Focus on adolescent pregnancy and childbearing: a bit of history and implications for the 21st century.
Early childbearing in the United States has roots in the past; is the focus of intense partisan debate at the present time; and will have demographic, social, and economic ramifications in the future. It is an extremely complex issue, for which its associated problems have no easy or simple answers. Early parenthood is viewed as a social problem that has defied public policy attempts to stem its growth. It has become the focus of concern primarily for three reasons: (1) sexual activity has increased sharply, most recently among the youngest teens; (2) out-of-wedlock childbearing has risen among all teenagers, regardless of age; and (3) the issue of welfare. A review of statistics highlights the problem and discussion focuses on means of mitigating the negative effects of early childbearing. (+info)
Problems of transition from tax-based system of health care finance to mandatory health insurance model in Russia.
This article examines three problems burdening the Russian system of health care finance in transition period: (a) unrealistic government promise to cover health care coverage too wide to be achieved with available resources; (b) inefficient management of health care delivery systems; and (c) lack in evidence of actual positive changes effected by the new players: mandatory health insurance carriers and funds. Radical reshaping of the health benefits promised by the government and introduction of patient co-payments are considered as a way to normalize public health sector finance and operations. Two alternative approaches to the reform of the existing eclectic system of health care management are available. Institutional preconditions for operational effectiveness of third-party purchasers of health services in public-financed health sector are defined. (+info)
Reflections on a painful transition: from socialized to insurance medicine in Russia.
After the collapse of the Soviet Union in 1991, Russia decided to replace its deeply flawed and under-funded system of socialized medicine by a scheme of health insurance that involved the decentralization of health services and of off-budget financing. Every enterprise would pay 3.6% of its salary fund into a Regional Health Insurance Fund, and the Fund would finance private insurance companies that would compete for clients. The non-working population would have its insurance premiums paid from the budgets of regions or municipalities. The transition from one system to another has been problematic and plagued with a variety of problems not the least of which is that the Russian economic structure is not geared to sustain an insurance system at the present time. The Russian case presents an instructive experiment with the premature introduction of a scheme touted as an "anti-model" to socialized medicine and geared to market and legal arrangements that are, as yet, largely non-existent. Under-funding of health services remains and leads to the polarization of the population into those few who can afford private care, and the vast majority for whom this care is difficult to obtain, or unobtainable. This has ominous political implications. (+info)
Pathologies of power: rethinking health and human rights.
The field of health and human rights has grown quickly, but its boundaries have yet to be traced. Fifty-one years after the Universal Declaration of Human Rights, consensus regarding the most promising directions for the future is lacking; however, outcome-oriented assessments lead us to question approaches that rely solely on recourse to formal legal and civil rights. Similarly unpromising are approaches that rely overmuch on appeals to governments: careful study reveals that state power has been responsible for most human rights violations and that most violations are embedded in "structural violence"--social and economic inequities that determine who will be at risk for assaults and who will be shielded. This article advances an agenda for research and action grounded in the struggle for social and economic rights, an agenda suited to public health and medicine, whose central contributions to future progress in human rights will be linked to the equitable distribution of the fruits of scientific advancement. Such an approach is in keeping with the Universal Declaration but runs counter to several of the reigning ideologies of public health, including those favoring efficacy over equity. (+info)
Sanctions and the struggle for health in South Africa.
This commentary describes the role of a major antiapartheid health organization, the National Medical and Dental Association (NAMDA), in reinforcing and maintaining international pressure on the racist South African government. NAMDA was a constituent of the Mass Democratic Movement (MDM), which was at the forefront in the struggle for freedom in South Africa. NAMDA endorsed the programs of the banned African National Congress (ANC), which included a range of sanctions. Debates within NAMDA on enlarging sanctions into an academic boycott are summarized. The development of a policy of selective academic support, which approved academic exchanges in accord with the aims of the MDM, is explained. Indirect evidence shows that international pressures created by specific types of economic sanctions and the forms of academic boycott decided on by NAMDA achieved their objectives. I have highlighted the tension between these strategies, which resulted in the isolation of the apartheid regime, as well as the responsibility to protect the most vulnerable from the burdens that resulted from these policies. (+info)
Adolescent alcohol use and the community health agenda: a study of leaders' perceptions in 28 small towns.
The study assessed leaders' perceptions of adolescent alcohol use as a public health issue in 28 small communities in northern Minnesota, as part of formative evaluation for a community-based intervention to reduce adolescent alcohol access and consumption. One hundred and eighteen leaders from five key community sectors were interviewed about their perceptions of social, health and alcohol-related problems in their communities. Analyses indicated that school representatives and police chiefs perceived adolescent alcohol use and related problems to be serious; newspaper editors mentioned other social problems more often; and mayors and business representatives did not perceive adolescent alcohol problems to be as serious. In relation to efforts to affect local policy, the study suggested government and business sectors in these communities may need to be educated about the problem to build its importance on the community agenda of health issues. Thus community leaders in some sectors may comprise a key target audience for intervention. (+info)
Trends in social consequences and dependence symptoms in the United States: the National Alcohol Surveys, 1984-1995.
OBJECTIVES: Given the decline in alcohol use in the United States since the 1980s, the purpose of this study was to assess shifts in self-reported social consequences of alcohol use (and 5 consequences subscales) and dependence symptoms from 1984 to 1995. METHODS: This study used data from 3 national alcohol surveys based on household probability samples of current drinkers (adults) in 1984, 1990, and 1995; samples sizes were 1503, 1338, and 1417, respectively. RESULTS: Overall, few changes in prevalence of social consequences or dependence symptoms were found. Significantly lower prevalence rates of 2 consequences subscales (accidents/legal problems and work problems) were reported between 1984 and 1990, but prevalence rates did not change for any of the scales from 1990 to 1995. CONCLUSIONS: This stability in alcohol-related outcomes despite reductions in alcohol consumption may be a result of cultural shifts in which problem amplification occurs in "drier" historical periods. Furthermore, rates of alcohol-related problems may be approaching their lowest limit and may not be readily influenced by any additional decreases in alcohol consumption. (+info)
The effect of poverty, social inequity, and maternal education on infant mortality in Nicaragua, 1988-1993.
OBJECTIVES: This study assessed the effect of poverty and social inequity on infant mortality risks in Nicaragua from 1988 to 1993 and the preventive role of maternal education. METHODS: A cohort analysis of infant survival, based on reproductive histories of a representative sample of 10,867 women aged 15 to 49 years in Leon, Nicaragua, was conducted. A total of 7073 infants were studied; 342 deaths occurred during 6394 infant-years of follow-up. Outcome measures were infant mortality rate (IMR) and relative mortality risks for different groups. RESULTS: IMR was 50 per 1000 live births. Poverty, expressed as unsatisfied basic needs (UBN) of the household, increased the risk of infant death (adjusted relative risk [RR] = 1.49; 95% confidence interval [CI] = 1.15, 1.92). Social inequity, expressed as the contrast between the household UBN and the predominant UBN of the neighborhood, further increased the risk (adjusted RR = 1.74; 95% CI = 1.12, 2.71). A protective effect of the mother's educational level was seen only in poor households. CONCLUSIONS: Apart from absolute level of poverty, social inequity may be an independent risk factor for infant mortality in a low-income country. In poor households, female education may contribute to preventing infant mortality. (+info)