Balancing Efficiency and Legitimacy: Institutional Changes and Rural Health Organization in China

The aim of this article is to contribute to the understanding of the institutional arrangements within which China's rural health facilities are embedded and of the contribution of policy to the creation of these arrangements. Information collected through field observations and in‐depth interviews with the managers, staff and patients of a township health centre indicates that with the gradual evolution of markets, encouraged by state policies, health care in rural China took on more of the characteristics of a commodity. In order to adapt to this change, the health centre and its employees are adjusting their behavioural norms and reconstructing an institutional network within which daily activities of simultaneously fulfilling public health responsibilities and pursuing economic gain are legitimized. This article focuses on the interwoven relationship between politics and markets at the micro level and examines the negotiations between stakeholders in constructing new institutional arrangements. It also describes how health sector managers are creating regulations to influence the performance of their facility. The article argues that while government policies play a crucial role in shaping the direction of development, institutional arrangements strongly influence the attempts by rural health organizations to implement them. It concludes that it is critical to take institutional factors into account in analyzing China's rural health‐care reforms.     

Mobilising patients towards transnational healthcare markets – insights into the mobilising work of medical travel facilitators in Delhi

ABSTRACT

Medical travel facilitators play an important role in mobilising patients towards transnational healthcare markets. However, little is known about the actual mobilising work of medical travel facilitators located at destination sites, such as Delhi, India. The following ethnographic study suggests conceptualising medical travel facilitators as brokers who are productive of a mobility infrastructure. This allows categorising three mobilisation strategies: direct patient mobilisation, channel partner mobilisation and patient testimonial mobilisation. These strategies draw attention to practices that build trust over distance, the power of word-of-mouth and the importance of nurturing personal relationships that translate into transnational channels that direct people to particular destinations.     

Assessing Potential Human Health Hazards and Benefits from Subtherapeutic Antibiotics in the United States: Tetracyclines as a Case Study

Many scientists, activists, regulators, and politicians have expressed urgent concern that using antibiotics in food animals selects for resistant strains of bacteria that harm human health and bring nearer a “postantibiotic era” of multidrug resistant “super‐bugs.” Proposed political solutions, such as the Preservation of Antibiotics for Medical Treatment Act (PAMTA), would ban entire classes of subtherapeutic antibiotics (STAs) now used for disease prevention and growth promotion in food animals. The proposed bans are not driven by formal quantitative risk assessment (QRA), but by a perceived need for immediate action to prevent potential catastrophe. Similar fears led to STA phase‐outs in Europe a decade ago. However, QRA and empirical data indicate that continued use of STAs in the United States has not harmed human health, and bans in Europe have not helped human health. The fears motivating PAMTA contrast with QRA estimates of vanishingly small risks. As a case study, examining specific tetracycline uses and resistance patterns suggests that there is no significant human health hazard from continued use of tetracycline in food animals. Simple hypothetical calculations suggest an unobservably small risk (between 0 and 1.75E‐11 excess lifetime risk of a tetracycline‐resistant infection), based on the long history of tetracycline use in the United States without resistance‐related treatment failures. QRAs for other STA uses in food animals also find that human health risks are vanishingly small. Whether such QRA calculations will guide risk management policy for animal antibiotics in the United States remains to be seen.     

明清江南民间信仰活动的展开与日常生活:以苏松为例

在明清时代的苏松地区,民间信仰活动的展开与多个群体密切相关,其中地方巫祝是信仰活动得以展开的核心群体,会首、衙役等群体则是信仰活动的具体组织与参与者之一,而不同阶层的女性在推动民间信仰活动方面也发挥着重要的作用.民间信仰活动的开展不仅仅关乎信仰层面,同时也是一些群体借以谋生的途径,这应该是其屡禁不绝的一个重要原因.     

