed2001

Maternal serum screening, political decision-making and social learning.

OBJECTIVE: Analysis and evaluation of the process by which serum screening has been introduced in Dutch maternity care. In our analysis of Dutch medical journals, reports of the government and the political and cultural debate, we use a theoretical framework in which the process of introduction of new technologies is described in terms of different social learning processes. RESULTS: The analysis shows a dual-track pattern: promotion by the medical community, and control and regulation of serum screening by the political decision-makers. This process left little room for social learning processes. This applied in particular to learning processes about the social and cultural meaning and acceptability of serum screening. Acceptability of the new serum screening was framed nearly exclusively in terms of freedom of choice. CONCLUSIONS: A too limited framework of assessment was used. Health technology assessment (HTA) should incorporate in the evaluation process the ethical, social, cultural and political dimensions of health technology, and stimulate the interplay between different perspectives and preferences among parties involved. As a new promising approach, we suggest the use of pilot experiments that are designed as social experiments involving different parties in a common learning process.

Congenital Abnormalities↗
PubMed1999

Effects of political and military traumas on children: the Palestinian case.

Social scientists have long recognized that individuals subjected to traumatic events associated with military and political conflict experience dire psychological consequences. The systematic study of this phenomenon, however, could be considered a nascent event. Research on the psychological sequel of traumatic events (traumatology) is well-rooted in the recognition and development of posttraumatic stress disorder as a separate psychological disorder category. The early studies in this field focused mainly on adult populations. With the recent advent of involvement of children in military conflicts such as in Africa (e.g., Mozambique), the Middle East (e.g., Palestine, Lebanon), and Southeast Asia (e.g., Cambodia), psychologists have taken a keen interest in examining the psychological effects such conflicts reap on children. Hence, a growing but modest body of literature has been amassed within the past 20 years on the subject. This article is an attempt to synthesize this literature in order to examine the universal and culture-specific correlates of political and military trauma. Specifically, the article will focus on the psychological symptoms children display following their exposure to such traumatic events. Special emphasis will be placed on anxiety, phobic, psychosomatic, and depressive symptoms. More importantly, however, an examination will be made to ascertain which factors (e.g., psychosocial, cultural, and political) serve to shield (protect) or predispose (vulnerability) children to psychological dysfunction. Furthermore, the analyses presented will be gender specific. The article will attempt to delineate a paradigm that explains the relationship between trauma, culture, and personality. Although the article will examine studies from various regions, specific emphasis will be placed on the Palestinian experience.

Adult↗
PubMed2001

Doing things with illness. The micro politics of the CFS clinic.

This paper focuses on lay and professional ideas about the nature of chronic fatigue syndrome (CFS), and in particular, the ways in which understandings of the disorder are developed in a clinical setting. Our data are drawn from observations of consultations between sufferers and physicians in a UK medical out-patients clinic. We treat the clinic as a political field. That is to say, as an arena in which 'problems' (about the management of illness) are constituted, and alternative approaches and solutions to such problems are pressed. We note that in the realms of symptoms, aetiology and treatment evaluation, lay people in the CFS clinic have quite distinct ideas about what their problems are and how they might be analysed and managed--ideas that are often in conflict with those of medical professionals. Thus, lay sufferers, for example, operate within a different conceptual terrain from that of many professional experts. They are more likely to refer to a disease (myalgic encephalomyelitis or ME), rather than a syndrome. They call upon different kinds of hypotheses to explain their symptoms. They hold to conflicting ideas about the order of causal sequences, and they give emphasis to different kinds of phenomena in their accounts of illness. As a consequence, clinical consultations can often take on the form of a political contest between physician and patient to define the true and real nature of the patient's disorder--a micro political struggle in which neurological symptoms can be re-framed as psychiatric symptoms, and psychiatric symptoms as neurological. In short, a contest in which the demarcation lines between mind and body are continually assessed and re-defined, and the tenets of 'biomedicine' are constantly challenged.

Anecdotes as Topic↗
PubMed2001

Who rules? The new politics of medical regulation.

