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The political process and the private health sector's role in Vietnam.

Vietnam has experienced a period of economic and political transition from a command economy to one of market socialism. This transition has precipitated a shift in the policies concerning the private sector, as well as increased demand for services from the private health sector. The private sector has evolved, though more rapidly in the Ho Chi Minh City area, with the passing of laws and regulations concerning private practice. The policy maker's concern is to maintain the equity gains realized under the public health system while using the private sector growth to make improvements in the system's efficiency. The political process enabling expansion of the private health sector has been slow, and will continue to be measured as it seeks to create a national health system with a rational integration of the public and private sectors.

Developing Countries↗

The dilemmas of incrementalism: logical and political constraints in the design of health insurance reforms.

Health care reform became a premier issue on the U.S. policy agenda in the 1990s. While the comprehensive proposal put forth by President Clinton failed, states and the federal government successfully pursued a variety of lesser initiatives. This article focuses on a set of reforms intended to make private health insurance more accessible and affordable to individuals and workers in small firms. It outlines the key arguments made by experts to justify stronger regulation of health insurance and the options and difficult tradeoffs that must be considered in policy design. It then examines the scope and strength of legislation adopted by 45 states and the federal government from 1990 to 1996. The substantial variation in state policies demonstrates that even though insurance market reform was the one issue that commanded nearly universal support in the health care debate, few design features were universally accepted by those who crafted the reforms. The article concludes by assessing the pattern of state and federal action. The reforms represent some progress on nominal access to insurance but little progress on the affordability of insurance for individuals and small groups. Few of the reforms present a serious challenge to existing practices and interests of the insurance industry. This pattern of policy design reflects the logical and political constraints of incrementalism. In a system where insurance coverage is voluntary, changes to increase access for one group tend to increase costs and thereby decrease access for another segment of the population. In addition, because incremental reforms will not attract sustained attention and support from the general public, it is politically difficult to impose substantial new regulation on a powerful industry.

Group Purchasing↗

Hospital role delineation: the technology and the politics.

Regulated health systems are under increasing pressure to improve the efficiency of their hospital provision. One approach is to have more coordinated hospital provision through hospital role delineation. This short communication proposes the use of Diagnosis Related Groups as part of the role delineation process. However, the role delineation process is not solely a technical one: it requires a blend of technical and political decisions. Political aspects of the role delineation process are also reviewed.

Canada↗

The state construction of affect: political ethos and mental health among Salvadoran refugees.

This essay seeks to extend current anthropological theorizing on emotion. Although anthropologists have convincingly established the specifically cultural status of emotion, recognition also of "state" (including sociopolitical institutions of nation-states) constructions of affect has been slow in coming. The present essay seeks to expand the emerging scholarly discourse on the emotions by examining the nexus among the role of the state in constructing a political ethos, the personal emotions of those who dwell in that ethos, and the mental health consequences for refugees. This analysis is intended as a bridge between analyses of the state construction of affect, on the one hand, and the phenomenology of those affects, on the other. To illustrate, I examine the state construction of affect and its traces in the narrative and clinical presentations of Salvadoran refugees in North America. The saliency of fear and anxiety among a group of psychiatric out-patients is framed by bodily experience, knowledge of illness, and the ethnopsychology of emotion within the context of chronic political violence and poverty. Distinctions between terror and torture, distress and disease are proposed as essential to an account of refugee experience. Future directions for the study of the "state construction of affect" are suggested.

Adaptation, Psychological↗

Consultation as a political process.

Consultation may be viewed as a political-bargaining process in which actors seek to maximize at minimal cost expertise, organizational position, and organizational reputation. A view of consultation as political process allows for a shift in language in discussions of consultation. Such a language shift suggests shifts in the social meaning of the consulation process. Emphasis was placed on four suggested functions of consultation: definition and legitimation of a situation or of facts as "problematic"; raising the priority of an i5sue on the agenda of action in a consultee's agency; legitimation of deviant administrative behavior, and creation and sustenance of interagency linkages. A perspective is proposed that looks at the consequences as well as the intents of the process. This view of consultation can be studied emprically.

Humans↗

Sex, politics, and personality: a multidimensional study of college students.

Two-hundred undergraduate students (100 males, 100 females matched on age and school year) in university dormitories were administered measures of sexual attitude and behavior, individual differences in stimulation seeking, personality, and political orientation (liberal-conservative). Factor analysis using the Harris interpretation strategy was applied to the data. Clear sexuality factors, with generally little contribution of the personality and political-orientation variables, were obtained.

Achievement↗

[Administration, politics and science in alcohol prevention in Swiss cantons].

