Pathways between education and health: a causal modelling approach

Summary.  The association of poor education and poor health has been consistently observed in many studies and in various countries. Thus far, studies examining the mechanisms underlying this association have looked at only a limited set of potential pathways. This study simultaneously examines six distinctive pathways, which have been hypothesized to link education and health and found support from previous studies. A causal analysis of education and health was performed using structural equation models. Data were used from six phases of the National Child Development Study, which is based on following up an initial sample of 17416 children who were born in 1958. The association between education and health appears to be explained by a combination of mechanisms: adolescent health and adult health behaviours for men and women, adult social class among men and parental social class among women. We conclude that improvements in population educational attainment may not automatically lead to improvements in population health, and that health policies for improving health and reducing health inequalities need to target specific causal pathways.     

Evaluation: Stakeholder-focused Criteria

Identifying and selecting suitable criteria is an important consideration in evaluating the performance of public sector organizations. Which criteria are chosen, and how they are weighted, will depend largely on the perspective being taken; different stakeholders (for example, clients, providers or commissioners) are likely to emphasize different criteria. In this paper a number of criteria are identified and an argument is developed to indicate which criteria are likely to be valued by various stakeholders. Furthermore, a number of approaches and mechanisms for evaluation are identified and the links between these, the criteria appropriate to them and the various stakeholders are made explicit. Finally, the issue of politics and the distribution of power between the stakeholders is addressed with a call for greater explicitness in using and balancing criteria (for example, as between professionals and the intended beneficiaries of services). In this way, while recognizing the inherent political nature of performance evaluation, the planning and implementation of services may be improved by a more mutually informed approach to evaluation.     

The Ecology of Family Guidance in Low-Income Mexican-American and European-American Families*

This two-part study applied an ecocultural perspective to socialization of daily and long-term goals in low-income Mexican-American and European-American families with children in third, fifth, and seventh grades. The first part of the study examined family members' participation and parents' socialization goals and guidance strategies for their children's daily household chores and homework activities. The second part of the study examined parents' long-term aspirations and guidance strategies for their children's educational, vocational, and moral development. For daily activities, results showed that in Mexican-American families both parents and siblings played important roles, whereas in European-American families parents were the primary socialization agents. As predicted, in both groups parents' expertise influenced their guidance strategies. Finally, Mexican-American and European-American parents differed in their relative endorsement of gender, relational, and self-reliance goals for household chores. For long-term goals, parents in both groups held high educational, vocational, and moral aspirations for their children. However, some parents of seventh-graders had lower educational and vocational aspirations than those of fifth- and third-graders. Although expertise consistently influenced Mexican-American parents' guidance strategies, the pattern for European-American parents was mixed. The discussion highlights between- and within-group differences in daily and long-term socialization practices with an emphasis on resources and vulnerabilities in the families.     

Physician-nurse migration to the United States: regional and health status origins in relation to legislation and policy

This article examines the origins of physicians and nurses who were admitted as permanent immigrants to the US from 1962-1979. Data are mainly from the Immigration and Naturalization Service. Countries used in the developmental analysis are only those whose population was estimated at 1 million or more as of mid-1979, encompassing 99% of the physicians and 97% of the nurses. Life expectancy at birth is the criterion used to differentiate origin countries by developmental dimension of health status. During the study period, health workers constituted about 30% of immigrants admitted to the US; of these, nurses and physicians constituted 72-82% throughout the study period. The period 1962-1979 has 4 distinct phases, marked by important legislative and/or policy changes; 1) 1962-1965, when the McCarran-Walter Act prevailed; 2) ending in 1968, the 2nd phase covers the transition mandated under the 1965 Immigration Act, which encouraged physician immigration; 3) the 3rd phase, 1969-1976, covers the transition to the 1976 Immigration and Nationality Act amendments; and 4) the 4th stage is 1977-1979. Results show that 1) under the McCarran-Walter Act, North America became the dominant physician source; 2) from 1966-1968, Asia attained dominance as the physician source and became even more predominant after 1968; 3) North America produced relatively few physicians in the early 1970s; 4) Europe produced substantially fewer physicians in the 1970s than in the 1960s; 5) South America, Africa, and Oceania were the lowest contributors of physicians; 6) during the McCarran-Walter years, North America and Europe produced almost 90% of nurses admitted into the US; 7) the 1965 Immigration Act and its aftermath resulted in Asia becoming the dominant source of nurses; 8) prior to the 1965 Immigration Act, Canada generated 20% of the aggregate number of physicians; 9) the Philippines surpassed Canada during the transition and India led after the transition; and 10) Canada supplied 30% of the nurses up through the transition, with the Philippines in the lead 1969-1979. Low health status countries were a relatively minor nurse source. Health status at the origin was a far less significant determinant of physician immigration than that of nurses. English language high and low health status country groups produced substantially more physician and nurse immigrants that their corresponding non-English language counterparts. The US attracted more physicians and nurses from less developed countries than more developed countries after 1968.     

