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PubMed2003

Ethnicity and the politics of the new genetics: principles and engagement.

Identifying the genetic basis of disease is not a straightforward medical procedure but implicates the broader social, cultural and political context. Ethnicity represents an important part of this context, particularly given the confused and poorly informed debate about genetic differences among supposedly different 'racial' populations. Debates about the 'new genetics', however, have not engaged fully with the issue of ethnicity and racism. This paper, by reviewing a mix of empirical and theoretical debates, explores the discursive practices that inform current thinking on genetics, ethnicity and race. The account begins by exploring some of the philosophical tensions inherent in providing genetic testing. In doing so, the paper argues that current debates about genetics are not neutral but evoke a specific set of received ideas and codes of intervention, embodying social and power relationships. The paper then broadens the discussion by exploring the general meaning of screening and counselling for the 'lay' population, before focusing on the process of providing information and identifying people as carriers. The paper concludes by suggesting that the social space in which the 'new genetics' is enacted, understood and given meaning raises generic concerns, irrespective of ethnicity. These include the potential tension between prevention and informed decision making, whereby ideas about empowering individuals to exercise choice exist alongside a more general societal concern with minimising impairment and illness. In more practical terms, individual choice is compromised by poor-quality care, inadequate information, insensitivity to an individual's worries and concerns and a more general failure to meet his or her needs. At the same time, however, the often racialised perspectives articulated through the activities of service professionals can further complicate the choices and decisions available to minority ethnic populations. The failure to recognise and respond to diversity; blaming minority ethnic populations for their health problems; and the pervasiveness of racist myths and stereotypes in service provision, serve to disadvantage minority ethnic populations. This explains why themes such as equity and access, political engagement as well as more general notions of deservingness based on the construction of citizenship and identity emerge as fundamental in making sense of the relationship between ethnicity and the politics of the 'new genetics'.

Ethics, Medical↗
PubMedDate not supplied

Science, politics and ethics in the low dose debate.

The roles of science, ethics and politics are identified in respect of the risks of exposure to low-dose radiation. Two case studies, the epidemiology of the United Kingdom nuclear test veterans and the risks to civilians associated with the military use of depleted uranium, are considered in the context of their ethical framing, scientific evaluation and political resolution. Two important issues for the present and future, the safe management of U.K. radioactive waste and the future of nuclear power, in which the science of low dose effects will be crucial and where the ethical issues are much more complex, are introduced. Specific consideration is given to the potential hereditary effects of ionising radiation in relation to the current state of radiobiological knowledge. It is concluded that for science to be useful in public health policy making there needs to be some reform from within the profession and the political imperative for freely independent scientific institutions.

Disaster Planning↗
PubMed2006

When are health inequalities a political problem?

Is it possible to define criteria by which a political decision on which inequities in health should be addressed can be made? It has been suggested that differences which are unnecessary and avoidable and those which are unfair and unjust are inequalities which should lead to political action. In the article it is argued that it is not possible to make a clear distinction between avoidable and unavoidable differences, and that the extent to which differences are considered unfair depends on political and normative standpoints, and generally acceptable criteria can therefore not be established.

Attitude to Health↗
PubMed1989

Is there a gray peril? Retirement politics in Florida.

Using data from Florida, the most significant destination for Sunbelt retirees, three hypotheses concerning the political impact of retirement migration on the Sunbelt were tested. Surveys of local government officials and socioeconomic data about local government regarding 103 municipalities and 62 counties suggested that aging persons, although politically active, are seldom involved in organized advocacy or political opposition to local policies that are largely beneficial to other interests.

Aged↗
PubMed1992

The political behavior of older American blacks.

Using a subsample of the National Opinion Research Center's 1987 General Social Survey, this study examined three competing explanations for the political behavior of older black Americans (n = 157, 55 and older). The socioeconomic model was a good predictor of political behavior; ethnic community theory and the empowerment model were, in varying degrees, predictors of alienation but not of political interest or activity. Some comparisons were made between older black Americans, younger blacks, and older and younger whites.

Adult↗
PubMed1994

Bangladesh pharmaceutical policy and politics.

An analysis of the politics of Bangladesh pharmaceutical policy in the 1980s shows how significant health policy reforms in developing countries depend on political conditions both inside and outside the country. Bangladesh's drug policy of 1982 illustrates that governments can sometimes change public policy in ways unfavourable to multinational corporations, while the failed health policy reform of 1990 shows that reforms unfavourable to powerful domestic interest groups can be more difficult to achieve, even contributing to a government's downfall. The case provides evidence of basic changes in how the international agenda for health policy is set, especially the growing role of non-governmental organizations in international agencies and national policy debates. Understanding the political patterns of policy reform in Bangladesh has important implications for strategies to affect health policy in developing countries.

