Showing papers on "International health published in 1982"

Cost-of-illness methodology: a guide to current practices and procedures

Abstract: illness and disease have been on a dramatic upward trend that is projected to continue. The most recent estimates of national health expenditures indicate a 400 percent increase since 1965 (Freeland and Schendler, 1981). As a proportion of the Gross National Product (GNP), the costs associated with illness and disease are projected to reach nearly 11 percent by the year 1990 (Freeland and Schendler, 1981) compared to 9.4 percent in 1980 and 6 percent in 1965 (Gibson and Waldo, 1981). It should not be surprising that the analytic literature on these costs has also grown rapidly. Medical journals, in particular, contributed to this growth as the medical profession has become increasingly involved with economists, sociologists, public health specialists, and others in scrutinizing the cost of modern health care (Warner and Hutton, 1980). Estimates of the costs of illness and disease are produced and used in cost-benefit and cost-effectiveness analyses and in other modes to set priorities and make government policy decisions, to prepare and deliver congressional testimony, and to support agency budgets. The application of the techniques of cost-benefit and cost-effectiveness analysis to health care, in particular, has been the subject of several

Health Policy in Britain

Abstract: The Development of Health Services and Health Policy.- Health Policy under Thatcher and Major.- Health Policy under Blair and Brown.- Financing Health Services and the Rediscovery of Public Health.- Policy and Priorities in the NHS.- Policy-making in Westminster and Whitehall.- Policy-making in Scotland, Wales and Northern Ireland.- Policy-making in the Department of Health.- Implementing Health Policy.- Auditing and Evaluating Health Policy and the NHS.- Power in Health Services.- Looking Back and Looking Ahead.- Conclusion.

Equity of access to health care: some conceptual and ethical issues.

Abstract: Problems of defining equity and equality of access are not trivial; there are fundamental disagreements about the nature of health care as a social good and about other principles of distributive justice. Presuppositions about equity underlying several current proposals for reform of health care "markets" are considered. Issues of equity--and theories of justice--arise also in contexts other than disputes about access.

Mandated mental health benefits in private health insurance.

Abstract: Eleven states mandate coverage of inpatient and outpatient mental health care in private health insurance. Health insurers have objected to these laws on the grounds that they interfere with consumer choice of health insurance benefits and are too costly. This paper analyzes the benefits and costs of mandates for psychotherapy. The potential benefits considered have to do with adverse selection in insurance markets and the offset effects of psychotherapy. Arguments based on economic efficiency are presented to justify the possible appropriateness of overriding individuals' choice of health insurance benefits. Mandates are estimated econometrically to increase the cost of psychotherapy in a state by about 10-20 percent. We conclude that mandates for mental health benefits in private health insurance may be reasonable state policy.

Family Income, Ill Health, and Medical Care of U.S. Children

Abstract: rD G)g OVERTY and excessive mortality have been recogmzed as associated phenomena since regular censuses of populations were inaugurated almost two centuries ago (1). Early attempts at reducing the disadvantage caused by poverty were addressed by social and envi>se& ronmental measures, but toward the end of the nineteenth century biologically-oriented science raised the possibility of controlling these types of illnesses with medical means. By the 1920S poverty as an antecedent of disease had ceased to be a focus of attention as concern shifted to the lesser exposure of the poor to the benefits of modern medicine. Although hypotheses regarding the association between poverty and ill health reappeared coincident with the Depression of the 1930s, modem studies of the etiology of disease generally have not included measurements of social class, and even fewer have assessed the possible differential effects of poverty and near-poverty on disease occurrence and prognosis. It is, however, well recognized that poor adults are in worse health than other adults, and the relationship between poverty and higher death rates has been conclusively documented (2). A major impediment to understanding the relationship between poverty and disease derives from the fact that ill health can predispose to poverty as well as be caused by it, especially in adults. The nature of the relationship is simpler in children, as disease is not as likely to reduce family income to the same extent as is the case for adults. This paper summarizes the nature of the link between poverty and ill health in childhood as reflected in current studies, examines the relationship between poverty and the receipt of medical care, reviews the evidence that increased access to medical care reduces the disparity in health status between poor and non-poor children, and speculates on the possible effects

