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PubMed1985

Healing and morality: a Javanese example.

Javanese traditional medicine is based on Sufi Muslim notions of personhood, knowledge and magical power. This world view motivates two conflicting modalities of medical practice: one based on the magic powers of curers (dukun), the others on the religiously validated powers of Sufi saints. The association of magical and bio-medical knowledge allows Javanese to interpret traditional and bio-medical cures as components of a unified health care system. Comparison of Javanese medical, religious and political systems suggests that the structural uniformity of cultural domains derives from the hierarchical organization of cultural knowledge and that the study of traditional medicine and medical pluralism can not be undertaken apart from that of world view.

Attitude to Health↗
PubMed2005

A review of UK housing policy: ideology and public health.

OBJECTIVES: The aim of this paper is to review UK public health policy, with a specific reference to housing as a key health determinant, since its inception in the Victorian era to contemporary times. REVIEW: This paper reviews the role of social and private housing policy in the development of the UK public health movement, tracing its initial medical routes through to the current socio-economic model of public health. The paper establishes five distinct ideologically and philosophically driven eras, placing public health and housing within liberal (Victorian era), state interventionist (post World War 1; post World War 2), neoliberal (post 1979) and "Third Way" (post 1997) models, showing the political perspective of policy interventions and overviewing their impact on public health. The paper particularly focuses on the contemporary model of public health since the Acheson Report, and how its recommendations have found their way into policy, also the impact on housing practice. CONCLUSIONS: Public health is closely related to political ideology, whether driven by the State, individual or partnership arrangements. The current political system, the Third Way, seeks to promote a sustainable "social contract" between citizens and the State, public, private and voluntary organizations in delivering community-based change in areas where health inequalities can be most progressively and successfully addressed.

Health Policy↗
PubMed1992

Nursing in Nazi Germany.

German nursing did indeed change during the Nazi period. There were external changes, in terms of the improved social status of nursing, the tightening and unification of professional nursing organizations, the laws affecting nursing, and the politicization of the profession. Articles written by nurses at the time and more recent interviews suggest that there were internal changes as well. It appears that at least a portion of German nurses accepted the National Socialism reinterpretation of professional nursing ethics and humanitarian principles in the assumption that through their obedience they were doing good. This historical research points to clear lessons for contemporary nurses. Nurses in Nazi Germany were under the illusion that they were remaining true to their professional ethics, unaffected by the social change around them. This apolitical professional consciousness made it possible for the profession to be subsumed as a part of the larger political system. I believe that we must be clear that nursing never takes place in a value-free, neutral context; it is always a socially significant force. This means that we cannot simply observe what is taking place around us but must take a stand and get involved, helping to shape sociopolitical developments. I also believe that we must deal with the history of our profession, especially its darkest hours, so that we may remain sensitive to any signs of inhumanity. We must call into question traditional principles, such as obedience, and replace them with professional competence, professionalism, and creative self-consciousness. And not least, we have a moral obligation to the millions of victims of National Socialism, even if it only means that, through historical research, we assure that they are not forgotten. By taking responsibility for this part of our history, we can become more sensitive for the future, with eyes and ears open for all social injustices.

Complicity↗
PubMed1975

Medical education in China in the postcultural Revolution era.

The Cultural Revolution has had an important impact on Chinese medical education. The Chinese system is engaged in a vigorous program to solve health-manpower needs in the rural areas by emphasizing de-professionalization, mass orientation and accountability to the community. Among the notable changes within the medical schools are the following: an admission process favoring the recruitment of peasants, factory workers, and the military; a three-year program with heavy emphasis on practicing in rural communities; widespread integration of the traditional Chinese and Western systems of medical practice; and manual labor and political seminars, which compose more than 25 per cent of the required curriculum. These innovations have been greatly facilitated by a strong national commitment and supportive political system. The fact that less than 10 per cent of doctors in China today are graduates of college-level medical education indicates the importance of other entry possibilities.

Allied Health Personnel↗
PubMed2003

Physical growth in a transitional economy: the aftermath of South African apartheid.