The recent politicization of medical regulation in the United Kingdom has destabilized the historic relationship between medicine, society and the state. The purpose of this article is to present a political analysis of that relationship and its likely future by identifying the essential elements of power which determine its composition and its capacity to change. That analysis is in three parts. First, it identifies the underlying political tensions in the relationship between medicine, society and the state and the implications of those tensions for any proposed settlement on the future of medical regulation. What are the political criteria by which such a settlement must be judged if the tensions are to be resolved? Secondly, it explores the ideological conflict concerning the nature of medical regulation between the major players, the expression of that conflict in their use of quite different discourses, and the incompatibility of the power assumptions contained therein. Thirdly, it examines the medical profession's particular response to the pressures for change. Finally, the article reflects on the necessary dialogue which must take place between medicine, society and the state before a lasting resolution of the present tensions can be achieved.

Attitude to Health↗
PubMed1998

The effects of political and economic transitions on health and safety in Estonia: an Estonian-Swedish comparative study.

A general and dramatic deterioration of health in Estonia during the transition period 1990-1994 was analysed using Sweden as a comparative example. Though there were diverging trends between Estonia and Sweden in the leading cause of death, cardiovascular diseases, the gap in mortality from injury had increased most rapidly. While the injury mortality rate slightly decreased in Sweden from 1990 to 1994, it almost doubled in Estonia. In 1994, the total injury death rate for men was about 6 times higher in Estonia than in Sweden. The death rates for some types of injuries, such as alcohol intoxication and homicide, were many tenfolds higher in Estonia than in Sweden. Injury contributed the most to the widening health gap between the countries, especially in males. The mechanisms of this sudden health deterioration remain to be fully explained. It could be hypothesised that behind the traditional behavioural risk factors, the influence of socio-political factors related to economic and political reconstruction is present. A widespread risk-taking and unhealthy behaviour among Estonians can likely be partly explained as a way of coping with the distress created by the new demands of transition society. An important challenge on the way to improvement is creating the political will among policy-makers to confront the tremendous problems of controlling the factors in society that affect the population's health in Estonia.

Cardiovascular Diseases↗
PubMed2001

The professionalisation of midwifery through education or politics?

The midwifery profession is redefining itself, with a national initiative to separate from nursing using several strategies at political, legal, educational and professional levels. These include lobbying for a Midwives' Act, a national approach to co-ordinate the education of student midwives, the introduction by the ACMI of competency based practice, the initiation of various models of practice and a three-year Bachelor of Midwifery. This paper argues that the educational strategy employed by midwifery is similar to that used by nursing. This strategy was overtaken by political and economic reforms within the health care sector. We argue that achieving professional dominance is not achieved simply through education but is fundamentally a political process.

Australia↗
PubMed2002

Promoting political empowerment: evaluation of an intervention with university students.

The aim of this research is to examine the effects of an intervention, focusing on the development of political empowerment, with university students. Undergraduates were randomly assigned to one of two conditions (intervention/ control) and were surveyed at two time points: before implementation of the intervention and upon completion of the intervention (or the equivalent two semester period). ANCOVA analyses reveal that individuals who participated in the empowering intervention had increased feelings of political commitment and a decreased sense of political efficacy compared to individuals who were randomly assigned to a waiting list/control group. Finally, limitations of this study are discussed and suggestions for future research are presented.

Adult↗
PubMed2003

Narrating survival and change in Guatemala and South Africa: the politics of representation and a liberatory community psychology.