OBJECTIVES: The article assesses the effects that different constellations of science, administration, and the political sphere have on the policy design and the output performance in the field of alcohol prevention policy. METHOD: Comparative bivariate analysis of results from a written survey of the Swiss cantons. RESULTS: A broad and adequate policy design is found in cantons with an alcohol prevention policy dominated by administrative actors. Output performance shows to be comparatively higher in cantons with a high influence either of scientific actors or of political actors. CONCLUSION: In an overall comparison focusing on the two dependent variables of this study, a combined model of administrative dominance with strong affiliation to the scientific community prevails against the other models considered.

Alcoholism↗

Political economy of transnational water pollution: what do the LMB data (1985-2000) say?

On the basis of the cross-section and time-series data of the Lower Mekong Basin (LMB)--including large sections of Thailand, Lao PDR, Vietnam, and Cambodia, we find little evidence in support of the environmental Kuznets curve (EKC) hypothesis. Instead, our regressions support the general views that water pollution had been positively related to income level and that, as a result of the end of the Cold War era, it had been significantly reduced in the 1990s vis-à-vis the 1980s. In most circumstances, water resources were more seriously polluted in the transnational border areas than in the other areas. Specifically, the estimated coefficients on the political boundary dummies show that political influence on transnational water pollution was more significant in areas near "the international border along which the river runs" (denoted by BORDER2) than in places near "the international border across which the river runs" (denoted by BORDER1). The estimated coefficients on the ASEAN dummy present some information about the positive role of the Association for Southeast Asian Nations (ASEAN) membership in the reduction of transnational water pollution. Finally, the country-specific dummies are found to present conflicting information about the transnational differences of water pollution, although Thailand is found to have the least water pollution in the LMB.

Asia↗

The science of politics/the politics of science: examining the snowmobile controversy in Yellowstone National Park.

The snowmobile controversy in Yellowstone National Park not only pits snowmobilers against environmentalists, but it also pits the Bush Administration against the Clinton Administration. Caught in the middle are the National Park Service, scores of natural and social scientists, and Yellowstone's permanent residents-the flora and fauna. The controversy's political aspects are the focus of this paper; specifically, the tenuous relationship among research scientists, whose job it is to inform management and policy decisions; politicians, whose job it is to formulate those same decisions in the public arena; and public land management agencies, whose job it is to implement the decisions. The crux of the paper concerns the politicization of natural resource policy and ways in which research scientists tend to get caught up in it. Lessons learned from this Yellowstone episode regarding the role of science in policy-making processes are also considered. Two recent federal court rulings shed additional light on the politics surrounding Yellowstone's snowmobile controversy, as does the importance of governmental checks and balances in resolving natural resource management disputes.

Conservation of Natural Resources↗

Foreword -- ADHD in the scientific and political context.

The foreword focuses on the three main critical questions within the political debate: (1) Is ADHD a psychiatric disorder? (2) Is there over-diagnosis and overtreatment of ADHD? (3) Are psychostimulants dangerous drugs? After discussing the problems within the context of general scientific and merely European political context, the authors conclude with a positive outlook comprising (1) step-up of research in ADHD, (2) exercised control over diagnosis and treatment, (3) the need for training and continuous personal development for doctors, and (4) Improvement of information to teachers and parents. The presented supplement on "ADHD -- beyond core symptoms. Not only a European perspective" underlines this perspective and reflects a broad spectrum of ADHD-related activities currently underway in Europe while having the worldwide development of the field in mind.

Attention Deficit Disorder with Hyperactivity↗

The politics of certainty: conceptions of science in an age of uncertainty.

The prestige of science, derived from its claims to certainty, has adversely affected the humanities. There is, in fact, a "politics of certainty". Our ability to predict events in a limited sphere has been idealized, engendering dangerous illusions about our power to control nature and eliminate time. In addition, the perception and propagation of science as a bearer of certainty has served to legitimate harmful forms of social, sexual, and political power. Yet, as Ilya Prigogine has argued, renewed attention to the irreducible reality of time has brought us to "the end of certainty". As we enter the age of uncertainty, there is disagreement about how science should be understood and communicated. Some scientists cling to the ideal of certainty, while others emphasize the creative potential of spontaneity, novelty, and surprise.

Cultural Diversity↗

A critique of the ideological and political positions of the Willy Brandt Report and the WHO Alma Ata Declaration.

This article (1) analyzes the Willy Brandt Commission Report and the WHO Alma Ata Declaration within the socio-economic and political context that determined them, and (2) makes a critique of the ideological and political assumptions that both documents make. Through an assumingly apolitical and technological-administrative discourse both documents reproduce the major positions upheld by the hegemonic development establishments of the Western world. The article analyzes (through a study of what is being said and not said) how those positions appear in the documents. It is indicated that (1) their understanding of the causes of underdevelopment and its major health and disease problems and (2) their suggestions for change based on 'moral calls for social justice' and 'enlightened self-interest' are faulty and insufficient. Alternative explanations and solutions are presented.

Delivery of Health Care↗

Toward a political-economy of alcoholism: the missing link in the anthropology of drinking.

