The alluring myth of private medicine.

Canada''s medicare system has provided Canadians with high-quality health care for almost three decades. Now Canadian health care appears to be at risk of losing the single-payer system, which is the premise on which medicare is built. As medicare comes under increasing financial pressure, many are calling for the introduction of private care as a means of bolstering our health care system and maintaining its quality. Although it appears alluring to some politicians, physicians and commentators, privatization could very well lead to the demise of the principles and practices of the Canadian health care system as we know it, with little clear benefit to the public or physicians.     

Setting priorities,can Britain learn from Sweden?

The Swedish government recently published a report on priorities in health care. It was written by a cross party group of politicians and drew extensively on the views of the public, health professionals, experience of earlier local exercises in priority setting, and research based evidence. It laid down an ethical framework for approaching issues of health care rationing. Underpinning the framework are the principles of human dignity, need and solidarity, and cost efficiency. The Swedish approach thus contrasts with the British experience of many local initiatives but an absence of national political guidance. The absence of political consensus on many aspects of social policy in the United Kingdom is a major obstacle to developing an agreed ethical framework within which decision makers in the National Health Service can work.     

Bioprophecy and the politics of the present: notes on the establishment of Mexico's national genomics institute (INMEGEN)

In 1999, a small group of genomic entrepreneurs and local politicians started mobilizing the idea of founding a national genomics institute in Mexico. Approximately four years later, and after 18 months of congressional debate, the Mexican National Institute of Genomic Medicine (INMEGEN) was established by presidential decree. As scholars, we are interested in how the call for a high-tech, high-cost genomics institute was able to gain political traction in a country, where many people struggle to secure access to even the most basic level of health care. Those behind the establishment of the INMEGEN used what we call technologies of bioprophecy to present it as a modernizing institution that would move the nation into the “new world order” by bringing not only biological and economic health, but also scientific prestige to Mexico.     

Refugees' perspectives on barriers to communication about trauma histories in primary care

Objective This study explores refugees'' perspectives regarding the nature of communication barriers that impede the exploration of trauma histories in primary care.Method Brief interviews were conducted with 53 refugee patients in a suburban primary care clinic in the Midwest USA. Participants were asked if they or their doctors had initiated conversations about the impact of political conflict in their home countries. Qualitative data analysis was guided by grounded theory. Peer debriefings of refugee healthcare professionals were incorporated into the analysis.Results Two-thirds of refugee patients reported that they never shared how they were affected by political conflict with their doctors and that their doctors never asked them about it. Most refugees stated that they would like to learn more about the impact of trauma on their health and to discuss their experiences with their doctors.Conclusion Refugees are hesitant to initiate conversations with physicians due to cultural norms requiring deference to the doctor''s authority. They also lack knowledge about how trauma affects health. Physicians should be educated to inquire directly about trauma histories with refugee patients. Refugees can benefit from education about the effects of trauma on health and about the collaborative nature of the doctor–patient relationship.     

Barriers and errors in the implementation of community psychiatry in Slovenia

Background Slovenian psychiatry is predominantly hospital based. A programme for the development of general community psychiatric services was proposed to improve access to and quality and comprehensiveness of psychiatric care according to the modern standards of delivery of psychiatric services.Aim The aim of the paper is to present the programme for developing community services that was proposed to the Slovenian government, and to describe the barriers to its implementation that were encountered, as well as the errors made by the programme authors, that contributed to the rejection of the programme last year.Conclusions There are historical, political, professional and service organisation characteristics that impede the development of community psychiatry in Slovenia. These are to be addressed through coordinated action involving primary care professionals, non-government organisations with service users and carers, the Health Insurance Agency and politicians involved in the planning of health services.     

Experimental Research

The chapter introduces a new version of semantic analysis, which was applied to political psychology, marketing, advertising, ethnopsychology, and psychoendocrinology. Only the study of a political leader's image in student predispositions is included in this chapter as an example. The elaborated method estimates the following aspects of student ratings: Stable and noise-related semantic components, semantic coordinates and intensity and rigidity (stability), interpretations of a political image in relation to a predefined mentality, the degree of polarization, the degree of proximity of specific politicians to the ideal prototype of a political image for a given mentality.     

WHO at country level--a little impact,no strategy.

The acid test of WHO''s effect on the world''s health is its impact at country level. Unless it has an impact there, all of its declarations, its debates at the World Health Assembly, its conferences, its pamphlets, its political manouvering in Geneva and the regions, all of these come to nothing. Working as it does through national governments, WHO insists that it has no role in directly managing or delivering health care. Judging WHO''s impact in individual countries is therefore difficult--its approaches are largely indirect, and initiatives may take years to bear fruit. But from the meagre resources that WHO makes available at country level it is clear why its country operations are criticised as the weakest link in an already weak chain of influence from its headquarters in Geneva to the people in its member states. Poorly funded, undertrained, and with no clear strategy to follow, its staff at country level stand little chance of making an impact.     

