The impact of ideology on regulation: The case of board and care homes

Debates about regulatory efforts to monitor the delivery of health and long-term care have become commonplace in health policy. Efforts to examine the key assumptions underlying the current regulatory strategies have been limited, however. Using the board and care industry as an example, this article examines how ideology influences the regulatory strategy developed. Three ideological perspectives-a free-market approach, a market correction strategy, and a critical policy framework-are reviewed in the context of efforts to regulate board and care homes in the United States. Differences in approaches to regulating board and care are presented for each of the major perspectives.     

RURAL POVERTY, URBAN POVERTY, AND PSYCHOLOGICAL WELL-BEING

Data from the National Survey of Families and Households are used to compare the psychological well-being of the rural and urban poor. Overall, the urban poor are higher in perceived health than the rural poor, although no differences are apparent in happiness or depression. Significant interactions are present between rural/urban poverty and sex, race, and family status. The psychological well-being of poor African Americans is higher in rural than urban areas, whereas the well-being of poor whites is higher in urban than rural areas. This trend is especially pronounced for depression among males. In addition, single men without children have especially high depression scores in rural areas, whereas married women without children have especially low depression scores in urban areas. The results are interpreted in terms of the environmental quality of inner-city neighborhoods and attitudes toward poverty in urban and rural communities.     

Rural/Urban Residence,Migration, HIV/AIDS,and Safe Sex Practices among Men in Zimbabwe*

Abstract The AIDS epidemic was initially thought to be primarily an urban phenomenon. However, migration between rural and urban areas has resulted in the spread of the virus to all segments of the population. Prevention efforts continue to focus on the ABCs of AIDS, namely, abstinence among young adults, being faithful within a monogamous relationship, and/or using condoms at each sexual encounter. We examine the effects of residence, migration status, and selected social and demographic variables on the use of these three practices among men in Zimbabwe, a nation experiencing one of the highest HIV/AIDS prevalence rates in the world. Both residence and migration status were found to be significantly related to safe sex practices. Knowledge of a source with easy access to condoms was the strongest predictor of this behavior. Knowledge of prevention methods and experience with persons with AIDS also exerted significant effects, although not always in the manner hypothesized. Possible reasons for the findings and implications for policy are discussed.     

Immigrants' Language Skills and Visa Category1

This article is concerned with the determinants of English language proficiency among immigrants in a longitudinal survey for Australia. It focuses on both visa category and variables derived from an economic model of the determinants of destination‐language proficiency among immigrants. Skills‐tested and economic immigrants have the greatest proficiency shortly after immigration, followed by family‐based visa recipients, with refugees having the lowest proficiency. Other variables the same, these differences disappear by 3.5 years after immigration for speaking skills; and although they diminish, they persist longer for reading and writing skills. The variables generated from the model of destination‐language proficiency (such as schooling and age at migration) are, in part, predictions of visa category, but they are more important statistically for explaining proficiency.     

Intuitive Toxicology: Expert and Lay Judgments of Chemical Risks

Human beings have always been intuitive toxicologists, relying on their senses of sight, taste, and smell to detect harmful or unsafe food, water, and air. As we have come to recognize that our senses are not adequate to assess the dangers inherent in exposure to a chemical substance, we have created the sciences of toxicology and risk assessment to perform this function. Yet despite this great effort to overcome the limitations of intuitive toxicology, it has become evident that even our best scientific methods still depend heavily on extrapolations and judgments in order to infer human health risks from animal data. Many observers have acknowledged the inherent subjectivity in the assessment of chemical risks and have indicated a need to examine the subjective or intuitive elements of expert and lay risk judgments. We have begun such an examination by surveying members of the Society of Toxicology and the lay public about basic toxicological concepts, assumptions, and interpretations. Our results demonstrate large differences between toxicologists and laypeople, as well as differences between toxicologists working in industry, academia, and government. In addition, we find that toxicologists are sharply divided in their opinions about the ability to predict a chemical's effect on human health on the basis of animal studies. We argue that these results place the problems of risk communication in a new light. Although the survey identifies misconceptions that experts should clarify for the public, it also suggests that controversies over chemical risks may be fueled as much by limitations of the science of risk assessment and disagreements among experts as by public misconceptions.     

Russki adventures

This case study, by Paul Beamish, was a prize-winner in the EFMD 1992 Annual Case Writing Competition, in the section entitled, ‘Entrepreneurship’. It concerns a daring new business venture in the Russian Caucasus Mountains.In mid-1991, Guy Crevasse and Andrei Kakov, the two major partners in Russki Adventures contemplated their next move. They had spent the last year and a half exploring the possibility of starting a helipcopter skiing operation in Russia.Their plan was to bring clients from Europe, North America, and Japan to the Caucasus Mountains to ski the vast areas of secluded mountain terrain made accessible by the use of helicopters and the recent business opportunities offered by ‘glasnost’.Three options for proceeding were being considered. The first was to proceed with the venture on their own, in the Caucasus Mountains area that had been made available to them by a Soviet government agency. The second was to accept the offer of partnership with Extreme Dreams, a French tour operator that had begun operations in the Caucasus region during the 1991 season. The final option was to wait, save their money and not proceed with the venture at this time.The data presented in the case includes information on: the company founders the helicopter skiing industry the Russian environment proposed market positioning of the business the potential alliance partners forecast financial analysis, under several scenarios.     

International Humanitarian Law and Combat Casualties

The purpose of the article is to provide an overview of the law regulating combat in order to assist in determining whether casualties inflicted in combat should be classified as victims of war or victims of war crimes. The boundaries and the content of International Humanitarian Law are indicated. A brief statement of the law regulating combat is given. The concepts of military objective and of proportionality are analyzed. The scope of an unlawful attack is addressed as is the relationship between unlawful attack offences and other offences in International Humanitarian Law. The article concludes with a discussion of when combat casualties are war crimes victims.     

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.