The Beveridge Plan: The main principles

To complete this special issue for the fiftieth anniversary of the Beveridge Plan, we felt it appropriate to reproduce an article written by the late Guy Perrin on the occasion of its fortieth. It seemed to us that his exemplary appraisal, as relevant today as it was then, amply merited republication, testifying as it does to the clearsightedness of its author. Publishing it also enables us to pay discreet homage to a colleague who will be much missed: we have no doubt, for example, that if he were still among us today he would use the Beveridge Report as a torch to illuminate for us the likely trends in social security over the next ten years. In this article, first published in 1983, Guy Perrin outlines the major principles governing the Beveridge Plan, namely those of universality, unity and what he calls integration. The many quotations and references afford an insight into the conditions under which the plan was written, enabling us to measure its impact both at the time of its publication and four decades later. It concludes by declaring that "the enduring topicality of Beveridge still exerts an impact today, in the sense that the time has come to stop following him and start imitating him". There lies a challenge which, today more than ever, is crucial for the future of social security in the world.     

Formal pooling of health risks in sub-Saharan Africa: Reflections on the obstacles encountered

Over the past few years a number of institutional solutions to the pooling of health risks have been advanced in a great number of reform proposals for developing countries. The empirical arguments in favour of such recommendations have the full force of accumulated experience in countries that have long been industrialized. However, rural realities in Africa and Asia naturally have very little to do with past or present realities in western countries. Whereas the technical-cooperation and scientific community has relatively good knowledge of techniques, a number of recent experiences of the introduction of mutual benefit schemes in Africa seem to show that this approach is now enjoying some success. The low levels of membership in particular make it essential to tackle the problem fully. This article tries to identify the various possible explanations for this lack of enthusiasm in sub-Saharan Africa.     

Attachment-based family therapy: adherence and differentiation

This study examined the fidelity of attachment-based family therapy (ABFT) for depressed adolescents. Trained observers used the therapist behavior rating scale (3rd version) to code therapist behaviors in 45 sessions of ABFT and 45 sessions each from two empirically based treatments for adolescent substance abusers: multidimensional family therapy (MDFT) and cognitive-behavioral therapy (CBT). Results indicate that ABFT therapists employed essential ABFT interventions, such as focusing on vulnerable affect, highlighting attachment-related themes, and promoting adolescent-parent reattachment through in-session enactments. In accordance with the sequential nature of the treatment, these interventions were used more extensively during the early stage of treatment, when there is a greater focus on reattachment. ABFT was perfectly discriminable from CBT, with ABFT therapists using more restructuring and reattachment interventions and CBT therapists using more signature CBT interventions, such as cognitive monitoring and homework. ABFT was also discriminable from MDFT, with ABFT therapists placing a greater emphasis on reattachment. These results suggest that ABFT is a viable and differentiated treatment. Together with prior findings supporting its efficacy, ABFT should be considered a promising new approach for working with depressed adolescents and their families.     

Treating cardiovascular disease in women

Cardiovascular disease (CVD) is the most common cause of death in women but some of the challenges of management differ from those in men. This article addresses the gender-specific issues of cardiovascular management, with emphasis on ischaemic heart disease and modification of coronary risk factors. Women with ischaemic heart disease present later than men, and are therefore older and more likely to suffer from co-morbidities such as diabetes and hypertension. Proven CVD risk factors in women can be divided into those that are modifiable and those that are non-modifiable. The former include diabetes, dyslipidaemia, hypertension, smoking, obesity, sedentary lifestyle and poor nutrition; the latter include family history of heart disease and older age at presentation. It is this difference in age and general health that explains much of the variability in response to treatment. Pharmacotherapy, percutaneous intervention, surgical revascularization, and cardiac rehabilitation and disease prevention are discussed.