Fighting for survival.

The political crisis in Haiti has had a severe impact on the health of the population. Mortality among Haitians is 13 per 1000, much higher than the Latin American rate of seven per 1000, and the incidence of AIDS, tuberculosis, and malnourishment is increasing among children. Although food and medicine are exempt, United Nations sanctions have had a negative impact on most of the population. In particular the embargo on fuel has limited most people''s access to health care. The difficulties of distributing aid and health care without softening the embargo on fuel are immense, and the health of Haitians is not likely to improve until the political crisis is resolved.     

Review article: Polonia studies and the collapse of Communism

This paper asks to what extent Suriname's consociational democracy still rests on its historically shaped meta-ideology of ethnic essentialism. Based on ethnographic data of the country's national elections in 2010, I suggest that the ‘ethnic taboo’ of ethnic mobilization by politicians was present to a certain extent. However, this taboo was challenged by the nationalist turn of Desi Bouterse's National Democratic Party. Furthermore, when considering voting behaviour and that of ethnically mixed Doglas in particular, we see that Surinamese politics is more complex. I will argue that while we have been thinking about Surinamese politics as being on a par with ethnic groupings, these 2010 elections were not simply about ethnicity. Ethnicity may have informed but did not fully explain people's political choices, because people are too complex to be captured in an exclusively ethnic category, and because the Surinamese political system is too complex to maintain clear ethnic categories.     

Where is the silver lining? Anxious doctors ask.

When Nova Scotia elected a Liberal government in September 1993, a wave of optimism washed over the province''s medical community. One of their own, Dr. John Savage, was now premier, and another, Dr. Ron Stewart, was minister of health. However, anticipation soon turned to anger as Stewart took aim at physician fees and hospital costs to help reduce the province''s health care budget by $62 million. Last November, relations between him and the Medical Society of Nova Scotia (MSNS) hit bottom. In an uncharacteristically political move, the society launched an ad campaign featuring slogans such as "Death by 1000 cuts" and "Uncle Sam want me. Ron Stewart doesn''t." Four months later, the health department and the MSNS called a truce, with an agreement that many physicians consider a positive step. Today the province and its doctors are speaking again, and the medical society is working hard to help define physicians'' roles in a new, regionalized health care system. But has the mood of doctors really improved? Last spring, CMAJ interviewed a cross section of Nova Scotia physicians to find out.     

Key issues in managed competition.

All managed competition proposals for health system reform must confront several key issues. The premiums paid to health care purchasing cooperatives will need to be subsidized for those who cannot pay full fare; the amount and sources of the subsidies are controversial political issues. The payments passed on by purchasing cooperatives to health plans must be risk adjusted to account for differences in the health care needs of their enrolled populations. This is essential to create a level playing field for competition and to eliminate incentives for plans to use risk assessment for attracting enrollees. The data and methods needed for risk adjustment, however, are not adequate at present. The Clinton Administration''s plan to limit expenditure increases raises a host of thorny issues. Maintaining quality of care will require health plan quality report cards to be supplemented by external quality assurance systems. Assuring quality will be particularly problematic for traditional indemnity plans. The structure and governance of the system, administration simplification, and other issues need to be addressed. The size and voluntariness of the purchasing cooperatives greatly influence all of these considerations. Physicians should inform their political representatives on how these issues should be resolved as compromise bills are drafted by the United States Congress this year.     

Canvases of Political Competition: Image Production as Politics in Tamil Nadu,India

In this article, I explore the production of political images in the Indian state of Tamil Nadu. The state is known for the ubiquitous presence of banners, murals and posters in its public spaces, featuring prominent politicians and actors. It is commonly argued that these images help to convey the heroic or exclusive status of political leaders. However, such images are actually produced by party workers and therefore do not simply transpose status and image. Instead, political supporters praise their leader via these images and act as ‘kingmakers’ in constructing reputation and power. Simultaneously, by putting political images on display, supporters also authorise their own power. While praise is important in showing a person's dedication to a political party, the images, in the motivations of their producers, are suffused with ambivalence and competition as well. Hence, I argue, political image practices are not representative of politics, they are politics.     

An overview of telemedicine: the virtual gaze of health care in the next century

This article considers the role of telemedicine in the production of biomedical health care using three specific theoretical constructs as lenses through which to examine this phenomenon: (1) Foucault's medical "gaze"; (2) the political economy of health; and (3) deterritorialization and multisite ethnography. This examination focuses first on the changing corporate structure of health care and changing political attitudes toward telemedicine. Second, it documents the current use of telemedicine in prisons, the military, and in cross-cultural settings. Third, it discusses responses to telemedicine of individual physicians, health care staff, and patients, finding that these responses are broadly conditioned by an individual's mode of articulation with biomedical institutions and that they are mediated by personal experience.     

