Setting health priorities: a review of concepts and approaches

The setting of health priorities is primarily concerned with the equitable distribution of resources and is now more than ever an important part of strategic planning within the National Health Service (NHS). The basic information which can be used to assist in such decision-making and the process by which different agencies become involved are important aspects of priority-setting; this article is based on a major review of the research literature on these aspects and provides a discussion and an analysis of experience within health and other fields. From this material a number of possible approaches to priority-setting are identified and discussed. The article concludes that, before it can be decided how priorities should be set in the future, outstanding questions about how far rational approaches are feasible, about who is to be involved and what role they should play, and about how far such decisions are to be taken nationally or locally will need further consideration.     

Planning for productivity

In the 1980s the subject of productivity will receive increasing attention as the old macro economic policies are replaced by micro economic policies. Everyone in various ways will discover the changes which will be involved in learning the real economic facts of life. The need to improve productivity and business performance is urgent and yet it is an area which is being neglected by management.     

Trends in marriage and divorce in Peninsular Malaysia

Summary Median age at marriage for women has risen sharply for each of the three major ethnic groups - Malays, Chinese and Indians, in Peninsular Malaysia since 1957. The sharpest rise has been recorded for Malays and Indians, whose median age at marriage was barely over 17 in 1957. A shortage of potential husbands in the traditionally sanctioned ages contributed to the rise for Malays and Indians, but was probably not the paramount reason; average age differences between the spouses narrowed, but median age at marriage for men actually rose. During the same period, the previously extremely high divorce rates amongst Malays have fallen sharply, though wide inter-state differences remain. The sharp changes in marriage patterns reflect, and in turn are partly responsible for, far-reaching social and economic changes. They have profoundly affected fertility levels and patterns, as well as intra-familial relationships.     

Effects of Questionnaire Length on Response Quality

A response tendency resulting from the length of a group-administeredquestionnaire instrument is described. Respondents answeringitems that are included in large sets toward the later partsof a long questionnaire are more likely to give identical answersto most or all of the items, compared with those respondingto items in smaller sets or in shorter questionnaires. Whilemeans and intercorrelations among items within the same setare affected by this "straight-line" response pattern, intercorrelationsbetween items from different sets are much less affected byit. These investigations are based on comparisons between along questionnaire, administered to 1,050 high school seniorsin nine high schools across the nation in 1978, and five shorterquestionnaires administered to large national samples of highschool seniors.     

Regression of area mortality rates on explanatory variables: what weighting is appropriate?

"One can often gain insight into the aetiology of a disease by relating mortality rates in different areas to explanatory variables. Multiple regression techniques are usually employed, but unweighted least squares may be inappropriate if the areas vary in population size. Also, a fully weighted regression, with weights inversely proportional to binomial sampling variances, is usually too extreme. This paper proposes an intermediate solution via maximum likelihood which takes account of three sources of variation in death rates: sampling error, explanatory variables and unexplained differences between areas. The method is also adapted for logit (death rates), standardized mortality ratios (SMRs) and log (SMRs). Two [United Kingdom] examples are presented."