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PubMed1998

Rehabilitation in complex political emergencies: is rebuilding civil society the answer?

The paper examines the challenge of rehabilitation from complex political emergencies (CPEs) and identifies a strategy that is characterized as a civil society rebuilding approach. It focuses on Somalia and a case study of CARE project that aims to build the capacity of local NGOs. The paper argues that civil society in CPEs is simultaneously being undermined and contested by warring parties and emerging after state collapse. The scope of the paper is limited to one case study and that case study examines only a single aspect of civil society: national and international NGOs The paper therefore presents tentative and preliminary results based on limited research. However, in reviewing the literature and presenting a way of approaching the subject, it aims to suggest a starting-point for developing a theoretical framework for such research. The paper finds that international agencies have tended to focus on civil society institutions simply as conduits for aid money and that this has tended to create organisations which lack downward accountability, are dependent on donors and are not addressing the wider roles for civil society envisaged in the approach. Rebuilding civil society does hold out the promise of giving non-military interests a stronger voice and starting a process of changing the aid delivery culture. Achieving these objectives, however, will be a slow and largely indigenous process and there is a need for lowered expectations about what outside assistance can achieve.

Civil Disorders↗
PubMed2000

The political economy of complex emergency and recovery in northern Ethiopia.

During the 1980s Ethiopia experienced the effects of conflict, drought and famine on a scale far greater than many CPEs elsewhere. In May 1991, after the decisive defeat of the military dictatorship of Mengistu Haile Mariam by the Ethiopian Peoples' Revolutionary Democratic Front (EPRDF) and after decades of civil war, drought and famine, Ethiopia faced the prospects of peace and of much needed development. This paper explores both Ethiopia's experience of conflict and humanitarian intervention in areas of Tigray held by the Tigray Peoples' Liberation Front (TPLF) during the 1980s, and its experience of post-conflict rehabilitation and reconstruction in the 1990s. It first deals with the roots of the conflicts within Ethiopia: political marginalisation, heavy state intervention and highly extractive relations between state and peasants, inappropriate and failed development policies, ethnic identity and the politicisation of ethnicity. The Mengistu regime's counter-insurgency measures are then contrasted with the policies and programmes of the TPLF, Ethiopia's most effective opposition movement and the leading element in the EPRDF, and its achievements in mobilising popular support: its establishment of democratically elected structures of local governance and its famine relief distribution programme.

Disasters↗
PubMed1998

The collision of economics and politics in Medicaid managed care: reflections on the course of reform in Maryland.

One of the most dynamic areas of health policy is the transition of Medicaid programs to managed care and market competition. Maryland has been a leader in this trend, initiating three different systems of managed care for the Medicaid population during the 1990s as it searched for an ideal plan. The Maryland experience illustrates the complex new demands that policy makers are facing. Health plans are expected not only to deliver budgetary savings, but also to improve the quality of their services and guarantee a place for safety-net providers in their delivery systems. As a result, there is a sizable gap between the original savings projected for the new Maryland system and its actual capacity for cost containment. The apparent collision between economic assumptions and political realities, however, may point the way to a constructive synthesis--a form of managed care that balances economy with important community, professional, and personal values.

Child↗
PubMed1999

A political history of the Indian Health Service.

One of the few bright spots to emerge from the history of relations between American Indians and the federal government is the remarkable record of the Indian Health Service (IHS). The IHS has raised the health status of Indians to approximate that of most other Americans, a striking achievement in the light of the poverty and stark living conditions experienced by this population. The gains occurred in spite of chronically low funding and can be attributed to the combination of vision, stubbornness, and political savvy of the agency's physician directors and the support of a handful of tribal leaders and powerful allies in the Congress and the White House. Despite the agency's imperfections and the sizeable health problems that still exist among American Indians and Alaskan Natives, the IHS is an example of one federal program that has worked.

Health Promotion↗
PubMed2005

Shadowed reality or the 'Prometheus-complex': analytical psychotherapy after political imprisonment and persecution.

Traumatic experiences of violence like those that were brought about by the communist regime of the former German Democratic Republic (GDR) are still present as if they happened yesterday, causing severe disadvantages in everyday life even after all those years. Consequently, in cases of extreme traumatization induced by political imprisonment, persecution and applied psychological methods of disintegration, regressive processes take place which corrode the ego. The breakdown of cathexis, i.e., the failure of empathic connection at the time of the trauma, is the strongest characteristic of severe traumatization. As a result of this destruction for the traumatized there is an inability to keep upright an inner empathic, emotional connection. As we try to grasp, from a Jungian point of view, the psychodynamics of severe traumatization, we can speak of a powerful pathogenous complex, which I call the 'Prometheus-complex'. Gustav Bovensiepen speaks of this complex as a sub-network, a limited fragment of the matrix of all internalized experiences, consisting of internal working models, feelings and patterns of anticipation which interact mutually. The human being, captured in such isolation and paralysis of the mind, can find himself 'in the therapist' on a mental level.