Preferential policies and the movement of the disadvantaged: The case of the Scheduled Castes in India

This article examines the effect of state actions on the political behaviour of disadvantaged minorities. Most studies of political mobilization fail to inquire about the role of the state in the formation and maintenance of political groups. This article describes the process through which the polity constructs new forms of group awareness and political action among previously inarticulate, unorganized sections of society. More specifically, it is about the political mobilization of an oppressed minority in India, the Scheduled Castes ‐ a group composed of distinct caste groups with specific cultural and occupational characteristics but lumped under a single category by the state. Through a longitudinal study comparing two periods in a state's political history I show how progressive state intervention in the form of preferential policies increased the political organization and activism of this oppressed minority. The analysis is based on a survey of government documents; coding of newspaper reports; interviews with politicians, administrative and police officials, grass‐roots activists and organizational leaders of the movement.     

Voice pitch influences voting behavior

It may be adaptive for voters to recognize good leadership qualities among politicians. Men with lower-pitched voices are found to be more dominant and attractive than are men with higher-pitched voices. Candidate attractiveness and vocal quality relate to voting behavior, but no study has tested the influence of voice pitch on voting-related perceptions. We tested whether voice pitch influenced perceptions of politicians and how these perceptions related to voting behavior. In Study 1, we manipulated voice pitch of recordings of US presidents and asked participants to attribute personality traits to the voices and to choose the voice they preferred to vote for. We found that lower-pitched voices were associated with favorable personality traits more often than were higher-pitched voices and that people preferred to vote for politicians with lower-pitched rather than higher-pitched voices. Furthermore, lower voice pitch was more strongly associated with physical prowess than with integrity in a wartime voting scenario. Thus, sensitivity to vocal cues to dominance was heightened during wartime. In Study 2, we found that participants preferred to vote for the candidate with the lower-pitched voice when given the choice between two unfamiliar men's voices speaking a neutral sentence. Taken together, our results suggest that candidates' voice pitch has an important influence on voting behavior and that men with lower-pitched voices may have an advantage in political elections.     

Global Health Care Justice,Delivery Doctors and Assisted Reproduction: Taking a Note From Catholic Social Teachings

This article will examine the Catholic concept of global justice within a health care framework as it relates to women's needs for delivery doctors in the developing world and women's demands for assisted reproduction in the developed world. I will first discuss justice as a theory, situating it within Catholic social teachings. The Catholic perspective on global justice in health care demands that everyone have access to basic needs before elective treatments are offered to the wealthy. After exploring specific discrepancies in global health care justice, I will point to the need for delivery doctors in the developing world to provide basic assistance to women who hazard many pregnancies as a priority before offering assisted reproduction to women in the developed world. The wide disparities between maternal health in the developing world and elective fertility treatments in the developed world are clearly unjust within Catholic social teachings. I conclude this article by offering policy suggestions for moving closer to health care justice via doctor distribution.     

Prioritising health services in an era of limits: the Oregon experience.

How do we decide who should receive the benefits that medical science has to offer? One approach to this decision process, that used by the state of Oregon, is described: who and what are covered, and how health care is financed and delivered, are considered. Oregon''s priorities were set on the basis of broad consensus. The objective of health care reform, it was agreed, is to improve, maintain, or restore health--not universal coverage, access to health care, or cost containment. A Health Services Commission was created to consider clinical effectiveness and, through public involvement, to attempt to integrate social values into the priority list. Oregon''s legislature can use the list to develop an overall health policy which recognises that health can be maintained only if investments in several related areas are balanced.     

Genres of waiting: patronage,healthcare, and dyadic sovereignty in Northeast Brazil

This article offers an ethnographic comparison of two genres of waiting for healthcare in Northeast Brazil in order to explain the persistence of patron-client practices at a time when people otherwise reject patronage. The explanation turns on a recasting of patronage as a form of sovereignty whereby politicians and afflicted persons may choose to suspend the emerging rights-based care regime in favour of older patronage-based approaches to care. Motivating such decisions is the afflicted person's experience of the wait for rights-based healthcare as a form of ‘bare life’, an experience they hope to escape.     

The Central San Joaquin Valley Area Health Education Center

With federal financial support, an area health education center was established in the central San Joaquin Valley of California. The center is a cooperative health sciences education and health care program organized by the University of California and some of the educational and health care institutions of the valley. The center''s goals include providing and improving primary health care education, and improving the distribution of health personnel. These goals are achieved through the cooperative development of a number of independent and interdependent activities. An extensive evaluation of the Area Health Education Center has shown that it is a highly effective program.     

Public health in inner London.

One of Sir Bernard Tomlinson''s aims in his inquiry into London''s health services was to advise the secretary of state for health on the future balance of primary and secondary health care "taking account of the health needs of Londoners." Sir Bernard, however, also made it clear that "we have not seen it as part of our remit to carry out a comprehensive needs assessment for the whole of London," but concluded that the extremes of health need found in London were "unparalleled in the rest of England." Dr Jacobson highlights some of the major determinants of health inequality in inner London and assesses the extent to which the proposed solutions are likely to meet these needs.