Contextualizing critical junctures: what post-Soviet Russia tells us about ideas and institutions

The present article asks what lessons the empirical case of institutional change in post-Soviet Russia yields for the recent research on ideas and institutions. Its main point is that in post-Soviet Russia a clash between imported foreground ideas and deep domestic background ideas led to an ideational division among the elite of the country that became a main obstacle to the provision of coherent economic reforms. This story stands in some contrast to much of the newer literature on ideas and institutions, which tends to see critical junctures as leading from one equilibrium to another. I argue that tensions between imported foreground ideas and deep domestic backgrounds are likely to occur in other cases of far-reaching processes of institutional change based on Western ideas but taking place beyond the realm of Western, industrialized countries. Therefore, I argue, some general lessons on the interplay between ideas and institutions might be drawn from this case study.     

College health services in California.

College health services are an underrecognized segment of California's health delivery system. Higher education institutions in California vary in their arrangements for the provision of health services. Some of the smaller institutions provide nurse triage, first aid, and referral only, whereas other institutions provide 24-hour-per-day/7-day-per-week comprehensive ambulatory and inpatient services. More than 200 full-time equivalent physicians are employed in college health services in California. Patient profiles served by college health services targeted the traditional college student age range. Some institutions, however, have expanded their services to include nonstudent university employees and their dependents. Comparing numbers of outpatient visits and professional staffing requirements to student enrollment showed significant variability between institutions, depending upon the scope of services provided (basic, intermediate, comprehensive) and the type of student population (residential, commuter, mixed).     

Culture Clash and Second Home Ownership in the U.S. Northern Forest

Culture clash, or intracommunity tensions related to rapid in‐migration, between permanent and newcomer residents has been well studied in relation to environmental conservation in natural amenity communities; however, less is known about culture clash within communities characterized by high rates of second home ownership. We examine the causes of perceived culture clash in communities of the U.S. Northern Forest using mail survey data from four case studies within New York, Vermont, New Hampshire, and Maine. In contrast to past culture clash research, we consider multiple dimensions of cultural capital that are independent of second home owners' rural or urban origins, and how key aspects of culture compare to economic standing and social interaction as drivers of perceived culture clash. Permanent residents perceive greater levels of culture clash than second home owners, net other measures, indicating that seasonal migration in and of itself encourages notions of otherness between residents. More frequent social interaction between resident groups helps to ameliorate intracommunity tensions. Cultural capital and social interaction measures were equally effective in explaining variation in perceived culture clash. Our findings indicate that the culture clash concept extends beyond scenarios of environmental conflict and applies to more general forms of intergroup tensions.     

Changing health culture in rural Appalachia: Implications for serving the elderly

This article explores the dual themes of place and time as influences on health care service delivery to the rural elderly, through a case study of rural Appalachia. Traditional patterns of indigenous health care practice and values are contrasted with more “professional” formal models of health care service delivery that have entered the region. The result has been a clash of health care cultures. The continuing validity of this perspective is appraised in relation to apparent generational differences between the old-old and the young-old in the degree to which contemporary health care practices and values are adopted. It is concluded that traditional and contemporary health care cultures can be reconciled through an expanded vision of health care service delivery premised on: understanding health care within a total community context; redefining the role of the health practitioner; improving education of both the rural elderly and service providers; and enhancing communication in the rural health care environment.     

Towards a (“thick”, “thin”, or “parallel”) European society? Understanding the dynamics of European multiplicity

In order to deal with the question of European society, it is useful to introduce a social-theoretical perspective that investigates the dynamics of multiplicity underlying European transformations. There are at least three co-existing routes to Europe-making that often clash with each other: “thick”, “thin”, and “parallel” Europe-making. These are in tune with definitions of Europe as an “exclusive civilizational entity”, as a “problem-solving instrument”, and as representing world society, respectively. Based on a notion of European multiplicity, this study argues that contemporary European society cannot to be reduced to a particular dynamic or to a set of actors, norms, and institutions because it paradoxically incorporates at the same time “thick”, “thin”, and “parallel” Europe-making.     