The economic transition in developing countries is not always the result of the change from a centrally-planned to a free-market economy, but may be found within an already existing free-market economy as a result of profound political change, as in South Africa. The release of Nelson Mandela in February 1990 heralded an end both to the political system of apartheid and to the concomitant social, political, and economic disenfranchisement of 30 million non-White people in South Africa. The first freely elected non-White government came to power in 1994 and initiated a number of social and economic reforms aimed at alleviating the worst consequences of apartheid. This paper examines the effect of post-apartheid economic and social transition on the growth and development of urban children. Over 4000 children born in Soweto and Johannesburg were enrolled in the Birth to Ten (BTT) birth-cohort study in 1990. Whilst these children were born with lower birth weights than in developed countries, they did grow strongly in infancy, particularly in weight, to reflect normal reference values for body mass index (BMI) by 1 year of age. While post-apartheid social and economic changes were expected to take some time to affect child growth and development, the rate of change has been slower than expected. Data from the BTT study demonstrate that the growth of White children continues to be superior to that of their non-White peers and differences that existed at birth and during infancy have not diminished during childhood and early adolescence. Whatever factors are changed at the national or community levels during economic (and social) transition in South Africa appear not yet to have resulted in improved child physical growth.

Capitalism↗
PubMed1993

The voluntary repatriation process of Chilean exiles.

"The purpose of this paper is to analyse the main characteristics of the reintegration process of Chilean exiles returning to their country: the voluntary repatriation process of those who left Chile in 1973 when a military coup overthrew the democratically elected government, and who began to return to Chile in 1978, especially after 1990 with the re-establishment of democracy. Data have been obtained from secondary sources (publications, working papers, institutional documents), official publications provided by governmental agencies, and informal interviews with professionals assisting the returned population. The research was undertaken in situ in Santiago, Chile, during May and June 1992." (SUMMARY IN FRE AND SPA)

Americas↗
PubMed1996

[The democratic movement, cholera epidemic and public health reform in the Zurich canton (1867)].

In the summer of 1867 Zurich, Switzerland, was struck by a severe Cholera outbreak. Recent research suggests that the Cholera epidemic had such an influence on the municipal policy makers that they pushed through a major reform of the public health system, namely of water supply and sewerage. This paper adopts a theoretical conception of crisis and social change to evaluate the plausibility of this hypothesis. The basic idea is that structural change can be usually understood as the consequence of a major social crisis. Exactly this was the case in Zurich during the 1860s. After a decade of economic stability and progress, a severe crisis simultaneously stuck Zurich's agriculture, textile industry and railway companies. The so called Democratic Movement threatened the existing political system; the old political establishment feared a political revolution. On top of all this, Cholera struck Zurich, precipitating a crisis in the public health system. Suddenly, old concepts and institutions were felt to be outdated. The democrats put through political reforms, the economic downswing ended and a large program to reshape the urban environment was initiated. It can be concluded that the Cholera epidemic alone did not cause the public health reform. But together with other crisis phenomena it played a major role in weakening the stability of the old system, and thus contributed to the society's ability to put in place new political, economic, and social structures.

Cholera↗
PubMed2002

Political cultures, health systems and health policy.

Policies for restructuring national health systems in low- and middle-income countries tend to follow similar packages of prescriptions along the lines of those discussed in the World Development Report of 1993. An ubiquitous reform measure is that of decentralisation. Research on decentralised health care in Northeast Brazil demonstrates the critical role played by informal aspects of health system management and the political cultures of the wider context on the implementation of policy and the performance of local health systems. Discussion of incorporating these results into policy making highlights a number of points. Health systems research has failed to take seriously the role of the cultural for various reasons, particularly because of the challenge it makes to our own fundamental values and because of the difficulties of including it into approaches based on rational systems models. At the same time, health system researchers cannot easily draw upon and operationalise more complex and sophisticated explorations of the nature of the cultural domain. Nonetheless, without a concerted effort to engage with this literature, to bridge the gap to the applied policy world and tackle the challenge of incorporating considerations of political culture into policy making, health system management through decentralisation is likely to increase inequalities between local districts rather than the opposite.

Brazil↗
PubMed2006

Towards an analytical theory of social change: the case of China.

Lockwood argues that contradiction between the core institutional order and the material substructure of a society gives rise to potential social relationships which constitute a threat to the existing institutional order and may lead to change in the type of the society. Parkin, in particular, has advocated the application of the idea to the study of socialist societies. However, the situation of socialist China opposes Lockwood's view in that the new social relationships arising from the changing economic system do not pose a threat to the existing political system. Moreover, Lockwood underdevelops the connection between human action and social structure and does not theorize the mechanism linking system weakness and social change. This article formulates an alternative perspective by building on Giddens's structuration theory and Mouzelis's work on sociological theory. The theoretical framework is applied to China to give a flavour of how social change can be studied.

China↗
PubMed2004

Virtual university governance.