Adult↗
PubMed2004

Medical modernization, scientific research fields and the epistemic politics of health social movements.

As health social movements (HSMs) and complementary and alternative medicine (CAM) professions increasingly mount challenges to the authority of medical knowledge, the tendency for the medical research community and medical profession to dismiss such epistemic challenges (termed here 'paternalistic progressivism') and the corresponding response from challengers that medicine is corrupt (termed here 'medical devolution') has given way to a process of incorporation of challenges under the rubric of evidence-based research (termed here the epistemic dimension of 'medical modernization'). Under conditions of medical modernization the distinction between lay/alternative knowledge and scientific knowledge, upon which the epistemic authority of medicine rested, is submerged in a more complex field of competing scientific networks and research programmes. Furthermore, the older policy of transmitting science to an illiterate public and suppressing dissidents is replaced by an emerging system of the 'public shaping of science', in which there is both greater agency of social movement/lay advocacy organisations and greater recognition of the legitimacy of that agency. Indirect and direct forms of the public shaping of science are discussed, as are emergent problems of co-optation. Understanding the emergent epistemic politics that are characterised here as medical modernization requires an ongoing theoretical integration of medical sociology and the sociology of science.

Attitude of Health Personnel↗
PubMed1993

The negotiation of New Zealand alcohol policy in a decade of stabilized consumption and political change: the role of research.

Significant changes in the key alcohol policy areas of availability, advertising and taxation have taken place in New Zealand from 1985 to 1991. These changes are described in the context of the social climate which was one of extreme fiscal crisis and an unprecedented swing to the right. The very limited role played by public health research in the process of policy development is viewed in part as a consequence of this social climate. The political changes affected the strength and extent of the public health voices in the debate and the reception they received. In each of the policy areas in which change occurred, the policy-keeper was other than a public health agency and the utilization of research by public health advocates was, therefore, in response to already articulated positions. The dissemination of research relied too heavily on lengthy written submissions, and too little on media advocacy and interpersonal contact. There was also a lack of directly relevant local research to inform the policy debate. The case study illustrates the constraints on researchers' in the policy development process, but suggests that such involvement is important for the public's health.

Advertising↗
PubMed1994

Nursing and health promotion practice: the creation of victims and winners in a political context.

Current political changes to the British National Health Service and the development of nursing as a profession contribute to the individualization of health. Such trends view the client as a victim of his or her behaviour and encourages a form of health promotion which focuses on the individual and ignores or decontextualizes social problems. Nursing needs to examine issues of power and control in health promotion encounters and not simply view health promotion as benign encounters. Health promotion practice needs to focus not on the development of skills as the central component but on the relationship between the nurse and the client. A simple shift in nursing from using communication skills to persuade, to using counselling skills does not evade the charge of victim blaming. Health promotion needs to place health and its influences within a context.

Clinical Competence↗
PubMed1995

Whooping-cough vaccination: historical, social and political controversies.

New acellular whooping cough vaccines may have the effect of leading us to forget that infectious diseases such as whooping cough have declined in the context of particular historical, social conditions and persist in the context of particular types of social inequalities. The debates over the existence of damage from whole-cell whooping cough vaccine, and the respective risks of the vaccine and the disease are still unresolved owing to methodological limitations of studies on both sides of the argument. One-sided health 'education' campaigns on whooping cough vaccine have questionable ethics, and suppression of dissenting views is counterproductive. Health professionals and parents have a right to know the political context of the debate.

Ethics, Medical↗
PubMed2004

Political leadership in action.

This paper explores the author's personal experience of working in positions of leadership in a variety of National Health Service roles. In particular how in these roles was it possible to influence policy and if not, why not, what the challenges are for leading in a political environment, and what competencies are needed to succeed. Readers will draw their own conclusions about how they approach their work and what might be done differently on reflection.

Adaptation, Psychological↗
PubMed2004

Context, convergence and contingency: political leadership for nursing.

AIM: This paper attempts to illuminate some of the factors necessary to influence policy, using recent changes in the UK research policy as a case study. BACKGROUND: Changes in the UK research policy have shown how the profession can successfully influence a government agenda. METHODS: The paper critically reviews recent UK research policy with relevance for nursing. RESULTS: Successful policy change in nursing requires a contingent alignment of professional and governmental agendas. CONCLUSIONS: Although nursing research has made significant gains over the last 10 years, there is need for the continued development of politically minded research leadership, lest these gains be lost.

Humans↗
PubMed1996

Attention deficit hyperactivity disorder: perceptions, practice and politics.

Some of the issues related to the doubts and complexities involved in the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) are reviewed. While some writers claim that it is clear that all children presenting with ADHD should be treated by pharmacological means, there are associated risks and politics. However, in the absence of well established and research-supported alternative understandings of the aetiology and treatment of the disorder, many practitioners feel unable to offer a useful service. Resulting frustrations have led some parents to form their own support networks, which make strong demands for increased services. More creative and innovative therapeutic interventions focusing on the broader impact of ADHD must be developed to deal with this disorder.