Family reunification

The author explores the problem of family reunification in the context of international migration. The focus is on international and national legislation, policies, and provisions concerning family reunification. The need for international cooperation to resolve the problems arising from international migration and the desire to reunite families is noted. (SUMMARY IN FRE AND SPA)     

Therapeutic compliments: setting the stage for successful therapy

Compliments are often viewed primarily as a linear event in which one person expresses approval or admiration of another. Far less attention has been given to the circular nature of compliments and the manner in which they enhance the positions of both the giver and the receiver of the compliment. Therapeutic compliments have proven to be highly effective means of motivating clients, while at the same time increasing therapeutic leverage. This article proposes that compliments should be purposefully given, and that the type of compliment should vary with the stage of therapy and the intended response of the client to the compliment.     

The prediction of learning in family therapy training programs*

Research on family therapy training has produced very little data regarding the kinds of trainees that do best in family therapy training programs. This study attempts to provide some rough and preliminary data on that issue. One hundred and seventy trainees, drawn from seven different structural!strategic training experiences, were evaluated as to how much they learned by taking the Family Therapy Assessment Exercise pre- and posttraining. Their performance was correlated using a hierarchical regression analysis with a number of trainee variables such as amount of conjugal family experience, amount of experience doing family or individual therapy, or prior knowledge of family therapy. The results indicate that, as predicted, conjugal family experience was positively related, and prior knowledge was negatively related to performance. Prior experience doing individual therapy was also positively related to performance.     

Migration and development: myths and reality

Recent research on the impact of labor migration on the socioeconomic development of developing countries has provided opportunity to try and resolve some of the long-standing polemics that have pervaded the literature on migration and development. This article focuses on findings concerning the labor, remittance, and social impacts of emigration on countries that have participated in labor emigration. While a great deal more research needs to be done, recent findings confirm that in some situations the sort-term impacts of labor migration on sending countries have been considerable.     

The right to life

In this issue is a lengthy, thought-provoking essay on the issues raised by unwanted pregnancy. Written by Robert Wennberg in 1984 for the Christian Scholar's Review (13:4), the article has been edited and condensed for our purposes and is quite relevant, I believe, for the student health population. Any practitioner who cares for students wrestling with these issues should at least acknowledge the moral and philosophical dilemmas presented. As one who has walked both sides of the argument, I find Wennberg's fair-mindedness compelling. In closing his article, the author raises the question of what will happen when it becomes possible to accomplish an "abortion"--or removal of the fetus from the mother--without killing the fetus. Will this procedure be acceptable to the average single college student? The New York Times, in an article on "High Tech Babies" (February 21, 1986), raised ethical questions posed by the technology of frozen embryos. Who decides what is to be done with frozen embryos? To whom do they belong? Do they have rights? The theoretical issues raised by Wennberg are already forcing themselves upon us. Whether we like it or not, the future is now. Regardless of your beliefs on this controversial topic, I urge you to read this article. Dr. Wennberg has also just completed a book on this subject, Life In The Balance.