Peace accords and international interventions have contributed to the suspension of armed conflict and the censuring of repressive regimes in many parts of the world. Some governments and their opposition parties have agreed to the establishment of commissions or other bodies designed to create historical records of the violations of human rights and foster conditions that facilitate reparatory and reconciliatory processes. This paper explores selected roles that community psychologists have played in this process of remembering the past and constructing new identities towards creating a more just future. With reference to two community groups (in Guatemala and South Africa) we show how efforts to "speak out" about one's own experiences of political and military repression involve complex representational politics that go beyond the simple binary opposition of silencing versus giving voice. The Guatemalan group consisted of Mayan Ixil women who, together with the first author, used participatory action research and the PhotoVoice technique to produce a book about their past and present struggles. The South African group, working within the ambit of the Truth and Reconciliation Commission and in collaboration with the third author and others, explored ways of speaking about their roles in apartheid and post-apartheid society. Although both these initiatives can be seen as moments in on-going struggles to overcome externally-imposed repressive practices that censor the voices of marginalized communities, they also serve to dispel overly romanticized notions of "univocal" communities now liberated to express themselves in an unmediated and unequivocal fashion. The paper discusses how each group of women instead entered into subtly nuanced relationships with community psychologists involving a continual interplay between the authenticity of their self-representational accounts and the requirements of the discursive technologies into which they were being inducted and the material conditions within their sites of struggle. In both cases the group's agenda also evolved over time, so that what emerged was not so much a particular account of themselves, or even the development of a particular "voice" for speaking about themselves, but an unfolding process--for the groups and for the community psychologists who accompanied them--of becoming active players in the postmodern, mediated world of self-representational politics and social struggle.

Culture↗
PubMed2004

The political economy of 'trauma' in Haiti in the democratic era of insecurity.

This article explores the challenges that emerge at the intersection of economies of compassion and terror: local, national, and international forms of humanitarian assistance; security practices in insecure social and institutional environments; questions of victimization and global reparations; and quests for justice, as revealed through an analysis of political violence and humanitarian interventions in Haiti during and after the 1991-94 coup period. Each domain is constrained by politics and history but can engender "occult economies" that challenge the intended consequences of restitution policies at international, national, and local levels of exchange. 'Trauma' and discourses about traumatic suffering are the hinge around which these economies pivot, generating new forms of political subjectivity for Haitian activists.

Altruism↗
PubMed2004

Writing trauma: emotion, ethnography, and the politics of suffering among Somali returnees in Ethiopia.

By comparing Somali narratives of emotion and suffering with literature about emotion in relation to trauma and "the refugee experience," this paper contributes to the understanding of emotion, suffering, and trauma in different cultural and sociopolitical contexts, and interrogates the roles and methods of ethnographies of trauma in situations of high political, social, and economic stakes. In the mid-1990s, emotional distress among Ethiopian Somali returnees was about social rupture and injustice and not simply about private suffering. Emotion is critical to creating, recognizing, reinforcing, and mobilizing the moral webs on which both individual and collective survival depend. In the aftermath of dispossession and war, and amidst ongoing hunger and destitution, certain expressions of emotion carry a particularly important valence: anger, passion, and rhetorics of demoralization revolving around a collective narrative of dispossession and demands for restitution. "Experience near" descriptions of Somali emotion expressions cannot be conflated with "psychological" analyses or "Posttraumatic Stress Disorder." Somali refugee narratives index and challenge the embodiment in lived experience of local, national, and global institutions' (in)action and inequality. To the extent that academic debates over emotion and trauma help to shape, reinforce, or challenge the assumptions and practices of institutions affecting millions of lives, we researchers must address in our analyses the practical and political implications of how we interpret and write about emotion, trauma, and politics.

Affect↗
PubMed1997

Vested interest, symbolic politics, and attitude-behavior consistency.

Considerable research suggests the relevance of vested interest for attitude-behavior consistency. Conversely, symbolic politics theory holds that self-interest is irrelevant for attitude valence and related attitude phenomena. Rather, attitudes acquired early in life generalize to other issues and motivate actions, even actions contrary to self-interest. The present research replicates and extends the findings of an earlier symbolic politics study (D. O. Sears, C. P. Hensler, & L. K. Speer, 1979) on the mandated busing of school children (N > 1,300). Analysis of the archival data revealed that vested interest is a significant moderator of (racial) attitude-criterion consistency and of attitude-behavior consistency as well. The results are taken as supportive of both the vested interest and the symbolic politics orientations and form the basis of a position that suggests both schools of thought can coexist.

Attitude↗