Social distress and the police

Police work is generally assumed to be inherently stressful. However, research suggests that much of the stress associated with police work may be related to the organizational and administrative setting in which the work is conducted. This is consistent with the concept of social distress which proposes that stress is generated by the social system in which the individual functions. The implication of understanding police stress within this framework for the implementation of police stress management programs is discussed.Based on a paper presented to the Midwestern Criminal Justice Association, Chicago, IL, October 1989.     

Reforming the health care delivery system

The health care delivery system is evolving rapidly. There have been changes in the way health care is financed, the types of treatments available, the sites of care, and the physician patient relationship. These changes have resulted primarily from reactions to health care cost inflation. Health care reform is likely to accelerate some of these changes. The threat/promise of health care reform has already accelerated the consolidation of the health care services market. Health care reform is likely to reduce the number of insurers, increase the number of Americans in managed health care plans, increase the number of physicians in group practice, change provider income, and in general make the health care delivery system more concentrated and vertically integrated.     

Dissociation in Medical Practice: Social Distress and the Health Care System

The average physician has developed several different headv, each representing another selfon the same body. One is that ofthe conventional, ethical professional who wants nothing more than to improve mankind’s health and well-being, the standard model. Another is the scientist who intends to be perceived as calculating, cold, and factual in determining what will or will not assist the ailing patient (Uexkull & Hannes, 1986). His tools are drugs, surgery, and hospitalization for presumed physical and mental ills. The third, and the one that concerns us the most, is what I will call “the neo-capitalist professional hero” (Lifton, 1971). This persona is an evolution of our American dominated internationaL cuLture which the medical profession as a group has honored by honing and poli5hing with extraordinary skil, second only to politicians and bankers, maximizing it to the ftuther detriment of the entire society. Though the body needv all three to function, none of these heads willingly acknowledges or suppOl1s the importance of the others. In what follows, a variety of media, journals, professional books, and a survey are refen"ed to in documenting data about ethical Laxity and fraud in the medical profession. Institutional, social concepts are developed that explain the data, and revealing how sociaL distress is the embodiment of the neo-capitalist professional hero. There are also suggestions for remedies in what follows, which are presented without realistic hope for implementation very soon, unfortunately, since they involve deep changes in established sociaL institutions. However, the country at large has developed some awareness of a problem which has reached epidemic propOrlions in the medical profession. FUrlher increments in awareness promise to tip the balance into positive government action.     

Behaviorally caused loss of health and the use of medical care

This paper extends the analysis of the demand for medical care to an aspect which has previously been ignored: variations in expected, as opposed to experienced, cause of losses of health and the current use of medical care. Losses of health which cannot be prevented by the prior use of medical care are hypothesized to decrease the use of medical care by reducing the rate of return to investments in health, ceteris paribus. The reduction in the rate of return occurs both because these losses curtail the length of the stream of benefits to the use of medical care and because prior use of medical care is not effective in reducing the occurrence of these types of loss. Empirical findings support this hypothesis. Results suggest that differences in expected losses may account for some of the differences in utilization of medical care by sex.     

Social aspects of health care in Igbo-Ora, Nigeria

The philosophy and aims of a health care scheme in Igbo-Ora, Nigeria, are outlined. Some of the problems related to creating a data base from which work can proceed are set out and discussed. Social factors are mentioned, and attention is drawn to the need for seeing health problems against general settings specific to a given area rather than measuring upto some abstract or "scientific" standards. The uncharted ground in many Third World practices make this particularly important.     

Social capital and psychological distress

The author proposes a conceptual model to explain the diverse roles of social capital--resources embedded in social networks--in the social production of health. Using a unique national U.S. sample, the author estimated a path analysis model to examine the direct and indirect effects of social capital on psychological distress and its intervening effects on the relationships between other structural antecedents and psychological distress. The results show that social capital is inversely associated with psychological distress, and part of that effect is indirect through subjective social status. Social capital also acts as an intervening mechanism to link seven social factors (age, gender, race-ethnicity, education, occupational prestige, annual family income, and voluntary participation) with psychological distress. This study develops the theory of social capital as network resources and demonstrates the complex functions of social capital as a distinct social determinant of health.     

Redefining consumer roles: changing culture & practice in mental health care settings

The creation of positions for CSPs is a phenomenon with a promising future for the delivery of mental health services. People who have direct experiences are the ones who best know the possibility of recovery from mental illness. They are the only ones who can serve as role models for others, providing them with hope and inspiration. With courage and determination, CSPs will make good partners with non-consumer providers, each needing to listen and learn from the other to work together effectively and to keep the wishes of those they serve as their highest priority.     

Health technology assessment between our health care system and our health

In this contribution, I wish to explore the potential of health technology assessment and ethics for increasing our capacity to pre-empt the shortcomings and undesired consequences of modern health care while maintaining its benefits. Central is the presumption that in case of some health problems this cannot be done unless we explicitly reconsider some features of the modern health care system, especially those related to its strong reliance on scientific rationality and the strong role played by medical professionals. So as to both maintain the benefits of advanced health care and ensure that it produces less reason for concern, we need to reconsider our approach to rationality—and maybe even the way in which we build our health care system around that rationality. That is, we need to introduce an element of reflexivity. Two types of circumstances are being explored in which such reflexivity may prove worthwhile: controversies on side effects, and persistent problems encountered in optimising health care. Drawing on brief discussions of typical cases, we explore the potential of reflexive HTA and its methodical prerequisites. We conclude that ethicists may contribute to reflexive HTA, if they combine a hermeneutic—and often also participative—methodology with a solid understanding of the relation between the health problem under scrutiny and more general critique of the health care system. Insights from the areas of science and technology studies, as well as from social philosophy may be critical items in their tool kit.