The Pervasive and Persistent Influence of Caste on Child Mortality in India

This study examines the effect of caste on child mortality and maternal health care utilization in rural India using data from the National Family Health Survey (NFHS-2) carried out during 1998–1999. Results from multilevel discrete-time hazard models indicate that, net of individual-level and community-level controls, children belonging to low castes have higher risks of death and women belonging to low castes have lower rates of antenatal and delivery care utilization than children and women belonging to upper castes. At the same time, the controls account for most of the differences within the low castes. Further analysis shows that the mortality disadvantage of low castes is more pronounced in poorer districts. These results highlight the need to target low caste members in the provision of maternal and child health services.     

农村医疗保障政策视角下的政府角色

为研究政府在农村医疗保障中的角色,厘清政府的职能和责任,分析了公共政策和农村医疗保障的制度性障碍及其深层次的问题。分析认为,当前农村医疗保障水平低的根本原因在于政府的治理失效。研究结果表明,农村社会保障制度的完善,农村医疗卫生事业的发展最终有赖于：政府明确自身的主导地位;制定符合中国国情的农村医疗卫生制度;设立农村医疗卫生事业的专项资金;推进和完善新型农村合作医疗制度。     

From Street‐level Bureaucrats to Street‐level Policy Entrepreneurs? Central Policy and Local Action in Lottery‐funded Community Cancer Care

Recent contributions to the policy implementation literature have applied Kingdon's model of ‘policy windows’ to the implementation of policy on health inequalities in the UK, and have identified the key role played by ‘policy entrepreneurs’ at local as well as national level. Despite this, the picture that emerges is of frustration of central policy intentions at the local level, alongside frustration of local aspirations by the centre. This article explores the relationship between central policy and local implementation in the context of a Lottery‐funded initiative to develop community cancer care in the UK. We examine the relationships: between the BIG Lottery Fund and central government; between BIG and the cancer care projects it funded; and between the projects and their local economy of cancer care. We found evidence of success both in vertical cascading of policy and in local policy innovation; 83 per cent of projects succeeded in obtaining continuation funding at the end of their Lottery funding. We suggest that this was due, in part, to two features of Lottery funding and accountability that combined to differentiate it from the other policy initiatives studied. They meant that projects were ‘buffered’ not just from national policy churn, but also from competing local priorities. In the ‘protected space’ that was thus formed, ‘street‐level policy entrepreneurs’ played a key role in developing cancer care innovations for adoption by mainstream funding agencies.     

从"100美元笔记本电脑计划"看数字鸿沟

假如电脑便宜到任何人都买得起,数字鸿沟就会消失吗?当今,数字鸿沟与Negroponte提出的“100美元笔记本电脑计划”产生了很多争论。在本文看来,即使拥有硬件设备或者有使用互联网的条件,消除数字鸿沟也不容易。如果旧的分化没有消除,即便更低的电脑价格也不能消除数字鸿沟,还有诸多社会文化因素需要考虑与探究。     

学生自杀与学校责任——(2002)天法民初字第1424号民事判决书之检讨

注意义务是指导致损害赔偿责任的不是过错,而是指在具体情况下被告没有尽到合理的注意义务。注意义务已成为确定损害赔偿责任的一项重要衡量标准。注意义务本质上是一种衡量结果而非行为的工具。注意义务的判断标准有:被害人和加害人之间关系的紧密性;被告对损害的发生的合理预见性;在具体案例中,为保护一方之利益,而对他方课以注意义务,还要考虑是否合理公平且符合正义要求。     

"四老一小"社会医疗保障面临的困境和出路

分析了我国现行社会医疗保障制度的现状及困境,提出了一个特殊群体:夫妻双方都是独生子女的家庭,面临的"四老一小"的医疗保健,是其他社会群体所没有的特殊困难和问题。分担这些家庭医疗保健的重担,是继续坚持计划生育基本国策的需要,是对"四老"当年积极实施计划生育政策应有的回报,是社会无可旁贷的责任。率先解决"四老一小"的医疗保障具有现实可行性。     

COMMUNITY AND CARE WORK IN A WORLD OF CHANGING IDEOLOGIES

Seymour B. Sarason, one of the founders of community psychology, has stated the need for developing barometers of community changes. The authors present a methodology for identifying societal ideologies, ideological shifts and power relations as reflected by the language of public discourse. As a case study, systematic analyses of changes in the Norwegian language over the last two decades are presented. It is demonstrated how Norwegian society has been gradually transformed from a traditional Scandinavian welfare society towards the values and ideals of neo-liberalist market ideology: for instance, language reflects and supports competitive practices increasingly being applied to public service provision. Another example is that the public discourse of individual rights has gradually been overshadowing the discourse of community duties and obligations. On the other hand, the analyses also reveal counter-ideologies, reflected, for example, in the launching of new words and expressions critical to neo-liberalist ideology.     

Participatory research meets validated outcome measures: Tensions in the co‐production of social care evaluation

Funding for care service research is increasingly subject to the satisfaction of two requirements: public involvement and adoption of validated outcome tools. This study identifies competing paradigms within these requirements and reveals significant challenges faced by researchers who seek to satisfy them. The focus here is on a study co‐produced between academic researchers and people with experience of adult social care services. It examines to what extent research studies can conduct high‐quality public involvement and genuine co‐production of knowledge, whilst attempting to produce quantifiable outcome scores. Findings add to debate around how to incorporate diverse perspectives in research, which may draw on incommensurate accounts of validity and reliability. Findings also highlight constructive attempts by academic and co‐researchers to make the combination of approaches work in the field. These small scale acts of researcher agency indicate some scope to combine the two approaches in future research studies. However, conclusions foreground the importance of broader awareness of how tensions and power imbalances related to this combination of approaches play out in social policy research practice.     

Willing but unable? Extending theory to investigate community capacity to participate in Ghana’s community-based health planning and service implementation

While primary health care programmes based on community participation are widely implemented in low- and middle- income settings, empirical evidence on whether and to what extent local people have the capacity to participate, support and drive such programmes scale up is scant in these countries. This paper assessed the level of community capacity to participate in one such programme – the Community-Based Health Planning and Service (CHPS) in Ghana. The capacity assessments were drawn from Chaskin’s (2001) theorised indicators of community capacity with modifications to include: sense of community; community members commitment; community leadership commitment; problem solving mechanisms; and access to resources. These capacity measures guided the design of an interview guide used to collect data from community informants, frontline health providers (FLP) and district health managers. Key qualitative themes were built into a questionnaire administered to households selected through systematic sampling approach. Findings showed that growing individualism, low trust in neighbours and apathetic behaviours undermined the capacity of mutual support for CHPS. The capacity to support CHPS was high for local leadership and community social mobilisation groups who often dedicated time to working with FLP to promote maternal and reproductive health service use, and in advocating broader support for CHPS. Within the wider community, commitment to voluntarism was low as members perceived CHPS to be owned by, and run on government funds and resources. Poor voluntarism was compounded by poverty that crippled the capacity to provide needed resource support for CHPS. Findings have great implications for building strong capable communities for participation in community oriented health programmes.