The public finance of medical and dental care in Newfoundland--some historical and economic considerations

The article discusses the evolution of Newfoundland's health care system from the turn of the century to the present. During this time there were considerable changes in social conditions, political arrangements and the availability of public monies, all of which influenced the structure of the health care sector. In general terms, Newfoundland's health care system shifted from one involving low expenditures and many British type institutions to one involving high expenditures and American type institutions. The evidence suggests that the changes have been particularly beneficial for Newfoundland's merchant class, including the doctors and dentists, although some benefits have also accrued to patients and fishermen.     

Engaging Experts: Expanding Participation and Enhancing Research in Chinese Eldercare Institutions

Due to the myriad factors straining China’s traditional family-based eldercare system, today unprecedented numbers of older adults are turning to institutions for caregiving needs. As researchers and policy makers organize conferences, analyze trends, and allocate resources, the subjective experiences of elders themselves are often forgotten or ignored. While providers recognize that institutionalized elders are at an increased risk for mental health issues, most cite personnel and resource shortages as insurmountable barriers to provision. Using examples from ethnographic research in Chinese eldercare institutions, this article examines the link between participation and mental health for contemporary Chinese elders and makes a case for expanding the role of elders in research in order to improve both the experience and understanding of institutional eldercare.     

Ontological Politics. A Word and Some Questions

This is a chapter that asks questions about where we are with politics now that actor network theory and its semiotic relatives have reshaped ontology . They have reshaped it by underlining that the reality we live with is one performed in a variety of practices. The radical consequence of this is that reality itself is multiple. An implication of this might be that there are options between the various versions of an object: which one to perform? But if this were the case then we would need to ask where such options might be situated and what was at stake when a decision between alternative performances was made. We would also need to ask to what extent are there options between different versions of reality if these are not exclusive, but, if they clash in some places, depend on each other elsewhere. The notion of choice also presupposes an actor who actively chooses, while potential actors may be inextricably linked up with how they are enacted . These various questions are not answered, but illustrated with the example of anaemia, a common deviance that comes in (at least) clinical, statistical and pathophysiological forms.     

NO ROOM FOR ABUSE

In Canada, media reports on health care tend to focus on the high costs of the health care system; reporting privileges the economic aspects of this social service. In the Canadian system, long-term care or chronic care is a type of service that is situated within the health care system. Long-term care institutions typically house older individuals who have lost a significant amount of autonomy and require constant care. Until recently, the services dispensed within these institutions were unseen by the media, and thus the public did not reflect much on these services. The publication of the Report of the Royal Commission on the Future on Health Care in Canada in 2002 has fostered a growing public awareness of the vulnerability of older individuals and those with chronic illnesses, and their relationship with their care-givers. Although it may be the case that the typical care for such persons in these situations is now emerging from a zone of invisibility, it is uncertain that the media coverage accurately portrays the realities of institutionalized care-giving. This essay examines the care practices in long-term care institutions in order to understand the processes at work in an environment in which care is commodified. The ‘area’ in which this caring labour is located is an area where constant moral compromise can create a climate where abuse can become endemic. This paper considers these environments and the potential for abuse in them in relation to the concept of ‘grey zone’, first formulated by Primo Levi and later adapted by Giorgio Agamben and Claudia Card, as well as in relation to the related concept ‘bare life’, also formulated by Agamben. The author argues that the ‘greyness’ produced by care practices that are bound to a cost-effective and task-oriented framework create an environment that is not conducive to proper moral behaviour.     

Promoting public/academic linkage.

1. Collaborative linkages between public mental health/mental retardation service systems and academic institutions have evolved in response to several problems: increasing numbers of individuals requiring long-term mental health care; the nursing shortage; and a decline in enrollment and students graduating from psychiatric mental health nursing programs. 2. Evidence suggests that a public/academic linkage in the form of a multidisciplinary training course in the care of seriously mentally ill patients promotes a recruitment of mental health professionals to work with these patients. 3. The establishment of academic/health care system linkages can enhance client care, expand and improve clinical experiences and education for students, and provide opportunities for collaborative research among clinical staff, faculty members, and graduate students.     

Understanding Social Inequality in the Kidney Transplantation System

The degree of racial inequality in transplantation outcomes is large and surprising in light of the commitment of the administrative institutions to maximizing allocative justice and to providing universal health coverage for those with kidney failure. This article adopts a sociological perspective which situates transplant candidates as participants in an allocative system with clearly defined distributive rules, while recognizing the permeation of other social institutions into this system. Taken together, the medical literature on social disparities in kidney transplantation and the social science literature on relevant processes suggest that social inequalities in kidney transplantation are produced through a combination of preexisting differences in traits made salient for inequality by the rules of the allocation system and group differences in the tendency to maximize their advantages within that system.     

