Socioeconomic, medical care, and public health contexts affecting infant mortality: a study of community-level differentials in Peru

Socioeconomic, medical care, and public health contexts are examined in Peruvian communities for their relationship to infant mortality. A deviant case analysis is used to uncover characteristics important in the social structure of Peruvian communities. Results from fieldwork in two "deviant" communities suggest that economic diversity, income disparity, social class fluidity, and women's autonomy, along with refined measures of medical care and public health resources, are important in understanding differentials in mortality. Attention is drawn to the community context and to the interplay of socioeconomic determinants affecting infant mortality.     

Remittances from labor migration: evaluations,performance and implications

2 evaluative views of worker remittances draw opposite conclusions. The negative one posits that remittances increase dependency, contribute to economic and political stability and development distortion, and lead to economic decline that overshadows a temporary advantage for a fortunate few. The positive view sees remittances as an effective response to market forces, providing a transition to an otherwise unsustainable development. They improve income distribution and quality of life beyond what other available development resources could deliver. The implications are tested for labor supply countries to Europe and the Middle East. The implications of the negative are not supported. Although the dire predictions of the pessimistic view have not materialized, the converse - contributions of remittances to economic performance - should not be overstated due to a lack of data.     

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.     

Immigration and the earnings of youth in the U.S.

"This article reports findings that have emerged from an effort made at statistically measuring the effects of immigration on the earnings of U.S.-born youth. The presence of immigrants arriving before 1965 has a positive impact on youth earnings. Recently arrived immigrants impact negatively, however. These results are consistent with recent findings that the skill level of immigrants arriving within the last two decades is lower relative to that of immigrants arriving earlier. The results also show that the negative effects diminish as the youth ages, reflecting skill acquisition and job mobility of the young worker into jobs less vulnerable to competition from immigrant workers."     

The technique of participatory research in community development

The technique of participatory research in community development is based on the involvement of the beneficiaries of the research in the entire research process, including the formulation of the research design, the collection of data, interpretation of information collected, and the analysis of findings. Thus, research teams utilizing this approach are composed of villagers, farmers, unemployed people, local leaders, and educators. The research process thus offers an educational experience that helps to identify community needs and motivate community members to become committed to the solution of their own problems. Moreover, this approach challenges the prevalent notion that only professional researchers can generate knowledge for meaningful social reform. A participatory research technique, based on the concept of citizen enlightenment for community development, was adopted by the Department of Adult Education at the University of Ibadan in a study of rural poverty in Oyo State's Apasan villages. The research team, comprised of local leaders, peasant farmers, teachers, local students, and university students, identified the villages' isolation and food scarcity as major causes of poverty. 2 actions were taken in response to these findings: 1) the construction of a road linking the Apasan communities with the State capital, enabling villagers to travel to the town, sell their goods, and purchase needed items; and 2) formation of a primary cooperative society for multipurpose farming. These actions have solved the food problem, improved the villagers' earning capacity, and resulted in the return of numerous villagers who had migrated to towns to find wage employment. Because the villagers were directly involved in the study of their problems, they were able to become more aware of their social reality and make the changes needed to lift them out of poverty.     

The developmental implications of migration from and between small island nations

