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.     

Passive Smoking and Health Care: Health Perceptions Myth vs. Health Care Reality

Individuals exhibit systematic tendencies to overstate the risks of unlikely lethal events. If the risks of passive smoking are overstated in this manner, and if passive smoking is not harmful to adult health, then passive smoking by adults should have a discernible effect on subjective evaluations of health status, but no corresponding effect on health. This idea is examined empirically below using data from the National Health Interview Surveys. The empirical results can be summarized as follows. Passive smoking is associated with assessments of significantly poorer health. Poorer health assessments are associated with significantly greater medical resource use. However, direct estimates of the effects of passive smoking on health care use indicate no statistical association whatsoever. These results are consistent with a model whereby individuals systematically overestimate the effects of passive smoking on their health and where the short-term effects of passive smoking on adult health care costs are negligible.     

The Individual's Health Is the Health of Society

Recently, a fact characterizing a fundamentally new phenomenon for Russia—net depopulation—has been repeated again and again in the mass media (and not only in the mass media). In the last quarter of the past year, our mortality rate was 11.3 per thousand, and the birth rate was only 11.2, i.e., there was a "negative growth." The phenomenon is serious enough in itself and has many aspects, from demographic to economic. It is natural that it should attract attention. However, the inclination to link it directly only with actions of the moment (or with the lack of action), to explain it by the liberalization of prices, etc., is annoying. The problem is much more long-term and complicated. The issue is not so much that the birth rate is declining (this is a worldwide tendency, and the birth rate in Russia is still much higher than in most European countries) as that the mortality rate is rising (this contradicts the same trends, forewarning us of trouble). The ultimate question is one of the stability of this negative process, of the potential, the reserve of health present in society as a whole and in each individual.     

District Health Organization

Government policy in the UK has been to provide comprehensive personalized health care to the whole population free at the point of delivery. However, the first major attempt to unify and regionalize the service in 1974 left a number of problems, and a further restructuring of the NHS was required. This article reports on the results of research into the 1982 restructuring. The main feature of this second reorganization was the formation of territorial entities called "Districts", and their organizational subdivision into "Units". The kind and level of work and authority assigned to Districts and Units is discussed. An important fading, seemingly counter to official policy, is the existence of small Districts which operate at the same level as Units of the larger Districts.     

Health and Politics

Politics, described as ‘the authoritative allocation of values for a community’, arises out of conflict. Each party to any conflict attempts to have its interest prevail. The more organized a group and the more resources at its disposal, the more likely that its interest will prevail. Politics is significant in the determination of eventual policies in health matters. The consumer in health matters tends to accept what is presented to him. The interaction of differing attitudes, values and actions of interest groups in the health field is surveyed, and it is maintained that the politics of health warrant a greatly increased focus of attention from political scientists.     

Common Health Concerns

No abstract available for this article.     

Allocating Health Resources

To clarify the polemics surrounding public and private responsibilities in health care, this article deals with the economic justification for the commitment of public resources. Public health measures do possess the properties of public goods or physical externalities, and yet may not have the sufficient conditions for allocating resources by political procedures. To publicly allocate resources to personal health care can only be justified by the properties of informational externalities, or regard for the humanitarian spillovers. Paradoxically, it is precisely in this latter area that a concern about minimum standards has led to a philosophical commitment to achieving maximum standards. The pursuit of such universal standards in the health sector has been the subject of growing disquiet. This dilemma is best resolved by reorientating the role of government towards an analysis of the costs and benefits of present and projected health practices.     

Aboriginal Health Courses

The relevance of social and economic factors other than physical circumstances in determining aboriginal health is discussed. How these factors determine the goals of aboriginal health and influence what the participants can do about them is examined. A critical need is seen for health courses to train indigenous health workers. Problems of running such courses and selecting candidates are raised, and a greater role for social scientists in such courses is noted.     

European Health Care Costs

The rising cost of health care in Western European countries is now seen by many governments as a problem, and attempts are being made to find a solution by introducing cost-containment policies.
The author begins by reviewing trends in health care expenditures, and examines some of the underlying reasons for the upward trend.
He then considers some of the more important differences in the organization and financing of Western European health care systems, before surveying the different kinds of cost-containment policies which are being, and could be, pursued.
The conclusion is that present cost-containment policies do not take sufficiently into account the underlying reasons for rising costs, and that the criteria for evaluating the success of these policies are inadequate. To be successful, the policies will have to be altered, and the objectives and means of evaluation reconsidered.     

When is a Health Department not a Health Department? The Case of the US Department of Health and Human Services

Given the current policy debate over health reform in the United States, it is not possible to describe the organizational structure that might emerge from this process. This article explores five of the attributes that underpin the context for a discussion of the structure and operation of a health bureaucracy in the USA. First, ambivalence in the US society about a public commitment to health and a general scepticism about a significant public sector in this area. Second, separation within the system between types of activities (e.g. health research activities, provision of services, and financing of health efforts). Third, the health system operates in the context of a government with shared powers as well as federalism and an assumption that some issues belong to states, and sometimes localities, and not to the federal government. Fourth, difficulty in the US system when it attempts to focus on prevention activities. And fifth, the structure of HHS creates tensions between management initiatives and professional expertise and standards. The article concludes with a discussion of possible organizational alternatives.     

Working in Multidisciplinary Community Mental Health Teams: The Impact on Social Workers and Health Professionals of Integrated Mental Health Care

Correspondence to Professor John Carpenter, Centre for Applied Social Studies, University of Durham, Elvet Riverside II, Durham DH1 3JT, UK. E-mail: J.S.W.Carpenter{at}dur.ac.uk Summary This study investigated the relationships between the organizationof community mental health services and professional and teamidentification, team functioning and the psychological well-beingand job satisfaction of staff working in multidisciplinary communitymental health teams (CMHTs). Staff in four districts in theNorth of England completed anonymous questionnaires on two occasions,twelve months apart. There were systematic differences in teamfunctioning, favouring teams in districts where mental healthand social care services were integrated. However, service organizationhad no evident impact on professional or team identificationor on outcomes for staff in terms of stress or job satisfaction.There were differences between social workers (n = 31) and healthservice professionals (n = 82) indicating that social workershad poorer perceptions of team functioning and experienced higherlevels of role conflict. Controlling for other factors includingthe study districts, role conflict was a significant predictorof stress and of job dissatisfaction, while role clarity promotedjob satisfaction. We conclude that support and supervision aimedat ensuring a social work contribution to multidisciplinaryworking should be provided in the course of establishing CMHTsand integrated health and social care services.