Why does cancer cluster?

What do Florida sunbathers, midwestern farmers, rural black men, and Long Island women have in common? They all have higher-than-average risks for certain cancers. Researchers know that cancer clusters are usually caused by several factors. As cancer becomes America's leading cause of death, the public will be keenly interested in sorting out the causes and reducing the risks.     

Income expectations,rural-urban migration and employment in Africa

This article develops a theoretical framework explaining the influence of economic conditions on rural-urban migration in tropical Africa. The model explains the continued process of migration despite high levels of urban unemployment. A lengthy discussion is devoted to short-, intermediate-, and long-term policies for relieving the urban unemployment problem. It is argued that efforts must be made to reduce the differences between the expectation of urban income and real rural income. No one single policy will slow rural-to-urban migration. The author suggests policies that would eliminate factor-price distortions, restrain urban wages, redirect development toward concentrated and comprehensive programs of rural development, resettle and repatriate unemployed urban migrants, and establish capital-goods industries. The capital-goods industries would develop labor-intensive technologies for agriculture and industry. The theoretical model assumes that migrants make decisions about moving on the basis of an expected income and the expectation of an urban job. It is argued that the urban-rural income differences and the probability of securing an urban job determine the rate and extent of rural-urban migration in Africa. If the migrant has a low probability of finding regular wage employment in the short term, but expects the probability to increase over time, the migrant would make a rational decision to migrate. Policies that operate solely on urban labor demand are considered unlikely to reduce urban unemployment. This model better estimates the shadow prices of rural labor.     

Migration and its risks

"This essay applies the theories of Ulrich Beck...to the politics of migration in Germany. In particular, the essay focuses on Beck's notion of the waning influence, indeed even relevancy, of science and scientists regarding postmodern risk phenomena. The essay argues that migration to Germany can be understood as a Beckian risk phenomenon, helping to explain the decreasing influence of social scientists over the politics of migration in the Federal Republic."     

The majority legal status of women in southern Africa: implications for women and families

Women in many countries of southern Africa do not have majority status or have only recently gained this right. Majority status grants individuals adult legal status and the right to bring matters to court, own and administer property, have legal custody of children, and contract for marriage. This article summarizes the legal status of women in Botswana, Lesotho, South Africa, Swaziland, Zambia, and Zimbabwe. Lack of majority status contributes to the ongoing risk of poverty for women and makes them overly dependent on men. Compounding the situation in these countries is the presence of a dual legal system. Improving the situation of women and their families involves targeting changes in the legal system, influencing implementation of laws, educating women about their rights, and giving women needed support to seek their legal rights. The legal status of women must be viewed in the context of historical changes in the economic, educational, political, and cultural developments of society.The research for this paper was conducted during her previous faculty affiliation with the University of Michigan, School of Social Work. Her research interests include the impact of social change on women and families, rural mental health services, and health and mental health linkages. She received her Ph.D. from Rutgers University and her M.S.W. from the Columbia University School of Social Work.Her research interests are gender, work and family, culture and power, social transformations in rural and peri-urban communities, critical education, women and community politics, history of women, family and kinship issues, and community-based program development and evaluation. She received her M.S.W. from Dalhousie University, Halifax.     

Meet the mandate to measure clinical quality

The mandate for health care organizations to be accountable for quality, as well as price, is now unavoidable. The Joint Commission's ORYX project is requiring every hospital to measure clinical outcomes of a majority of its patients within the next three years. This mandate can be met best with systems of clinical outcomes measurement that provide valid, reliable risk adjustment; yield meaningful information about many different diseases and procedures; and measure more than mortality or cost--all using primarily billing data. New outcomes measurement tools with all of these capabilities are available and have already enabled quality improvement in dozens of hospitals across the U.S.     

The role of public health in population health

The role of public health is central in population health. What distinguishes public health from clinical medicine is that it's focus is on the entire population--not the individual patient. To achieve the goal of population health, healthy communities, or Healthy People 2000 requires physician leadership in medicine and public health at all levels--local, state, and national. The challenge is formidable, but the goals are attainable through strategies that focus on the goal of the common good and through collaboration of public health, medicine, and the community.     