Bangladesh↗
PubMed2005

Towards a politics of health.

The importance of public policy as a determinant of health is routinely acknowledged, but there remains a continuing absence of mainstream debate about the ways in which the politics, power and ideology, which underpin public policy influence people's health. This paper explores the possible reasons behind the absence of a politics of health and demonstrates how explicit acknowledgement of the political nature of health will lead to more effective health promotion strategy and policy, and to more realistic and evidence-based public health and health promotion practice.

Health Policy↗
PubMed2004

Health by association? Social capital, social theory, and the political economy of public health.

Three perspectives on the efficacy of social capital have been explored in the public health literature. A "social support" perspective argues that informal networks are central to objective and subjective welfare; an "inequality" thesis posits that widening economic disparities have eroded citizens' sense of social justice and inclusion, which in turn has led to heightened anxiety and compromised rising life expectancies; a "political economy" approach sees the primary determinant of poor health outcomes as the socially and politically mediated exclusion from material resources. A more comprehensive but grounded theory of social capital is presented that develops a distinction between bonding, bridging, and linking social capital. It is argued that this framework helps to reconcile these three perspectives, incorporating a broader reading of history, politics, and the empirical evidence regarding the mechanisms connecting types of network structure and state-society relations to public health outcomes.

Health Promotion↗
PubMed1996

Preventing sexually transmitted diseases through individual- and population-based public health approaches: social and political implications.

Epidemiology provides the scientific rationale for public health decisions. Epidemiologists construct taxonomic collectives on the basis of individual attributes, or "risks." One of the public health approaches to the control of sexually transmitted diseases (STDs) is to identify population-based strategies that can be targeted to these risk groups. Public health decisions, however, are largely political and open to discussion beyond the academic environment. Terms such as "risk group" have different meaning in public discourse than in scientific jargon. The language of epidemiology, when used in public health campaigns to control STDs, has led to stigmatization and victimization of individuals. Public health policies that ignore the political and social organization of populations are in danger of becoming instruments of social and political repression.

Health Promotion↗
PubMed1998

Treatment of survivors of political torture: administrative and clinical issues.

Treatment of survivors of political torture is a new field, the symptoms of survivors are many and difficult, clinicians in general are not experienced in treatment, and there is little money available. Both administrative and clinical decisions often must take into account political realities not found in other treatment environments. To overcome these obstacles has required building an agency with a small economy, a sense of community among its workers, flexibility about the presence and pervasiveness of politics, the ability to address countertransference, and goals that allow workers to cope with the difficulty and size of the problem of torture.

Caregivers↗
PubMed1998

The dose-effect relationships between torture and psychiatric symptoms in Vietnamese ex-political detainees and a comparison group.

The purpose of this study was to determine in Vietnamese ex-political detainees newly arrived into the United States a) the prevalence of torture and psychiatric symptoms and b) the dose-effect relationships between cumulative torture experience and the psychiatric symptoms of posttraumatic stress disorder (PTSD) and major depression. The study population included Vietnamese ex-political detainees (N = 51) and a comparison group (N = 22). All respondents received culturally validated instruments with known psychometric properties including Vietnamese versions of the Hopkins Symptom Checklist-25 and the Harvard Trauma Questionnaire. The ex-political detainees, in contrast to the comparison group, had experienced more torture events (12.2 SD = 4.2 vs. 2.6 SD = 3.1) and had higher rates of PTSD (90% vs. 79%) and depression (49% vs. 15%). Dose-effect relationships between cumulative torture experience and psychiatric symptoms were positive with the PTSD subcategory of "increased arousal" revealing the strongest association. These findings provide evidence that torture is associated with psychiatric morbidity in Vietnamese refugees. The demonstration of significant dose-effect responses supports the hypothesis that torture is a major risk factor in the etiology of major depression and PTSD. The generalizability of these results to other torture survivor groups is unknown. The interaction between torture and other pre- and post-migration risk factors over time in different cultural settings still needs to be examined.

Adult↗
PubMed1997

Science, politics, and AIDS prevention policy.

The relationships among science, politics, and health care policy have changed dramatically over the years since AIDS was first diagnosed in the United States. Initially politics was viewed as inimical to prevention; now it is viewed as central. The challenge is to ensure that policies facilitate prevention of the spread of HIV and do so in a way that protects those most vulnerable. The policies of the first decade of the epidemic were hostile to research in areas such as needle exchange and sexuality. More recently, the political climate has been more sympathetic, but whether this will result in a more effective health-care policy is not yet clear. Two important debates continue in AIDS prevention policy: (a) the issue of whether prevention efforts should be targeted to high-risk populations and geographic areas or should be more broadly focused, and (b) whether prevention priorities are best established through democratic participation that includes federal government agencies, local health departments, and community-based organizations.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Premigration exposure to political violence among independent immigrants and its association with emotional distress.