Applied Anthropology and International Health: Retrospect and Prospect

Abstract: George M. Foster is the 1982 recipient of the Malinowski Award, presented at the 42nd Annual Meeting of the Society for Applied Anthropology, Lexington, Kentucky. This annual award is given to a senior colleague in recognition of efforts to understand and serve the needs of the world through social science. The following is Professor Foster's acceptance speech. IS A HIGH HONOR INDEED to be the recipient of the Tenth Malinowski Award, thus to be associated with the names of Bronislaw Malinowski and of my nine distinguished predecessor recipients. When Peter New advised me of my selection, I experienced mixed emotions: first, pleasure and appreciation, and second, concern as to my topic. Fortunately, colleagues came to my rescue; several suggested that I talk about the involvement of anthropologists in international health programs, a field to which I have been exposed for more than 30 years. Hence, the title of this address. Specifically, I propose to note the early events that drew anthropologists to the international health field, to take stock of where we are today, and to suggest the opportunities and problems we may encounter in the future development of the field.' To limit my remarks to reasonable length I exclude mental health and family planning, and restrict myself largely to American anthropology. I use the term "international health programs" to denote those national and international efforts designed to improve the health care services of peoples who, until recent years, have relied largely or entirely on indigenous medical resources. These include most of the people, both urban and rural, in developing countries, and substantial numbers of minority ethnic groups in some industrialized countries. The common characteristic of these programs is that they are cross-cultural: historically, health care providers and health care recipients have represented distinct cultural, social or ethnic groups. Whatever the setting, the basic problems associated with planning and delivery of health care, and utilization of services, are essentially the same. A generation ago physicians and anthropologists alike defined the problem of providing better health care for traditional peoples as how to persuade them to accept scientific medicine. As anthropologists, our fundamental research task was to learn those things about the health beliefs and practices of these peoples that would enable health care providers to convince them of the superiority of modern medicine over their traditional therapies. Our practical goal was to further effective cross-cultural communication which, we assumed, would lead to scientifically acceptable health beliefs and behavior.

Rural health under colonialism and neocolonialism: a survey of the Ghanaian experience.

Abstract: This paper discusses some of the implications of colonialism and neocolonialism for rural health in Ghana. The starting point for discussion is a critical review of the dominant ahistorical, atheoretical, and technocratic conception of the underdevelopment of rural health. It is argued that the problems of rural health cannot be fully explained without a consideration of Ghana's colonial and neocolonial experiences. It is necessary to examine the impact of the colonial capitalist mode of production on rural health and health care, as well as the mechanisms underlying the post-colonial entrenchment of the colonial legacy. The implications of the reformist approach to the problems of health are examined, and the possibility of a structural transformationist solution, which must start from the elimination of imperialist control, is assessed. It is concluded that the Ghanaian social formation, given its current constitution and crises, makes structural transformation the only viable alternative to solving the problems of rural health.

The prospective Pareto Principle and equity of access to health care.

Abstract: < < 'T^ -gORALITY IS MADE FOR MAN, NOT MAN FOR / morality." I interpret this aphorism as suggesting that LVTL _questions of morality can most fundamentally be addressed by considering human benefits and human harms-those benefits and harms to which our acceptance of various alternative moral principles would tend to lead. This formula is vague, but I shall be concerned in this paper with one attempt to state clearly at least a part of what is involved. I shall be examining issues of social justice in access to health care. Does justice, I shall ask, require that everyone be assured access to every kind of health care that can be expected to benefit him? If not, does it at least demand that everyone have equal access to health care, without regard to income or place of residence? Or does justice rather demand no more, and no less, than that everyone be assured a "decent minimum" of access to health care-and if that is so, what comprises that "decent minimum"?

Health and Health Care under Apartheid

Abstract: UJ 2 more obvious than elsewhere. Stark contrasts and sharp 171 5 variations, naked to the meanest sensibility, can be seen to stem directly from the politics, the social order and the economic base of the society. In what follows we make some assertions about the political, social and health care contexts of the country, and then proceed to weigh published data on mortality and morbidity. We do not hesitate to draw conclusions, speculative though some of these may be.

Epidemiology and the public health movement: a historical perspective.