Attention Deficit Disorder with Hyperactivity↗
PubMed1994

Confronting 'reality': nursing, science and the micro-politics of representation.

In an age where previous frames of reference lose their certainty nurses are finding themselves rethinking their relations to the 'real'. In this paper I interrogate an empirical 'text' of a local nursing cultural practice through a poststructural critique of the ways in which language, discourses, representation and experience intersect to construct 'reality' for us with specific consequences. I do this in an attempt to disclose the micro-politics at work in the processes of signifying and thus representing nursing to a world of potential students. The discourses of science and caring find themselves exposed in particular representational technologies and practices that mark nursing's collusion with the 'truths' of science at the expense of those we loosely name 'caring'. This cultural theoretical work constitutes a provisional and historical fragment of analysis designed to trouble the relations we often unwittingly sustain with dominant 'regimes of truth'.

Adolescent↗
PubMed2004

Different voices: reviewing and revising the politics of working with consumers in mental health.

Working with consumers is now a common expectation in contemporary mental health services. Yet health professionals may not entirely understand the difference between patient and consumer roles. Alternatively, they may feel they do not have the skills or resources to deal with people in roles other than patient or carer. Nor may they be able to separate out their personal experiences with particular consumers from the ideals and goals for effective consumer partnerships. This paper reviews a concept known as the politics of difference as well as the rise of the consumer movement in order to explore areas of difference between consumers and providers, to reexamine how power and marginalization practices occur. It reminds professionals that generalizing from one failed experience relating with a consumer is just as invalid as idealizing the current policy of consumer inclusion. Inviting, allowing, amplifying and improving the effectiveness of the consumer voice in mental health services today requires active commitment, educative processes and novel strategies to move beyond superficial relationships so that consumers and professionals work together to make enduring change.

Australia↗
PubMed2006

Color blindness and interracial interaction: playing the political correctness game.

Two experiments explored the ramifications of endorsing color blindness as a strategy for appearing unprejudiced. In Study 1, Whites proved adept at categorizing faces on the basis of race, but understated their ability to do so. In Study 2, Whites playing the Political Correctness Game--a matching task that requires describing other individuals--were less likely to use race as a descriptor when paired with a Black partner than when paired with a White partner, a strategy that impaired communication and performance. In addition, avoidance of race was associated with Whites making less eye contact with and appearing less friendly toward Black partners.

Adolescent↗
PubMed1996

Major chemical accidents in industrializing countries: the socio-political amplification of risk.

Accidents in the chemical industry, such as those that took place in Seveso (1976) and Bhopal (1984), may kill or injure thousands of people, cause serious health hazards and irreversible environmental damage. The aim of this paper is to examine the ever-increasing risk of similar accidents becoming a frequent ocurrence in the so-called industrializing countries. Using figures from some of the worst chemical accidents in the last decades, data on the Bhopal disaster, and Brazil's social and institutional characteristics, we put forward the hypothesis that present social, political and economic structures in industrializing countries make these countries much more vulnerable to such accidents and create the type of setting where--if and when these accidents occur--they will have even more catastrophic consequences. The authors argue that only the transformation of local structures, and stronger technical cooperation between international organizations, industrialized and industrializing countries could reduce this vulnerability.

Accidents, Occupational↗
PubMed1987

Professional politics and the concepts of family therapy, family consultation, and systems consultation.

At a time when an increasing number of professionals are calling themselves "family therapists," many teachers and theorists in this field are troubled that the term "family therapy" no longer adequately characterizes the concepts or activities of the field. Recently, clinical, political, and economic circumstances have emerged that suggest the need for alternatives to the role of "family therapist." By adding the roles of family consultant and systems consultant, we can open up new options for ourselves and our clients. During initial contacts with families, agencies, and other professionals, we can heighten our therapeutic potential by proceeding with consultative stocktaking, not starting with therapy. Family consultation also can assist in redirecting therapy when a new problem or an impasse develops, in focusing on competency rather than on pathology, and in engaging constructively with families that have a physically or mentally ill member.

Adolescent↗
PubMed1997

The validity of screening for post-traumatic stress disorder and major depression among Vietnamese former political prisoners.

The aim of this study was to investigate the validity of the Harvard Trauma Questionnaire (HTQ) and the depression sub-scale of the Hopkins Symptom Checklist-25 (HSCL-25) in screening for post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) among Vietnamese former political prisoners (POWs). The study population included Vietnamese POWs (n = 51) who migrated to the Boston metropolitan area between January 1990 and July 1992 under the Special Released Re-education Center Detainees Resettlement Program. The criterion validity of the HTQ in assessing PTSD and of the depression sub-scale of the HSCL-25 in assessing MDD is supported by the results. Consideration of an appropriate cut-off score should include examination of the utility of a given screening instrument for PTSD or MDD within different settings, such as refugee camps vs. countries of third asylum.

Adult↗