Managing Risk as a Duality of Harm and Benefit: A Study of Organizational Risk Objects in the Global Insurance Industry

This study examines how organizations construct and manage risk objects as a duality of harm–benefit within their normal operations. It moves beyond the existing focus on accidents, disasters and crisis. We study the risk‐transfer processes of 35 insurers where they navigate the tension of retaining risk in their insurance portfolio to increase the benefit of making profit and transferring risk to reinsurance to reduce the harm of paying claims. We show that organizations’ constructions of risk are underpinned by everyday risk management practices of centralizing, calculating and diversifying. Through variation in these practices, not all organizations seek balance and we in turn uncover the sensemaking processes of abstracting and localizing that enable organizations to prioritize harm or benefit. This contributes to the risk literature by illuminating the co‐constitutive relationship between risk sensemaking processes and everyday risk management practices. Following the complex linkages involved in the construction of risk objects as sources of harm–benefit, our analysis also contributes to the literature on dualities. It shows that while immediate trade‐offs between harm–benefit occur, prioritizing one element of the duality is ultimately a means for attaining the other. Thus, while initial imbalance is evident, prioritization can be an enabling approach to navigating duality.     

Absent bodies and present memories: marking out the everyday and the future in Eastern Sri Lanka

Drawing from ethnographic work carried out between 2005 and 2007, this article considers the ways in which a women’s network has developed strategies to find meaning around the absences of loved ones, killed or ‘disappeared’ during the decades of conflict in Sri Lanka. For most of these women, the fate of their husbands, brothers, sons and fathers is not known and the lack of answers means that they are unable to fully grieve and find closure. In order to survive, they must find ways to deal with the absent bodies and present memories of those who may never be located and accounted for. These strategies include tree-planting ceremonies carried out as a way of not only remembering and mourning loved ones but also asking questions about how one makes sense of loss and what it means to carry the burden of unanswered absences through everyday life and into the future.     

Statistics for weighing benefits and harms in a proposed genetic substudy of a randomized cancer prevention trial

Summary.  When evaluating potential interventions for cancer prevention, it is necessary to compare benefits and harms. With new study designs, new statistical approaches may be needed to facilitate this comparison. A case in point arose in a proposed genetic substudy of a randomized trial of tamoxifen versus placebo in asymptomatic women who were at high risk for breast cancer. Although the randomized trial showed that tamoxifen substantially reduced the risk of breast cancer, the harms from tamoxifen were serious and some were life threaten-ing. In hopes of finding a subset of women with inherited risk genes who derive greater bene-fits from tamoxifen, we proposed a nested case–control study to test some trial subjects for various genes and new statistical methods to extrapolate benefits and harms to the general population. An important design question is whether or not the study should target common low penetrance genes. Our calculations show that useful results are only likely with rare high penetrance genes.     

Factors Affecting Children’s Adjustment to the Death of a Parent: The Social Work Professional’s Viewpoint

This study investigated factors affecting the adjustment of parentally bereaved children by reviewing existing literature and comparing it to observations made by professional social workers. Interviewees had between 1 1/2 and 22 years of experience in counseling bereaved children. The specific factors examined were age and sex of the bereaved child, circumstances of the death, and adjustment of remaining caregiver. Participants (n = 5) responded to an interview instrument specifically designed for this study which contained seven in-depth, open-ended questions. Participants’ replies were mostly in accordance with the literature, but also generated some new perspectives that had not been previously considered for this study and had not appeared in the literature. This study has implications for practice with parentally bereaved children and their surviving caregivers.Rebecca M. Hope, LCSW, Outpatient Clinician, New River Valley Community Services, 700 University City Boulevard, Blacksburg, VA 24060.Diane M. Hodge, Ph.D. is an Associate Professor of Social Work, Radford University, P.O. Box 6958, Radford, VA 24141; e-mail: dmhodge@radford.eduAddress correspondence to Rebecca M. Hope, LCSW, Outpatient Clinician, New River Valley Community Services, 700 University City Boulevard, Blacksburg, VA 24060; e-mail: rmhope@verizon.net     

The ascendancy of primary care: permanent or temporary?

The conventional wisdom strongly suggests a health care provider food chain for the future: Primary care physicians (PCPs), principally family practitioners, on the top playing the lead role, distantly followed by specialists, with hospitals and other ancillary services even further down the line. Is this a reasonable expectation? Will PCPs dominate the new systems? Or will they be but one of many equally necessary components of these developing integrated health care delivery organizations? Looking at the various models now developing, it would seem that future integrated delivery systems will utilize both PCPs and specialists, but with strong augmentation from a diverse assortment of other health care professionals, including nonphysician providers, educators, and administrators. To separate the illusion of primary care dominance of the coming health care system from the likely reality, we should first determine what is driving the apparent present demand for primary care physicians. Next, we will examine the possible and probable reactions to that demand from an economic standpoint and from the points of view of both health care professionals and the public. Finally, we must try to picture how health care provider organizations of the future are likely to look and how they will integrate their health care professionals.     

Why social status matters for understanding the interrelationships between testosterone,economic risk‐taking,and gender

We conduct an extensive review of the literature on testosterone and economic risk‐taking behavior. In sum, there is evidence of a positive association between testosterone and economic risk taking, although it is unlikely to be a strong association given the abundance of null results. However, we argue that the existing literature may overstate the causal effects of testosterone on economic risk taking (or even report a spurious correlation) because this research has not considered the potentially confounding role of social status. Status could concurrently influence both testosterone and economic risk taking, given that testosterone is a social hormone with a reciprocal relationship with social status, and social status has been found to drive risk‐taking behavior. We also argue against using findings from this literature to make gender essentialist claims, primarily because social phenomena influence the size—and existence—of gender differences in economic risk‐taking behavior. We conclude with suggestions for future research.     

Substance use disorders and referral to treatment in substantiated cases of child maltreatment

Parents with substance use disorders (SUD) require treatment and support in order to provide children with appropriate care and protection. Using the 2012 National Child Abuse and Neglect Data System (NCANDS), this paper analysed 464 313 substantiated child maltreatment reports to determine (i) the proportion and characteristics of reports involving substance abuse; and (ii) the child and caregiver/perpetrator (C/P) characteristics that predicted referral to treatment as recorded in service plans. Findings indicate that 12% (N = 53 234) of maltreatment reports involved C/P SUD. Yet, of those reports, only (19%) (N = 10 088) were referred to substance abuse treatment as part of their service plan, indicating a large gap between those who need treatment and those who receive it. This finding is important given that parental SUD is consistently linked to poorer child outcomes. Amongst other variables, reports indicate that C/P with co‐occurring emotional disturbance were three times more likely to be referred to treatment for SUD as part of service plans. Additional research is needed regarding the characteristics that distinguish C/P who receive referrals for SUD treatment in substantiated cases of child maltreatment.     

Funding Strategies for Population Researchers: Perspectives from the National Institutes of Health

The purpose of this article is to briefly describe the application and funding process at the National Institutes of Health (NIH). We target our discussion to demographic and population science at the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), but the general strategies are applicable to social and behavioral scientists for all NIH funding opportunities.