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.     

Physician perceptions of medical malpractice and defensive medicine

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.     

The impact of P.L. 93-641, the National Health Planning and Resources Development Act, upon health and mental health programming

Federal legislation regarding health care in the U.S. has increased rapidly in the past few years. A major law with potential far-reaching effects was enacted as a result of increasing legislation and rising health care costs. This law,The National Health Planning and Resources Development Act,has created a network of over 200 local, mostly nongovernment units, called health systems agencies. These agencies are responsible for areawide health planning, plan implementation, review and approval of federal health care expenditures for local programs, and facilities review. They will affect health and mental health programs at the local level. The article is directed to local health and mental health care providers who will, of necessity, deal directly with the local HSA's.     

Mental health program evaluation: Where you start?

Seduced by the elegance, sophistication and jargon characteristic of new developments in applied research, practicing evaluators are in danger of becoming distracted from achievement of their evaluative goal: that of providing timely, reliable and useful data to program management to facilitate rational data-based decision-making. To avoid such seduction, the author advocates adaptation of simple, inexpensive and efficient evaluative methods tailored to organizational needs and presentation of findings in language readily understood by constituent groups. Likewise, insistance by evaluators upon maintenance of a strict role boundary — that is, limiting role functioning exclusively to those tasks considered evaluation — may be dysfunctional. Rather than detract from accomplishment of his goals, the author maintains that such participation allows development of skills, insights and staff relationships which enhance the evaluator's effective functioning within the organizational context and contribute to organizational acceptance and use of his evaluative results.     

The validity of indices for rural health manpower needs assessment

Population-to-practitioner ratios have long been the primary index in the designation of health manpower shortage areas. This paper documents that application of the widely used population-to-dentist index results in understatement of the need for dental health manpower in rural areas. Through the analysis of utilization data collected from a statewide health screening program in Colorado, the practice of sole reliance on the population-to-dentist indices as an indicator of need was tested. Another measure, the area-(square miles) to-dentist ratio was formulated, examined, and found to be a more useful referent of the need for additional health manpower in rural areas. Utilization of dental services in sparsely settled rural counties of Colorado was unrelated to population-to-dentist ratios. A strong, statistically significant association of utilization with land area-to-dentist ratios was found. The findings of this analysis suggest a need for reevaluation of needs assessment methodologies used in the designation of health manpower shortage areas. Indices more sensitive to consumer circumstance than to the number of health care providers available must be considered.     

On the limiting properties of social indicators

Characteristics of the population and economic measures that constitute traditional social indicators are compared with more recent “quality of life” measures to demonstrate that social indicators are always value statements at the policy level. The possibility of alternative perspectives is illustrated. It is suggested that an awareness of the assumptions implicit in any given indicator is as important as the data they provide.     

美国主流媒体对“一带一路”报道的话语建构研究

共建“一带一路”倡议如今已经走过十余年历程,取得了突出成就,为共建国家发展赢得新的机遇。随着美国对“一带一路”的关注度持续上升,分析美国主流媒体对“一带一路”的相关报道可以反映美国对该倡议的态度,便于中国做出有效应对措施。研究运用语料库文本挖掘方法,选取美国两大主流媒体《纽约时报》《华盛顿邮报》中涉及“一带一路”的报道文本,从主题分布、主体建构、搭配词和索引行等维度考察美国主流媒体对该倡议的话语建构方式。研究发现,十年间美国两大媒体对“一带一路”的报道包括“一带一路”建设内容和中国影响力等多个主题。根据时间变化,报道主题存在三个阶段的差异:初期突出中国与亚洲国家的合作,中期重点报道中国的世界影响力,近期涉及新冷战等主题。两大媒体通过勾勒基础设施建设与投资、大国关系和中美贸易等内容建构“中国”和“一带一路”形象,对该倡议的认知从早期的中性态度转向中近期的消极态度。基于此,一方面适时开展舆论反击工作是应对美国舆论的关键,向美国媒体传递高质量“一带一路”信息以回击不实言论;另一方面事实胜于雄辩,继续坚持共建“一带一路”是长期发展之要义,展现大国的胸怀与担当,吸纳更多国家参与“一带一路”,推动共建国家合作共赢,促进文明交流互鉴。     

论运动和营养

不良的饮食习惯和缺乏活动的现代化生活方式 ,引起了各种疾病和特殊病的发生。诸如 ,肥胖症、慢性腰部劳损、高血压、腹部肌肉衰弱和容易罹患的心血管疾病。本文概要地论述关于人体健康的两个方面———运动和营养。     

Cohort Succession in the US Housing Market: New Houses, the Baby Boom, and Income Stratification

Federal housing policy in the US across the postwar period supported the construction of new houses more than public provision or renovation of older structures as a means of ensuring a sufficient supply of quality dwellings. Understanding trends in new housing in particular is thus crucial to understanding the housing regime. Following Myers (Housing demography: Linking demographic structure and housing markets. University of Wisconsin Press, 1990; Housing Studies, 14, 473–490,1999), this paper conceptualizes historical change in the housing stock within a demographic framework as the movement of cohorts of households through cohorts of housing stock. Recent evidence suggests that a new cohort of houses arose in the 1980s and 1990s (larger with more amenities than past vintages), and that buyers of those new houses were increasingly affluent. In this paper, I link the succession to a new cohort of houses to household cohort succession and examine the increasing affluence of new house buyers by age and cohort, focusing especially on the entry of the Baby Boom generation exactly when the new cohort of houses arrived. I use US Census microdata for 1960–2000 to develop a cohort longitudinal dataset, and analyze historical change in stratification in new house ownership. I find significant shifts between cohorts in income inequality among new house buyers, with implications for the capacity of the housing regime to meet the future needs of an increasingly diverse population.