The Evolution of Community Mental Health Services in Asian American Communities

This paper explores the history of Asian immigration to the United States, and its intersections with the mental health system. As mental health care have evolved since the 1960s from institutions to the community, public mental health services for Asian Americans have become increasingly culturally relevant. Major policy shifts, trends in immigration, and mental health practice will be presented with a focus on the Bridge Program at the Charles B. Wang Community Health Center. Integrative practice and research models that extend evidence-based knowledge to Asian American communities and practice implications are discussed.     

American College Health Association National College Health Assessment (ACHA-NCHA) Spring 2005 Reference Group Data Report (Abridged)

Assessing and understanding the health needs and capacities of college students is paramount to creating healthy campus communities. The American College Health Association-National College Health Assessment (ACHA-NCHA) is a survey instrument developed by the ACHA in 1998 to assist institutions of higher education in achieving this goal. The ACHA-NCHA contains approximately 300 questions assessing student health status and health problems, risk and protective behaviors, access to health information, impediments to academic performance, and perceived norms across a variety of content areas (eg, injury prevention; personal safety and violence; alcohol, tobacco, and other drug use; sexual health; weight, nutrition, and exercise; mental health). Twice a year, the ACHA compiles aggregate data from participating institutions in a reference group report for data comparison. Results from the Spring 2005 Reference Group (N = 54,111) are presented in this article.     

American College Health Association-National College Health Assessment (ACHA-NCHA) Spring 2004 Reference Group data report (abridged)

Assessing and understanding the health needs and capacities of college students is paramount to creating healthy campus communities. The American College Health Association-National College Health Assessment (ACHA-NCHA) is a survey instrument developed by the ACHA in 1998 to assist institutions of higher education in achieving this goal. The ACHA-NCHA contains approximately 300 questions assessing student health status and health problems, risk and protective behaviors, access to health information, impediments to academic performance, and perceived norms across a variety of content areas, including injury prevention; personal safety and violence; alcohol, tobacco, and other drug use; sexual health; weight, nutrition, and exercise; and mental health. Twice a year, the ACHA compiles aggregate data from participating institutions in a reference group report for data comparison. Results from the Spring 2004 Reference Group (N = 47,202) are presented in this article.     

Race,class and the shaping of a policy for immigrants: the case of the Netherlands

Ethnic stratification constitutes a (potential) threat to social stability. The major factors that determine the immigrants' position are 1) ethnic differences between them and the original population (and among the various immigrant groups themselves) and 2) the social system of the receiving society and the way in which the major distribution mechanisms in that system operate. For a very long period immigration policy in the Netherlands was based on the principle that it was not a country of immigration and it would not become one. Thus, it had a rather liberal admissions policy until 1980 because immigration was not expected to lead to permanent settlement. Ethnic minority groups constitute about 4.3% of the total population, but they are heavily overrepresented in the metropolitan areas. The culturalist approach in Dutch policy allowed opportunities for migrants to retain their own "cultural identity." During the 1970s the government supported the creation of a variety of institutions which served exclusively the different immigrant groups. After the policy change in the 1980s the Dutch allowed the immigrant institutions to continue to exist, to provide a "shelter" which would help the migrants emancipate within Dutch society. Meanwhile, they launched campaigns to inform the Dutch about immigrant cultures. This approach encountered difficulties: 1) the relatively small size of each immigrant group, the large and growing differences and oppositions within these groups, and their geographical dispersal, often made it impossible to set up separate institutions with even minimal viability; 2) there was a lack of leaders in most minority groups; 3) the economic crisis of the early 1980s hit the immigrants much more strongly than the general population; and 4) a "blame-the-victim" attitude developed among a growing number of Dutchmen. In 1983 the government shifted to a structuralist approach, by striving to overcome social disadvantage and achieve legal equality. This approach also has its limitations. Recently, institutional racism has been growing. The government now aims to have immigrants proportionally represented in all major institutions, but it is only on a voluntary basis. The author concludes: 1) both the cultural and the structuralist approach are insufficient in overcoming the migrants marginal position; and 2) culturalist and structuralist approaches clash sometimes. Ethnic pluralism should no longer be viewed as a stage in integration processes, but rather as one of its possible outcomes.     