This article discusses the role of migration in relieving population pressures, thus making continuing development possible, using small nations in the Caribbean and the South Pacific as examples. The Caribbean islands and many Pacific islands have used out-migration to ease population pressures in this century. Surplus labor has been emerging in various Caribbean nations, independent of the international marketing problems of plantation agriculture. Rural populations alienated from plantations have had to make do on questionable and/or remote land. Population surpluses appear to originate in rural areas, but little evidence exists to suggest that those surpluses are the basis for the emigration patterns of the Caribbean islands. Emigration does not solve population problems because when ambitious, skilled workers leave their country, their actions have little to do with the existence of domestic surplus labor and their leaving may do little to facilitate domestic labor absorption. Thus, if mini-states wish to sustain their hopes of economic expansion, they must find the means to employ their surplus labor. Since mainly skilled migrants leave, their going may actually slow development and retard opportunities for labor absorption. Population movements internal to the Caribbean region may further complicate surplus labor and/or population problems. If protective entry requirements impede normal inter-island relations, they may interfere with developmental processes. In general, migration is not a feasible strategy for population control for small island nations. While temporary migration has a more positive impact than other forms of migration, problems do exist. For example, temporary migration 1) can impose significant economic costs on the source-country, and 2) may result in the source country being unable to capitalize on its initial investment in training and education of temporary migrants. In conclusion, import substitution through cooperation between small island nations, production for export where feasible, and more attention to more sophisticated international service linkages hold a better prospect for material progress than relying on the export of surplus populations.     

Compulsive gambling and the medical model

The medical model as a conceptual and operative approach to compulsive gambling is discussed. The terms medical model and disease are defined and the practical implications of their application to compulsive gambling are explored. Special attention is given to the addictive disease concept. Finally, a variety of objections to the medical model are described, but it is concluded that the many individual and social advantages of the medical model make it the preferred conceptualization at our present state of knowledge.     

Evidence for a common dissociative-like reaction among addicts

A questionnaire was designed to test selected aspects of the author's General Theory of Addictions (Jacobs, 1982). Data were collected from groups of compulsive gamblers, alcoholics, and compulsive overeaters, and compared with the responses to the same questionnaire obtained from normative samples of adolescents and adults. The more inclusive term, compulsive gambler, has been used throughout, since the sample of gamblers in this study included an inpatient subgroup who had been diagnosed as pathological gamblers, as well as a subgroup of Gamblers Anonymous members who had not been clinically evaluated. Findings support the author's theoretical position that, when indulging, different kinds of addicts will tend to share a common set of dissociativelike experiences that differentiate them from nonaddicts. This has been termed a state of altered identity.     

Elective single mothers and their children: The missing fathers

Elective single mothers are adult, unmarried women who intentionally become mothers. This study utilized longitudinal data about 17 Caucasian, elective single mothers and their children to identify fathers' roles in these families, and to understand children's views of their fathers. These single mothers and their children resided for the first six years of the children's lives in father-absent households. By age six, most of the children had ghost fathers, whom they had never met or knew little about. The data suggest that the father often becomes a family secret, and that children may blame themselves for their fathers' absence.     

Demography and ageing -- a truism highlighted

Since the aging of populations, with its extensive consequences, requires ample planning, demography is the soothsayer of gerontology. The realization that aging is the main demographic event of this century has generated an interdependence among demography, gerontology, and geriatrics, and created a base from which to extrapolate socio-political consequences from population changes. Demography transforms the personal unidimensional experience of aging to a dynamic one which traverses time and geography. Chronological age is not an exclusive criterion; this presents an opportunity to explore avenues grounded in the realms of economics, politics, policy, and culture. The inclusion of demography in international training courses of the International Institute on Aging (United Nations-Malta) has made possible an easier progression toward discussing policy, planning, funding, and social services within a broader context. The dependency of aging upon demography established the collaborative development between the Committee for International Cooperation in National Research in Demography (CICRED) and INIA and the joint hosting of a synthesis meeting on Population Ageing Research Project. In this collection of papers, Don Rowland creates the concept of the Gerontological Transition which interprets aging as a process of cohort flow; Raul Hernandez, through an evaluation of regional data, provides a classic analysis of changing age ratios within the population as a whole; Anthony Warnes, through use of mortality rates, provides a demographic analysis to expose the age-dependent variability in health and welfare payments; Paul Paillat transposes demographic numbers into social consequences; Miroslav Macura focuses on the youth in these population shifts; and the emerging elderly in the never ending cycle of events are viewed. Planning beyond the individual lifetime will become a necessity for mankind.