Self rating of health is associated with stressful life events, social support and residency in East and West Berlin shortly after the fall of the wall. (1/55)

STUDY OBJECTIVE: To compare the health status and factors influencing the health of populations that had previously lived under different political systems. DESIGN: Cross sectional health and social survey using postal interviews. The relation between self reported health and psychosocial factors (stressful life events, social support, education, health promoting life style and health endangering behaviour) was investigated. To determine East-West differences a logistic regression model including interaction terms was fitted. SETTING: East and West Berlin shortly after reunification 1991. PARTICIPANTS: Representative sample of 4430 Berlin residents aged 18 years and over (response rate 63%). RESULTS: Of all respondents, 15.4% rated their health as unsatisfactory. Residents of East Berlin rated their health more frequently as unsatisfactory than residents of West Berlin (Or(age adjusted)= 1.29, 95%CI 1.08, 1.52), these differences occurred predominantly in the over 60 years age group. Logistic regression showed significant independent effects of stressful life events, social support, education, and health promoting life style on self rated health. The effects of education and health promoting life style were observed to be more pronounced in the western part of Berlin. Old age and female sex showed a stronger association with unsatisfactory health status in the eastern part of Berlin. CONCLUSIONS: For subjects aged over 60 years there was evidence that living in the former East Berlin had an adverse effect on health compared with West Berlin. The impact of education and a health promoting lifestyle on self rated health seemed to be weaker in a former socialist society compared with that of a Western democracy. This study supports an "additive model" rather than a "buffering model" in explaining the effects of psychosocial factors on health.  (+info)

Choices without reasons: citizens' juries and policy evaluation. (2/55)

Citizens' juries are commended as a new technique for democratising health service reviews. Their usefulness is said to derive from a reliance on citizens' rational deliberation rather than on the immediate preferences of the consumer. The author questions the assertion of critical detachment and asks whether juries do in fact employ reason as a means of resolving fundamental disagreements about service provision. He shows that juries promote not so much a critically detached point of view as a particular evaluative framework suited to the bureaucratic idiom of social welfare maximisation. Reports of jury practice reveal a tendency among juries to suppress by non-rational means the everyday moral language of health care evaluation and substitute for it a system of thought in which it can be deemed permissible to deny treatment to sick people. The author concludes that juries are chiefly concerned with non-rational persuasion and because of this they are morally and democratically irrelevant. Juries are no substitute for voting when it comes to protecting the public from zealous minorities.  (+info)

Devolution to democratic health authorities in Saskatchewan: an interim report. (3/55)

BACKGROUND: In 1995 Saskatchewan adopted a district health board structure in which two-thirds of members are elected and the rest are appointed. This study examines the opinions of board members about health care reform and devolution of authority from the province to the health districts. METHODS: All 357 members of Saskatchewan district health boards were surveyed in 1997; 275 (77%) responded. Analyses included comparisons between elected and appointed members and between members with experience as health care providers and those without such experience, as well as comparisons with hypotheses about how devolution would develop, which were advanced in a 1997 report by another group. RESULTS: Most respondents felt that devolution had resulted in increased local control and better quality of decisions. Ninety-two percent of respondents believed extensive reforms were necessary and 83% that changes made in the previous 5 years had been for the best. However, 56% agreed that there was no clear vision of the reformed system. A small majority (59%) perceived health care reform as having been designed to improve health rather than reduce spending, contrary to a previous hypothesis. Many respondents (76%) thought that boards were legally responsible for things over which they had insufficient control, and 63% perceived that they were too restricted by rules laid down by the provincial government, findings that confirm the expectation of tensions surrounding the division of authority. Respondents with current or former experience as health care providers were less likely than nonprovider respondents to believe that nonphysician health care providers support decisions made by the regional health boards (45% v. 63%, p = 0.02), a result that confirmed the contention that the role of health care providers on the boards would be a source of tension. INTERPRETATION: Members of Saskatchewan district health boards supported the general goals of health care reform and believed that changes already undertaken had been positive. There were few major differences in views between appointed and elected members and between provider and nonprovider members. However, tensions related to authority and representation will require resolution.  (+info)