New Issues in an Old Dilemma: The Confidentiality of Mental Health Records

Assessing and understanding the health needs and capacities of college students is paramount to creating healthy campus communities. The American College Health Association-National College Health Assessment (ACHA-NCHA) is a survey instrument developed by the ACHA in 1998 to assist institutions of higher education in achieving this goal. The ACHA-NCHA contains approximately 300 questions assessing student health status and health problems, risk and protective behaviors, access to health information, impediments to academic performance, and perceived norms across a variety of content areas, including injury prevention; personal safety and violence; alcohol, tobacco, and other drug use; sexual health; weight, nutrition, and exercise; and mental health. Twice a year, the ACHA compiles aggregate data from participating institutions in a reference group report for data comparison. Results from the Spring 2004 Reference Group (N = 47,202) are presented in this article.     

Moving mountains together: strategic community leadership and systems change

Traditional leadership practice frameworks to guide systems change often fall short in today's practice environment. Reclaiming Futures is a national initiative to create an integrated, comprehensive, seamless system of care for teens with substance abuse problems involved in juvenile justice. It uses leadership and systems reform strategies to improve public health institutions. The premise is that interruption of the destructive cycle of drugs and delinquency can only be attained through the cultivation of shared strategic leadership. This article presents the limitations of traditional practice frameworks of leadership, describes the theory of this new approach to leadership development, and clarifies collaborative leadership and system change. The article includes an example of the framework in action, a discussion of lessons learned, and recommendations for community leadership development initiatives.     

The American College Health Association National College Health Assessment (ACHA-NCHA), Spring 2003 Reference Group report

Assessing and understanding the health needs and capacities of college students is paramount to creating healthy campus communities. The American College Health Association-National College Health Assessment (ACHA-NCHA) is a survey instrument developed by the American College Health Association (ACHA) in 1998 to assist institutions of higher education in achieving this goal. The ACHA-NCHA contains approximately 300 questions assessing student health status and health problems, risk and protective behaviors, access to health information, impediments to academic performance, and perceived norms across a variety of content areas, including injury prevention; personal safety and violence; alcohol, tobacco, and other drug use; sexual health; weight, nutrition, and exercise; and mental health. Twice a year, ACHA compiles aggregate data from institutions using the ACHA-NCHA to provide a reference group for data comparison. A portion of the data from the Spring 2003 Reference Group is provided in this article for use by professionals, researchers, institutions, departments, and organizations invested in advancing the health of college students.     

Flexible work schedules, older workers, and retirement

Older workers in the United States indicate that they would prefer flexible work arrangements rather than abrupt retirement, yet management has done very little to make this possible. A review of two bodies of literature from the late 1980s is presented: social science writings including sociological, gerontological, and economic literature, and business and management literature. There is a clash between the way jobs are traditionally scheduled and the needs of growing numbers of older workers. Workers continue to be subject to obstacles to phased retirement due to the structuring of health care and pension benefits, downsizing, organizational inflexibility, and "corporate culture." Thus, general views among social scientists regarding the desirability of flexible schedules toward retirement will not produce real changes unless management becomes committed to such changes and they are securely embedded in company policies.     

Can (and Should) We Construct an Evolutionary Psychological Theory of Institutions?

This article considers the question of whether, as a number of scholars have suggested, we can (or should) develop a theory of institutions from the perspective of evolutionary psychology (EP), construed broadly. To do so, the article reviews EP's core explanatory strategy and the main claims that have been made by proponents of an EP institutional theory, focusing on arguments about (1) welfare states and (2) “honor cultures” and the institutions associated with them. On the one hand, the article argues, there are both logical and empirical problems with current efforts to develop EP theories of these institutional domains. On the other hand, sociology's relative absence from the development of such theories contributes to these problems, and sociologists can learn from EP. Above all, insights drawn from EP may help us to construct better accounts of various institutions’ micro‐foundations. To this end, collaboration and exchange between EP scholars and sociologists is called for, and some suggestions are made about how this might be done most fruitfully.