Abstract: r s j N a recent article, we came across Table 1, which shows 9 the "limits of variation" (confidence limits) compatible J g with the equal chance of two events occurring; "by equal chance" the author means that the probability of the event is 1/2. The actual table from which this was 94 ~ ~taken was more extensive than this, going up to 4,000 cases. This table appeared in the "Medical Statistics" section of the Cyclopedia ofAnatomy andPhysiology, published in England between 1849 and 1852 (1) . It was written by William Augustus Guy, first the Professor of Forensic Medicine, and then of Hygiene, at the King's College Hospital Medical

The developing nations: A comparative perspective

Abstract: PART I: INTRODUCTION 1. Medical Sociology 2. Epidemiology 3. The Social Demography of Health: Social Class 4. The Social Demography of Health: Gender, Age, and Race PART II: HEALTH AND ILLNESS 5. Social Stress and Health 6. Health Behavior And Lifestyles 7. Illness Behavior PART III: SEEKING HEALTH CARE 8. The Sick Role 9. Doctor-Patient Interaction PART IV: PROVIDING HEALTH CARE 10. Physicians 11. The Physician in a Changing Society 12. Nurses, Physician Assistants, Pharmacists, and Midwives 13. Healing Options PART V: HEALTH CARE DELIVERY SYSTEMS 14. The Hospital in Society 15. Health Care Reform and Health Policy in the United States 16. Global Health Care

Federal health program reforms: implications for child health care.

Abstract: The "Omnibus Budget Reconciliation Act of 1981" included a number of provisions designed to reduce federal spending for health care and to increase state authority over health programs. Evidence concerning the financial condition and health care needs of children served by federally-financed health programs, and recent trends in coverage and eligibility, make it possible to assess the likely impact of the new legislation. One conclusion seems clear: extensive federal funding reductions cannot be accommodated by eliminating excesses. While reforms of the Medicaid program may be advisable for a number of reasons, a simple reduction to funding will have serious, adverse consequences for poor children.

Doctors in Spite of Themselves: The Limits of Radical Health Criticism:

Abstract: This paper distinguishes a materialist from a medical approach to health (including as medical the clinical, epidemiological, sociological, environmental, and radical approaches). Three themes are developed. The first concerns a broad definition of medicine. Derived from the actual strategies that capital and labor adopt to health, this definition encompasses all attempts to manage the social factors responsible for ill-health as "conditions" while maintaining (or concealing) the contradictory basis for these conditions in capitalist social relations. The second theme concerns the roots of medicine. Radicals treat scientific medicine as a tool introduced by capitalists and a professional elite to maximize profits, increase productivity, and control women and other oppressed minorities. The materialist view, by contrast, emphasizes the role of worker initiatives in transforming the relations responsible for epidemic disease in the 19th century and the extent to which this transformation led directly to the utility of medical care after 1900. The fact that modern medicine can acknowledge its dependence neither on these initiatives nor on the progress of suffering created through the accumulation process is far more important than the market position of doctors in determining medicine's limits and the ideology of professional doctors. The third theme concerns the utility of a materialist epidemiology for reinterpreting many of the same issues examined by radicals, including medicalization, victim blaming, professional ideology, elitism, the exclusion of certain oppressed groups from "the sick role," and medicine's failure to combat the diseases of stress. The basic contention is that a revolutionary health strategy is impossible as long as medical care remains the centerpiece of our analysis.

The strategy cost and progress of primary health care.

Abstract: Since the 1978 Alma-Alta International Conference on Primary Health Care investments in primary health care projects throughout the world have been increasing. However with the exception of China no national projects have demonstrated the ability to provide longterm comprehensive primary health care in conditions of chronic proverty with local resources. Programs in China Cuba and Tanzania have achieved primary health care coverage for 100% of their populations. These countries have in common strong governments that have been able to implement radical changes in the health system. Individual freedoms in these societies have been restricted in favor of improved health. Programs in Nigeria India and Afghanistan have been less successful although some progress has been made in projects using external funds inspite of a strong committment by the governments. Efforts to reorganize the health care system have lacked needed political strength. Currently these systems have resulted in less than complete coverage without the prospect of attaining acceptable levels of infant mortality life expectancy and net population growth. Economic political and cultural costs may be high as for example national security or traditional practices are traded to achieve primary health care with 100% coverage. WHO has devised a global strategy which when translated into operational policies will need to address several unresolved issues. These include recognizing that the goal of comprehensive primary health care may not be justified given the lack of progress to date and that effective selective primary health care focused on nutrition immunization control of endemic diseases and health education may be a more realistic goal; and that a system of international social security may be an effective means of assuring that the poorest countries are able to provide care. In addition questions concerning continued funding of programs that can never be locally funded the role of traditional healers in a system of free care the supply of basic medications the need for audit systems realistic expectations of costs the role of international agencies and the distribution of resources between more developed and less developed countries will need to be addressed.