Setting the agenda for urban bioethics. (4/55)

Urban bioethics has two goals. First, it aims to focus attention on neglected bioethical problems that have particular salience in urban settings. Three problems are highlighted: socioeconomic inequality as a major determinant of health inequality, the foundations of an ethic for public health, and the impact of social context on the therapeutic alliance between patients and physicians. Second, urban bioethics serves as a vehicle for raising deep theoretical and methodological questions about the dominant assumptions and approaches of contemporary bioethics. Demands for cultural sensitivity, so pronounced in the urban context, compel us to reexamine the central commitment in bioethics to personal autonomy. The multiculturalism of urban life also argues for a dialogic approach to bioethical problem solving rather than the monologic approach that characterizes most bioethical thinking. Although my brief for redirecting bioethics will resonate with many critics who do not consider themselves urban bioethicists, I argue that there are special advantages in using urban bioethics to expose the limitations of contemporary bioethical paradigms.  (+info)

From the urban to the civic: the moral possibilities of the city. (5/55)

Relating bioethics to the philosophy of the city creates the possibility for developing the field along paths not yet explored. In the Western tradition, the city has been understood as the venue for two quite different forms of activity and two different types of moral possibility. In one guise, the city is an urbs, a center of commerce, market exchange, and social individualism. In another guise, the city is a civitas or polis, the space of active democratic citizenship, equality under law, and civic virtue. As civitas, classical philosophers regarded the city as the place of moral growth and full human self-realization. These two possibilities of human moral and political experience in the city have given rise to distinct traditions of political theory--liberalism and civic republican and democratic theory. This article traces these conceptual configurations into the domain of contemporary bioethics, arguing that most work in the field has drawn on the liberal tradition and hence has been insufficiently critical of the moral paradigm of market individualism and unduly inattentive to the values of civitas and the civic tradition. It argues for the creation of a form of civic bioethics and explores some of the theoretical foundations that type of bioethics would require.  (+info)

Social democratic government and spatial distribution of health care facilities. The case of hospital beds in Germany. (6/55)

BACKGROUND: In this paper, the hypothesis that the spatial distribution of hospital beds is more even in countries with socialist or social democratic governments than in countries with conservative or Christian democratic governments was tested. To avoid the confounding influences of historical and institutional differences between countries, we used the Federal Republic of Germany as a case study. The German federal states have their own governments who play an important role in creating structures for the planning of hospital facilities. METHODS: The test of the hypothesis was largely quantitative. At the level of federal states the rank correlation was computed between the weighted number of years of left-wing government participation and the coefficient of variation in the number of hospital beds per 1000 inhabitants. In addition to this, the hospital plans of two federal states were studied. RESULTS: The hypothesis was supported by the data, showing a positive association between the number of years of left-wing government participation and regional variation in the number of hospital beds. A comparison of the hospital plans of two contrasting federal states showed less government interference in hospital planning in the state with a tradition of right-wing government. CONCLUSION: There seems to be a relation between left-wing government participation in West German states and a more equal distribution of the number of hospital beds per 1,000 inhabitants.  (+info)

Reenergizing public health through precaution. (7/55)

The precautionary principle has provoked a spirited debate among environmentalists worldwide, but it is equally relevant to public health and shares much with primary prevention. Its central components are (1) taking preventive action in the face of uncertainty; (2) shifting the burden of proof to the proponents of an activity; (3) exploring a wide range of alternatives to possibly harmful actions; and (4) increasing public participation in decision making. Precaution is relevant to public health, because it can help to prevent unintended consequences of well-intentioned public health interventions by ensuring a more thorough assessment of the problems and proposed solutions. It can also be a positive force for change. Three aspects are stressed: promoting the search for safer technologies, encouraging greater democracy and openness in public health policy, and stimulating reevaluation of the methods of public health science.  (+info)

Paternalism versus autonomy: medical opinion and ethical questions in the treatment of defective neonates.(8/55)