Changes in physician and non-physician relationships

At the end of World War II, one-third of the nation's hospital administrators were physicians. During the 1950's through the mid-1980's a new breed of masters'level administrator, with well-honed coordinating skills, orchestrated a major expansion of new programs, services, and facilities. With the advent of the Medicare prospective payment system (PPS), more governing boards restructured their administrative staffs with corporate titles. Meanwhile, physicians sensed that trustees were becoming far more concerned with bottom line performance to repay a mounting debt that hospitals had incurred to remain technologically competitive. Since mergers and integrated health systems by themselves will be unable to generate significant operating efficiencies, governing boards will be forced to change direction and shift back to recruiting physicians as their CEOs or in other senior positions to assure themselves of the clinical leadership required to implement the managed care concepts of reducing utilization and cost, and simultaneously enhancing quality of patient care.     

An Exploration of the Meaning and Consequences of Workaholism

Although much has been written aboutworkaholism, rigorous research andtheoretical development on the topic is in its infancy.We integrate literature from multiple disciplines andoffer a definition of workaholic behavior. We identify three types ofworkaholic behavior patterns: compulsive-dependent,perfectionist, and achievement-oriented workaholism. Apreliminary model is proposed; it identifies potential linkages between each type of workaholismpattern and important outcomes such as performance, joband life satisfaction, and turnover. Specificpropositions for future research are articulated. Weconclude that, depending on the type of workaholicbehavior pattern, workaholism can be good or bad, andits consequences may be experienced or evaluateddifferently by individuals, organizations, and societyat large. Researchers and managers should avoidmaking judgments about the positive or negative effectsof workaholism until more carefully controlled researchhas been published.     

Trends in health insurance coverage

This Issue Brief presents data on trends in health insurance coverage between 1987-1995. In 1995, 70.7 percent of the nonelderly population had private health insurance coverage, compared with 75.9 percent in 1987. During this period, the percentage of the nonelderly population with employment-based health insurance declined from 69.2 percent to 63.8 percent, while the percentage covered by Medicaid program increased from 8.6 percent to 12.5 percent. The percentage of the nonelderly population without any form of health insurance increased from 14.8 percent in 1987 to 17.4 percent, or 40.3 million individuals, in 1995. The percentage of nonelderly Americans with employment-based coverage fell for both individuals with coverage in their own name and those with coverage as dependents. In 1995, 32.7 percent of the nonelderly population had coverage in their own name, compared with 33.8 percent in 1987. Similarly, 31.1 percent of the nonelderly population had employment-based health insurance as dependents in 1995, compared with 35.4 percent in 1987. One of the most important determinants of health insurance coverage is work status and hours of work. While employment-based health insurance received directly from worker's employer decreased between 1987 and 1995 from 66.2 percent of 63.2 percent among full-time workers, the percentage of part-time workers with employment-based health insurance coverage in their own name increased from 17.2 percent to 20.1 percent. The percentage of workers with dependent coverage fell for both full-time and part-time workers, as did the percentage of nonworkers with dependent coverage. Workers in the manufacturing industry are most likely to have employment-based health insurance; they are also the workers most likely to have experienced a decrease in employment-based coverage between 1987 and 1995. In contrast, workers employed in most of the service sectors, experienced an increase in employment-based health insurance, self-employed workers experienced a decrease, and government workers experienced a slight increase. Cost is one of the primary factors contributing to the decline in employment-based health insurance coverage. While health insurance premium cost increases have slowed during the past three years, many health care analysts are predicting an increase in health insurance premiums during the next few years. Inflationary pressure may come from health care providers, health insurers, consumers, and/or policymakers. If inflationary pressure increases health insurance premiums, we are likely to see a continued decline in employment-based health insurance and a subsequent increase in both Medicaid and uninsured populations.