This paper addresses a shortcoming in the existing anthropological and related social science literature on alcohol use and abuse, namely the general inattention to global political-economic forces that have in the past and continue to reshape social relations and drinking practices cross-culturally. Following a critical review of the dominant approaches adopted in the varying explanations of heavy drinking and alcoholism, several alternative concepts are presented and developed in order to lay the ground for the emergence of a political-economy of alcoholism. The paper urges transcendence of the existing narrow boundaries of inquiry and perspective characteristic of most anthropological study of drinking and drinking problems.

Alcohol Drinking↗

Linking the geographical, the medical and the political in analysing health care delivery systems.

The models and methodologies used by medical geographers for analysing health care delivery systems are critically reviewed. As a result, it is argued that an intellectual cul-de-sac has been reached because of the lack of linkage in these models and methodologies that explicitly recognize the socio-cultural and political-economic influences in the environment, where the health care delivery system under study exists. Using the example of abortion services in Canada in general, and Ontario specifically for illustrative purposes, a general model for linking the geographical, the medical and the political aspects of health care delivery is proposed.

Abortion Applicants↗

Nursing research and societal needs: political, corporate, and international perspectives.

Tension exists between political and public pressure for fiscal constraint in health care expenditures and the scientific community urging greater allocation of research funds. Some contend that scientists are out of touch with the rest of society. This issue is discussed from the political, corporate, and international perspectives. Nurse researchers need to examine their priorities and determine whether they are congruent with societal need. In addition, increased interaction with the public, increased involvement with the federal decision making process, and the building of research consortia and collaborative endeavors are recommended.

Global Health↗

The Nazi symbiosis: politics and human genetics at the Kaiser Wilhelm Institute.

The case of the Kaiser Wilhelm Institute for Anthropology, Human Heredity and Eugenics (KWIA), from its inception in Weimar Republic Germany to its apogee under the rule of the Third Reich, is an example of how politics and human heredity can function as mutually beneficial resources. Whether it was a result of the Nazi bureaucrats' desire to legitimize their racial policy through science, or the KWIA personnel's desire to secure more funding for their research, the symbiotic relationship that developed between human genetics and Nazi politics could help explain why many scientists in the Third Reich undertook research projects that wholly transgressed the boundaries of morally acceptable science.

Academies and Institutes↗

Pharmaceutical regulation in Greece at the crossroad of change: economic, political and constitutional considerations for a new regulatory paradigm.

This paper examines the economic, political and legal characteristics of the Greek pharmaceutical market, which is largely affected by the paradox of state intervention: while pharmaceutical regulation is mainly directed towards a rationalisation of total pharmaceutical expenditure, all measures taken to date aim at exhaustive pricing controls, i.e. interventions on the supply side alone, disregarding the "balloon" effect of shrinking prices on the expanding volume of consumption. As a result, pharmaceutical expenditure has been steadily rising, adding a disproportional burden on both social insurance and private income. The "unconstitutionality" of current pricing regulations exerted further pressure for a comprehensive reform. The paper proposes an alternative regulatory paradigm, which is loosely founded on European experience with regulating pharmaceutical markets. The conclusions of the economic, political and constitutional analysis help formulate a proposal for a comprehensive pharmaceutical policy that could assure the financial viability of the system as well as adhere to the principle of "legality", as the latter is constitutionally defined.

Drug Industry↗

The politics of heterosexuality--a missing discourse in cancer nursing literature on sexuality: a discussion paper.

In this article, a critique of cancer nursing literature on the issue of sexuality is presented, with particular reference to literature on cancers common to women. The paper begins with an account of two competing perspectives on sexuality. The first is a version of sexuality rooted in sexology, underpinned by biomedical science that makes a claim to having identified 'normal' sexuality. The second is a version of sexuality developed within feminist scholarship that tends to reject biological determinism as a basis for understanding sexuality, instead favouring constructionist perspectives, with the socio-political context of sexual relations problematised. The focus of the article then shifts to cancer nursing literature on sexuality that deals primarily with cancers common to women, to appraise the extent to which either of the above perspectives on sexuality is invoked. Within this body of nursing knowledge, I argue that there has largely been an uncritical endorsement of biomedical constructions of sexuality, rooted in orthodox sexology, with a dominant focus on sexual functioning and on sexual rehabilitation for women with cancer. Moreover, in this knowledge base, phallocentric heterosexuality over and above other forms of sexual expression is privileged, and the socio-political context of unequal gender power relations is largely excluded. References to the social sphere as a dimension of nursing care are focused almost exclusively on maintaining normality, and reflect the emphasis on functional restoration. The largely individualistic, uncritical and biocentric emphasis in this literature may serve inadvertently to reinforce and maintain existing gender inequalities in heterosexual relationships. Finally, I consider the difficulties for oncology nurses in dealing with contradictory truth claims or conventional wisdoms about sexuality from the disparate disciplines of which holism is comprised.

Female↗