Determinants of morbidity and disability trends in the united states, 1958–77

Macrodynamic structural-equation models are presented that show how changes in annual levels of aggregate indexes of several morbidity and disability conditions for the United States over the years 1958 to 1977 affect each other and are affected by other aggregate demographic and socioeconomic changes. After reviewing the record of annual changes in these indexes based on data from the National Health Interview Survey, patterns of temporal covariation in the time series are discussed and some tentative structural-equation models are constructed to account for their behavior. Statistically, the analyses reveal considerable variation in levels of year-to-year variance explained for these indexes-from 35 percent explained for days of school loss to 97 percent for all acute conditions. Substantive findings imply that a decreasing proportion of preschool children in the population contributes to a decline in the incidence of infective and parasitic diseases, and an increasing proportion of the population at the older ages results in increases in the prevalence of chronic conditions, days of bed disability, and days of restricted activity. Further, increases in economic prosperity lead to an increase in the incidence of injuries and a decrease in the incidence of viral conditions, while higher levels of unemployment produce more injuries and restricted activity days. These inferences corroborate, for the most part, results of prior studies that have been restricted to crosssectional analyses. In addition, however, they provide a basis for making explicit quantitative projections of future levels of morbidity and disability in the American population on the basis of exogenous demographic and socioeconomic conditions.     

Commentary on “Analysis of Choice Expectations in Incomplete Scenarios”

Journal of Risk and Uncertainty -     

Welfare Reform's Impact on Homelessness

As the most dramatic shift in welfare policy occurs since its inception in 1935, it is imperative to examine potential impacts on homelessness. This paper describes changes in homelessness and welfare policy, assesses potential effects of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, and addresses public policy issues stemming from these changes. Of utmost concern are the continuing growth in female-headed families among the ranks of the homeless and a decline in affordable housing units. Welfare reform has already reduced the numbers of persons on welfare rolls, but it remains unclear as to whether the situation of low-income and homeless female-headed families will become better or worse.     

Morality Politics vs. Political Economy: The Case of School-Based Health Centers

Objective . Scholars continue to debate whether morally charged political issues constitute a distinct type of policy question or produce essentially the same political dynamic as public controversies lacking an overt moral dimension. The debate will not be resolved until scholars test the determinants of putative morality policies with predictors drawn both from morality politics theory and from the socioeconomic factors that account for the distribution of many other public policies. This study reports such a test. Methods . We analyze data from our national survey of directors of school-based health centers. We use ordinary least squares regression models to predict the level of reproductive health care services provided to adolescents. Results . Service levels were influenced not only by cultural considerations, as morality politics theory would anticipate, but also by the same socioeconomic forces that account for policy levels in other domains. Conclusions . Policy for morality issues appears different from that for nonmorality issues but less distinctive than commonly imagined.     

Looking for Their Dick Vermeil: How Prior Performance Influences the Selection Decision

When replacing an executive, an organization is faced with the choice of either promoting someone internally or hiring an outsider. Prior research in the private sector supports the contention that poor performing organizations will be adaptive and seek an outsider in hopes of initiating change that will improve performance. Do public organizations behave similarly? We address this question in the context of public education and examine the superintendent hiring decisions in 491 school districts. We find that school boards make sophisticated assessments of the district’s performance and these assessments influence their selection decisions.     

Effects of Conservative Sociopolitical Attitudes on Public Support for Drug Rehabilitation Spending

Objective . In this article we investigate why traditionally conservative social groups show less support for spending on drug rehabilitation programs than for drug control spending in general. Methods . Using data from the 1984 through 1998 General Social Surveys, we first estimate logistic regressions of support for drug control spending across five sociopolitical cleavages. We then estimate effects of three types of sociopolitical attitudes on support for drug spending within traditionally conservative groups. Results . Resistance to rehabilitation spending among conservatives is related to their opposition to the welfare state, punitive attitudes toward criminals, and among whites, racial attitudes. Conclusions . Our findings suggest that citizens may withhold support for a social policy to the extent that it evokes negative associations with other salient sociopolitical issues or attitudes. We discuss the importance of these associations for understanding the relationships among political debate, public opinion, and policy outcomes.     

The effect of the future on today's decisions

What is the effect of the future on today's decisions? The future plays a part in all of our decisions whether we utilize formal forecasting techniques or not. Some of the uncertainty of the future can be reduced by applying one or more of the techniques of trend extrapolation, subjective opinion of experts, and construction of scenarios. The results, to be useful to decision makers, must be pertinent, credible and capable of realization.