Standing Up for Health? Health Departments in EU Health Policy Formulation

When are health departments and ministers influential across policies? This article looks for an explanation in the variable ability of the French, German and UK health departments to influence their states' approaches to EU health policy‐making. It proposes that the extent of departmental power within government and the likelihood that the government imposes a single line across all its departments explain the variable success of the three health departments in influencing EU policy – some have voice in their government's overall stance on EU matters, as in the UK, some have the ability to escape central control and pursue their own agendas in Brussels, and some have neither, and sometimes find themselves pursuing overall strategies that conflict with their analyses and preferences, as in France. The framework, using exit and voice, should be generalizable to the overall influence of health or other ministries in general government policy.     

工作-家庭冲突、性别角色与工作满意度——基于第三期中国妇女社会地位调查的实证研究

本文使用2010年第三期中国妇女社会地位调查数据,研究了工作-家庭冲突对工作满意度的影响及其性别差异,发现来自工作和家庭两方面的角色压力是引发工作-家庭冲突的主要原因,而且无论是因工作影响家庭,还是因为家庭耽误工作,员工都会对工作表达不满。与男性员工相比,工作压力和家庭压力会使女性员工陷入更为严重的工作-家庭冲突,而且女性员工也更可能因为工作影响家庭而降低对工作的满意度。这些发现不仅为工作-家庭冲突及其相关后果的理论研究提供了丰富的经验证据,还为各级管理人员激励员工士气和提高组织绩效提供了很多实践上的启示。     

Comparison of Conflict of Interest Policies and Reported Practices in Academic Medical Centers in the United States

The authors reviewed the conflict of interest policies of 9 academic medical centers in the United States and interviewed members of the Institutional Review Boards (IRBs) and Conflict of Interest Committees (COICs) at those institutions. They found that many institutions used processes for reporting and managing conflicts of interest that were more decentralized than the processes described in their policies. Also, most institutions had no clear and comprehensive policy to guide investigators regarding disclosure of conflicts of interest to potential research participants. Considerable differences in understanding of conflict of interest policies were observed between IRB and COIC officials.     

Comparison of conflict of interest policies and reported practices in academic medical centers in the United States

The authors reviewed the conflict of interest policies of 9 academic medical centers in the United States and interviewed members of the Institutional Review Boards (IRBs) and Conflict of Interest Committees (COICs) at those institutions. They found that many institutions used processes for reporting and managing conflicts of interest that were more decentralized than the processes described in their policies. Also, most institutions had no clear and comprehensive policy to guide investigators regarding disclosure of conflicts of interest to potential research participants. Considerable differences in understanding of conflict of interest policies were observed between IRB and COIC officials.     

The Indian family in the seventies; an integrated family policy

Social and economic stresses of urban and industrial developments are eroding the traditional closeknit Indian family structure and causing a change in values among the young people. A comprehensive program aimed at strengthening all aspects of family life is needed. This would include legislation raising the minimum age of marriage and counseling in sexual matters and family planning. In India families are still considered more important than individuals and counseling should be directed to the family as a unit. The family's needs of housing, education, health, welfare, and employment should be considered as part of a whole package program.     

Policy Stable States in the Graph Model for Conflict Resolution

A new approach to policy analysis is formulated within the framework of the graph model for conflict resolution. A policy is defined as a plan of action for a decision maker (DM) that specifies the DM’s intended action starting at every possible state in a graph model of a conflict. Given a profile of policies, a Policy Stable State (PSS) is a state that no DM moves away from (according to its policy), and such that no DM would prefer to change its policy given the policies of the other DMs. The profile of policies associated to a PSS is called a Policy Equilibrium. Properties of PSSs are developed, and a refinement is suggested that restricts DMs to policies that are credible in that they are in the DM’s immediate interest. Relationships with existing stability definitions in the graph model for conflict resolution are then explored.     

Inter-agency Collaboration in the All-Wales Strategy: Initial Comments on a Vanguard Area

A key element in the All-Wales Strategy (AWS) for Services for Mentally Handicapped People is the collaboration of statutory agencies involved in planning and managing mental handicap services. This paper discusses the experience over the first three years in one county. The inter-agency county strategic planning group exhibited a high level of consensus reflecting its structure, group processes and the issues discussed. Controversial matters were rarely raised. Further weaknesses were the low input from the Education Department and the poor communication outside the group. This consensus image is contrasted with the considerable conflict in the inter-agency county operational management group, the failure of which reflected the different management structure and style of the health and local authority, weaknesses in the management structure for AWS developments, and a failure to resolve some crucial issues in the early stages of the strategy. The lessons learnt from these experiences and the necessary ingredients for effective collaboration are explored — a framework for collaboration, including a clear definition of function, authority and the interrelationship of the various parts and a formal system of communication, commitment from those participating and the authority of participants to implement collaborative decisions.     

