The just provision of health care: a reply to Elizabeth Telfer.
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Dr Hillel Steiner in this reply to Elizabeth Telfer takes each of her arguments for different arrangements of a health service and examines them--'four positions which can be located on a linear ideological spectrum'--and adds a fifth which could have the effect of 'turning the alleged linear spectrum into a circle'. Underlying both Elizabeth Telfer's article and Dr Steiner's reply, the base is inescapably a 'political' one, but cannot be abandoned in favour of purely philosophical concepts. Whatever the attitude of mind of the reader of these two papers to the provision of a health service, the stimulus to more careful assessments of our own National Health Service and its problems can only be good. (+info)
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.
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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)
Social democratic government and spatial distribution of health care facilities. The case of hospital beds in Germany.
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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)
Political abuse of psychiatry--an historical overview.
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Defining HIV risk and determining responsibility in postsocialist Poland.
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Drawing on 15 months of ethnographic research on HIV prevention programs in Poland, I explore the consequences of the shift from models of HIV prevention that emphasize "risk groups" and AIDS blame, to models that focus on "risky behaviors" and universal risk. The centrality of choice making and individual risk management in these models suggests objective risk assessment free from moralizing arguments. The Polish national prevention strategy shifted to focus on choice making, address all risk groups, and include concrete prevention strategies. This shift created a backlash that resulted in the reassertion of moral arguments about risk and risk groups that positioned those most vulnerable to HIV outside the purview of prevention efforts. AIDS organizations working with marginalized, "morally problematic" populations used the label "at risk" to legitimize claims to resources. They enacted a model of risk reduction in which the relevant actor is the individual buffeted by social forces; behavior change, and therefore HIV risk reduction, is a long process because of myriad forms of vulnerability clients face. Despite efforts to reconceptualize risk, organizations positioned the individual as the locus of HIV prevention interventions, rather than attempting to address the social context that shapes risk. (+info)
Determinants of witnessed parental physical violence among university students in transitional Albania.
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