There is a need to establish collaboration alliances or partnerships if we are to provide global Health Informatics educatics education. Agreements need to make provision for the existing diversity between country educational systems as well as variations in funding, legislation and political systems and a number of other issues including intellectual property and copyright. Four virtual University governance models were identified, 1) evolution of existing universities, 2) newly created organisations collectively delivering one type of program eg MBA, 3) a consortium of partners using a common portal and 4) a commercial enterprise. Collectively IMIA academic members need to be in a good position to respond to the global changes in higher education and minimise the risk of failure when establishing a virtual University to collectively deliver Health Informatics education. Others have undertaken a similar path in the past, some successful others not so, we need to learn from these experiences.

Accreditation↗
PubMed2005

[Continuity in personnel--change in contents: German physiologists in National Socialism and in the Federal Republic of Germany].

This paper illustrates how German physiologists during the Second World War succeeded in making a case for the relevance of their research for the war effort. In this way the paper contributes to the recent historical debate about how scientists--in this case the physiologists--could enforce their interests within the National Socialist system and to what extent they were "misused" by the political and military leaders. Most scientists were able to continue their careers in the new political system after 1945, using the old scientific network from the National Socialist era. They successfully changed their research topics, responding quickly to the new challenges in peace. As a typical example the career of the physiologist Hans Schäfer is described in this article.

Biomedical Research↗
PubMed1994

Economics of health care reform.

Several economic points require consideration when assessing the current cost of health care in the United States and the potential savings from proposed reforms. Most savings projections are based on assumptions and estimates that cannot be accurate under the best of circumstances, and the error in the final results is greatly compounded by even small errors in the initial estimates. Experience with health care programs worldwide, including our own Medicare program, has shown that final costs are usually much larger--often several times larger--than initial estimates. It is even more difficult to predict the behavior of the population under a system that does not yet exist, and it is not clear whether a system such as the Jackson Hole Plan will actually produce savings. The effect of our political system will have on any health system enacted through legislation must also be considered. The political process itself frequently results in more benefits rather than fewer, more regulation rather than less, and the shifting of costs to other sectors of the economy to minimize costs in the health sector. When presented with projections and predictions in health care planning, we must critically examine the initial assumptions, knowing that errors in these assumptions will magnify errors in the final results.

Attitude to Health↗
PubMed2004

The emergence of political priority for safe motherhood in Honduras.

Each year an estimated 500,000 to 600,000 women die due to complications from childbirth, making this one of the leading causes of death globally for women in their reproductive years. In 1987 a global initiative was launched to address the problem, but few developing countries since then have experienced a documented significant decline in maternal mortality levels. Honduras represents an exception. Between 1990 and 1997 the country's maternal mortality ratio--the number of deaths due to complications during pregnancy, childbirth and the postpartum period per 100,000 live births--declined 40% from 182 to 108, one of the largest reductions ever documented in such a short time span in the developing world. This paper draws on three political science literatures--constructivist international relations theory, policy transfer and agenda-setting--to explain how political priority for safe motherhood emerged in Honduras, a factor that underpinned the decline. Central to the explanation is the unusually cooperative relationship that developed between international donors and national health officials, resulting in effective transfer of policy and institutionalization of the cause within the domestic political system. The paper draws out implications of the case for understanding the political dynamics of health priority generation in developing countries.

Delivery of Health Care↗
PubMed2006

Violence and complex humanitarian emergencies: implications for livelihoods models.

This paper explores the nature of the violence that characterises complex humanitarian emergencies and the related implications for modelling livelihoods systems. While noting the importance of livelihoods approaches in complex humanitarian emergencies, it deliberates the limitations of sustainable livelihoods frameworks when applied in environments marked by protracted instability. Adaptations to the model are discussed, with a particular focus on the relationships among violence, assets and liabilities within livelihoods systems. Political economy of violence theories intimate that the assets on which livelihoods systems are constructed in peaceful times may instead become life-and livelihood-threatening liabilities in periods of conflict. Adaptations to livelihood systems in violent settings require that analysts consider violence from policy, institutional and process perspectives. It is suggested that vulnerability should be re-conceptualised as endogenous to livelihoods systems in violent settings. Building on the work of others, a livelihoods model adapted for complex humanitarian emergencies is presented.

Adult↗
PubMed1992

Determinants of a merger in a publicly-funded health system: a political-economy perspective.

This article reports the results of a case study, spanning a period of 10 years, of the merger of two hospitals in a publicly-funded health system. A political economy model was used to analyse the determinants of the merger. Results show that external political economy factors, mainly pressure from the state to rationalize health services and the organization's needs to acquire critical resources, significantly contributed to the merger decision. At the internal political economy level, groups and individual strategies also played a determinant role. Our study suggests that merger in the public sector may not necessarily result from efficiency motives.

Health Facility Merger↗