Local autonomy,municipal size and local political participation in Europe

Local autonomy in Europe has, on average, increased since 1990 and has decreased (a little) since 2009. The average population size of a European municipality has increased continuously during the last two decades. European countries with larger municipalities do not have more local autonomy. Citizens of large municipalities are less interested in local political matters. Inhabitants of small municipalities tend to be more interested in local political matters when their municipalities have more local autonomy while a similar strong correlation between local autonomy and local political interest cannot be established for larger municipalities. Finally, a discrepancy exists between the stated policy objectives of many European countries that support both decentralization and (more) local political participation on the one hand and actual policy results on the other hand that are not necessarily in line with increasing local autonomy and stimulating local political participation.     

How Minorities Prevail: The Context/Comparison–Leniency Contract Model

The pioneering efforts of Moscovici in the late 1960s motivated social psychologists to understand how minority groups affected the majority, and conversely, how the majority affected the minority. The underlying processes of influence have been found to be quite different, and understanding their operation provides insight into the processes of social influence, persuasion, and intragroup conflict and cooperation. This review tracks some of the development of this progression and details some contributions to understanding fundamental features of the influence process that have been uncovered as a result of this work. We consider major explanatory models, with particular emphasis on Crano's (2001) context/comparison model, and its allied leniency contract, a comprehensive account of the conditions that prevail when majorities and minorities wield influence. Finally, how this work informs important processes of influence in the world outside the laboratory are discussed.     

从全球生态危机看发达国家与发展中国家的合作

生态危机的全球性迫使各国认识到跨国合作的必要性 ,各国追求自身利益的强烈冲动与国际社会的根本特征决定了这种合作关系自始至终与其对立面———冲突交织在一起 ,合作是在冲突中实现的。国家间的能力差异对国际合作具有特别重要的意义 ,发达国家与发展中国家的合作关系是全球生态领域合作的焦点。伴随着冲突的合作关系表现在道德的价值取向、经济问题、政治问题和公平问题四个方面。     

COI Policies: Tax Dollars Should Not Be Used to Fund U.S. Institutions Not Making the Grade

Over two billion dollars was awarded by the U.S. Department of Health and Human Services (HHS) in research funding from 2010 to March 2012 to institutions receiving a grade of “C,” “D,” or “F” on their conflict of interest policies, as determined by the American Medical Student Association's scorecard on conflict of interest policies. More institutional oversight is needed with regard to assuring conflict of interest policies at U.S. research institutions are adequate. As stewards of public funds, HHS should require a minimum standard which institutional conflict of interest policies should meet, beyond current regulatory requirements, before granting funding.     

Children of the Troubles: The Impact of Political Violence in Northern Ireland

This article explores the effects of political violence on children and young people in Northern Ireland. The article begins with a brief historical account of the Northern Irish conflict and the recently negotiated Belfast Good Friday Agreement of 1998. This account illustrates, as is the case with many conflicts, its basis is religious, national, economic, and political, despite its frequent construction as a battle between Protestant and Roman Catholic. The article goes on to review young peoples' experience of conflict in Northern Ireland and the impact of conflict experiences on three related areas of young people's lives. These include the effects of the conflict on everyday aspects of life, social identity, and mental health .     

“非直接利益冲突”的法理思考

＂非直接利益冲突＂根源于现实利益问题。我国现行法律制度的不健全,是导致群众利益受损并引发＂非直接利益冲突＂的深层次原因。要从根本上化解＂非直接利益冲突＂,必须切实做好法律制定和法律清理,为群众利益筑起坚固的＂防火墙＂和＂安全网＂。     

COI Policies: Tax Dollars Should Not Be Used to Fund U.S. Institutions Not Making the Grade

Over two billion dollars was awarded by the U.S. Department of Health and Human Services (HHS) in research funding from 2010 to March 2012 to institutions receiving a grade of "C," "D," or "F" on their conflict of interest policies, as determined by the American Medical Student Association's scorecard on conflict of interest policies. More institutional oversight is needed with regard to assuring conflict of interest policies at U.S. research institutions are adequate. As stewards of public funds, HHS should require a minimum standard which institutional conflict of interest policies should meet, beyond current regulatory requirements, before granting funding.     