Although the distinction between independent immigrants and refugees has an impact on policy, services, and public opinion because it implies differences in resettlement needs, few recent studies have documented the validity of this assumption. In this population-based survey of recent migrants in Quebec (N = 1871), immigration status (refugee, independent, or sponsored immigrant) is examined in relation to premigration exposure to political violence and refugees' emotional distress, assessed with the SCL-25. A higher percentage of refugees reported exposure to political violence in their homeland, but the percentages of exposed independent (48%) and sponsored (42%) immigrants were unexpectedly high. Emotional distress was significantly higher among Chinese respondents who had witnessed acts of violence and in subjects from Arab countries who reported persecution. These results suggest that service providers and policy makers should not assume that independent immigrants have not been exposed to political violence before their migration.

Adolescent↗
PubMed1986

Policymaking, politics, and the neuroscience nurse.

To fulfill social contracts to those suffering from neurological disease or trauma and to thrive as professionals, neuroscience nurses must enter the political arena. To do so requires an understanding of policy, politics, and policymaking in our society. Social changes affecting neuroscience nursing, including increases in the aged and in minority populations and changes in state and local health care policies are discussed. Ways for neuroscience nurses to become politically active are presented.

Community Participation↗
PubMed2003

Early socio-political and environmental consequences of the Prestige oil spill in Galicia.

The controversial form in which the oil industry is run has once more caused a huge disaster--this one affecting the Galician coastal environment and economy. Oil-spill clean-up operations have been managed in Europe with some success but with considerable economic, environmental and social costs. The oil industry often avoids fully or even partially compensating those affected. The lack of both political will and political power has let the culprit (the oil industry) off the hook. This paper considers the spill of the Prestige to assess whether the balance of power between affected people and the oil industry can be changed. The paper examines the growing awareness of environmental issues among ordinary people in Spain, through the massive involvement of volunteers concerned with the damage done to the environment and to the livelihoods of fishing communities in Galicia. To understand these growing public concerns and the strength of opinion, the paper examines the details of the decisions taken by the central Spanish and local governments and the way these have informed the clean-up operations, the character of the oil companies involved and the feeling of impotence in the face of such disasters. The conclusion here is that the operations of the oil industry should be tightly regulated through EU legislation, and that this can come about as a result of organised political pressure from those affected by the oil spill, from the mass of volunteers, as well as from public opinion at large.

Environmental Pollution↗
PubMed2003

Public health ethics: asylum seekers and the case for political action.

This paper is a case study in public health ethics. It considers whether there is a basis in ethics for political action by health professionals and their associations in response to inhumane treatment. The issue arises from Australia's treatment of asylum seekers and the charge that this treatment has been both immoral and inhumane. This judgement raises several questions of broader significance in bioethics and of significance to the emerging field of public health ethics. These questions relate to the role of health professionals in response to inhumane treatment of people in their charge; to the discipline of public health in light of a growing recognition of its ethical basis; and the role of public health and bioethical associations in response to ethical issues arising in a political context. It is argued that, in serious cases of humanitarian and human rights abuses affecting health and well-being, there is a case for political action by health professionals, academic and professional institutions, and associations of public health and ethics.

Australia↗
PubMed1990

The politics of American health care.

The developments leading to the present American health care organization are traced. It is clear that hospitals have dominated at the expense of primary health care programmes. Health care costs have soared dramatically. There are particular problems inherent in a system shared between federal and state governments and a private health care industry. Attempts to provide a fully (or partially) tax-funded health service in the USA have been bedevilled by a number of factors. These include opposition from labour unions, politicians, vested-interest groups and, in particular, the American Medical Association. As part of its opposition, the AMA politicized itself in 1950. But, in the political literature, American nurses are not portrayed as being very politically active. Reasons for this are explored. The introduction of Medicare and Medicaid programmes is discussed and the legal, social and political implications. Recent attempts in the USA to control costs are assessed and new trends and new problems identified.

American Medical Association↗
PubMed2004

Political leadership in Europe--an assessment of the impact of the 2004 EU Accession round on nursing in Europe.

BACKGROUND: The accession of 12 countries to the European Union necessitated mechanisms to be put in place to offer support to the professions to comply with Directives applying to their training. The author led missions to these countries on behalf of the European Union Commission. This paper reports on the issues arising from the accession process in terms of the political leadership of nursing in Central Europe. It places the current developments in historic and geo-political contexts. KEY ISSUES: The development of nurse leadership is central to the response of the profession to this. Challenges emerging from the history of the region, socio-cultural norms, and current political maturity are addressed. CONCLUSIONS: The need for nurses in both Western and Central Europe to work together is emphasized. The future challenges to be faced as further accession rounds occur are also identified.

Europe↗