The Medical Profession and the State: GPs and the GP Contract in the 1960s and the 1990s

This paper examines the two major conflicts between general practitioners and the state in the mid-1960s and again at the end of the 1980s. In the mid-1960s morale in general practice was low, but GPs emerged with a strong endorsement from government for their professional autonomy. In 1990 morale was high, but government succeeded in imposing a new contract on GPs that sought to increase their accountability. GPs have always defended their status as "independent contractors". However, the paper argues that GPs saw this status as a means of protecting their professional freedom and autonomy. When the government treated them more as independent contractors in 1990 and demanded more specific terms, GPs did not like it. Furthermore, the new GPs' contract was introduced alongside the new internal market of the NHS, which has had further implications for GPs' status as independent contractors.     

Another Way of Looking

This article presents a discussion that emerged in response to a dilemma faced by an experienced social work lecturer in planning an introductory life course lecture about people labelled as having learning disabilities. The dilemma related to whether or not to begin with a quote from a parent reflecting on her own feelings shortly after her twin children, aged six months, had been identified as having a congenital impairment. The statement, reproduced below, was made 13 years later, and involved a recollection of how the mother had felt when seeing a display of skipping ropes in a department store. A discussion ensued concerning how ways of thinking about impairment can be informed by the affirmative model of disability, a recent theoretical development within disability studies. The article takes the form of a dialogic exchange where the affirmative model is presented and examined as an alternative to the way disability has traditionally been understood in social work education. The aim is to illustrate the application of the affirmative model and to provide disabled people/social workers/families with a theoretical tool with which to look differently at impairment and disability and to challenge some traditional assumptions and practices.     

Design and development of a film-based intervention about teenage men and unintended pregnancy: Applying the Medical Research Council framework in practice

Following the UK Medical Research Council's (MRC) guidelines for the development and evaluation of complex interventions, this study aimed to design, develop and optimise an educational intervention about young men and unintended teenage pregnancy based around an interactive film. The process involved identification of the relevant evidence base, development of a theoretical understanding of the phenomenon of unintended teenage pregnancy in relation to young men, and exploratory mixed methods research. The result was an evidence-based, theory-informed, user-endorsed intervention designed to meet the much neglected pregnancy education needs of teenage men and intended to increase both boys’ and girls’ intentions to avoid an unplanned pregnancy during adolescence. In prioritising the development phase, this paper addresses a gap in the literature on the processes of research-informed intervention design. It illustrates the application of the MRC guidelines in practice while offering a critique and additional guidance to programme developers on the MRC prescribed processes of developing interventions. Key lessons learned were: (1) know and engage the target population and engage gatekeepers in addressing contextual complexities; (2) know the targeted behaviours and model a process of change; and (3) look beyond development to evaluation and implementation.     

“第三只手”：一个边贸市场的民间权威及其成长

中、越、老边境线附近的滇村“三号街”是当地人自发形成的边境贸易市场,经由传统社会生活方式所确立的民间权威,是维系“三号街”市场运行的重要力量。在传统的乡村社会,无论行政权力还是市场本身,都无法凭借一己之力建构稳固的经济体系并维持其运行,而民间权威在地方社会的经济生活中是不可或缺的。     

从传播主体的差异探寻广西凭祥市壮族山歌文化的传播与传承

广西凭祥市壮族山歌文化的传播现状和传播内容因当地政府部门、商家团体、学者文人、歌师歌手和普通民众等不同传播主体的参与,使其形成主流意识形态的传达、商业经济利益的诉求、民族文化传承的责任使命和民间日常生活及情感表达的多声部交响。主流意识形态、商业经济利益等外力的影响起到或制约或推动的作用,它们对于山歌文化的传播和传承都是表面的和浅层的,深层的动力源泉却是存在于民间、存在于壮族广大的普通民众身上。山歌文化只有深深扎根于民间,从普通民众中汲取源头活水,才能枝繁叶茂。     

成效为本教育理论对我国高等教育改革的启示倡--以英国敦提大学医学院为例

成效为本教育理论认为,教学应从学习成效出发,由此逆推整个教学过程,最终保证成效的实现。英国敦提大学医学院以该理论为基础,将教学过程分为明确社会所需、明确教育成效、确定教学大纲等十个步骤,其教学改革取得了显著成效。该校对成效为本理论的实践经验可为我国高等教育改革提供有益参考。