论"有限度"的法律发展观——以中国转型期非现实性社会冲突为分析对象

非现实性冲突是基于价值观、信仰等对立形成的,两方或多方执著于"紧张释放"的冲突行动。法律作为控制社会冲突的手段,对非现实性冲突显示出"控制不能"的困境。科学的法律发展观不应该是刺激法律万能奢望的滋长,而应是对法律限度保有理性的自觉。     

Reforming health insurance: A question of principles?

Most industrialized countries have financed health services through health insurance. Two systems prevail: private, or public (social) health insurance. The theoretical differences between them are reviewed. It is argued that most health systems are, however, hybrids and that health insurance reform in Europe and the United States has accentuated this trend because the principles distinguishing the two systems have often been ignored. This is illustrated through the evolution of voluntary vs. compulsory affiliation, coping with moral hazard, and provider regulation.     

Professional Dissonance

Abstract

Social workers in mental health face a complex climate where they encounter value-laden intervention choices daily. Examples of these choices may include deciding to initiate treatment in spite of a client's wishes to the contrary, making a decision to break confidentiality, feeling pressured to diagnose a client with a reimbursable condition despite a treatment philosophy that may be to the contrary, or feeling the need to “pick and choose” therapy topics in light of severe shortages in benefit coverage. These and other scenarios put social work clinicians at risk for professional dissonance or what has been called a feeling of discomfort arising from the conflict between professional values and expected or required job tasks. The current article explores professional dissonance as a pertinent concept for social work in general, and mental health social work in particular. The theory base of the concept is explored as well as its utility for understanding burn-out in a deeper way.     

我国药价虚高的形成机制分析及其治理途径

药价虚高是我国民生建设的一个大难题。国家多次推出降价政策措施,实行药品招标政策,但成效见微。究其成因,主要是公共卫生支出不足、政策利益冲突、药品监管不力、药价制度漏洞、委托代理扭曲,这五大层面形成了药价虚高的路径依赖。因此,从体制上彻底切断药价虚高的生存路径,才是根本的治理途径。其关键在于完善制度设计：实行医药分业,加大政府公共卫生支出,强化药品体制监督管理。     

Devolution and Centralism in the National Health Service

The reforms to the NHS following the White Paper, Working for Patients, were presented by the Conservative government as promoting devolution, defined as “decisions … taken at the lowest possible level” by Douglas Hurd (1991) — reflecting a senior Minister's interpretation of the overall policy agenda, including health. It was further claimed that such policies (“reforms in hospitals, in schools and in housing”) were a way to “empower citizens”. This approach was naturally an attempt to present the Conservatives' policy as pro-community and ‘practical’ rather than ‘ideological’ or free-market obsessed. It is worth renewing the debate about whether power and/or responsibility were devolved in the NHS — or, indeed, to the NHS from the Department of Health. Rudolf Klein, in the first edition of his The Politics of the National Health Service (1983), had no sooner pointed to the ‘devolution’ inherent in the 1982 reorganization of the NHS (based on the document Patients First (HMSO, 1981) when the Griffiths Inquiry recommendations were accepted. As a result, he was soon to observe that the pendulum — at that time — had quickly swung back to centralism, an observation reiterated after a few years when The Politics of the National Health Service came out in its second edition (Klein, 1989). In other words, there may be a cycle from centralism to devolution and back, or at least an interpretation of events as such in health policy, which makes a current reassessment timely. Which direction did the NHS Act of 1990 and related initiatives embody?     

Preservation versus motorized recreation: Institutions, history, and public lands management

The management of the public lands in the United States has been shaped by the long-running conflict between environmental and utilitarian values. Recently, changing social expectations have increased demand for motorized recreational use and access. Critics contend such use of the public lands is a threat to their ecological health. Yet even as motorized use draws increased scrutiny and challenge, some commentators conclude that the battle is already over—and recreational users have won. This article focuses attention on the U.S. Forest Service and National Park Service and contends they are predisposed as institutions to favor demands for motorized recreational use and access. It concludes that what is needed is an explanation that seeks to place motorized recreational use in a historical and institutional context that offers a more complete understanding of why such users might be winning the battle.