Social science & medicine
-
Social science & medicine · Nov 2009
Inequality in individual mortality and economic conditions earlier in life.
We analyze the effect of being born in a recession on the mortality rate later in life in conjunction with social class. We use individual data records from Dutch registers of birth, marriage, and death certificates, covering the period 1815-2000, and we merge these with historical data on macro-economic outcomes and health indicators. We estimate duration models and inequality measures. ⋯ Lower social classes suffer disproportionally from being born in recessions. This exacerbates mortality inequality. Upward mobility does not vary much with the business cycle at birth.
-
Social science & medicine · Nov 2009
Why doctors choose small towns: a developmental model of rural physician recruitment and retention.
Shortages of health care professionals have plagued rural areas of the USA for more than a century. Programs to alleviate them have met with limited success. These programs generally focus on factors that affect recruitment and retention, with the supposition that poor recruitment drives most shortages. ⋯ These results support a focus on recruitment of both rural-raised and community-oriented applicants to medical school, residency, and rural practice. Local mentorship and "place-specific education" can support the integration of new rural physicians by promoting self-actualization, community integration, sense of place, and resilience. Health policy efforts to improve the physician workforce must address these complexities in order to support the variety of physicians who choose and remain in rural practice.
-
Social science & medicine · Nov 2009
Comparative StudyThe role of health insurance in explaining immigrant versus non-immigrant disparities in access to health care: comparing the United States to Canada.
Using a cross-national comparative approach, we examined the influence of health insurance on U. S. immigrant versus non-immigrant disparities in access to primary health care. With data from the 2002/2003 Joint Canada/United States Survey of Health, we gathered evidence using three approaches: 1) we compared health care access among insured and uninsured immigrants and non-immigrants within the U. ⋯ Findings suggest health care insurance is a critical cause of differences between immigrants and non-immigrants in access to primary care, lending robust support for the expansion of health insurance coverage in the U. S. This study also highlights the usefulness of cross-national comparisons for establishing alternative counterfactuals in studies of disparities in health and health care.
-
Social science & medicine · Nov 2009
Governing childhood obesity: framing regulation of fast food advertising in the Australian print media.
Childhood obesity is widely constructed as reaching epidemic proportions with consumption of fast food viewed as a contributing factor. This paper analyses media reporting of the regulation of fast food consumption to children. A media search of five Australian newspapers for the period January 2006 to June 2008 elicited 100 articles relating to the regulation of fast food advertising to children. ⋯ The Federal Government, food and advertising industries and free to air broadcasters favour industry self-regulation and personal responsibility for fast food consumption while the proponents of government regulation include consumer groups, state government health ministers, nutrition and public health academics and medical and health foundations. The regulation of fast food advertising to children is discussed in relation to ideas about governance and the public health strategies which follow from these ideas. The paper argues that all proposed solutions are indicative of a neoliberal approach to the governance of health insofar as the responsibility for regulation of food marketing is viewed as lying with industry and the regulation of lifestyle risk is viewed as an individual responsibility.
-
Official policy-making bodies and experts in medical error have called for a shift in perspective to a blame-free culture within medicine, predicated on the basis that errors are largely attributable to systems rather than individuals. However, little is known about how the lived experience of blame in medical care relates to prospects for such a shift. In this essay we explore the benefits and costs of blame in medical culture. ⋯ Physicians articulate several important functions of blame: as a stimulus for learning and improvement; as a way to empathically allow physicians to forgive mistakes when others accept responsibility using self-blame; and as a way to achieve control over clinical outcomes. We argue that, since error is viewed as a personal failing and tends to evoke substantial self-blame, physicians do not tend to think of errors in a systems context. Given that physicians' ideology of self-blame is ingrained, accompanied by benefits, and limits a systems perspective on error, it may subvert attempts to establish a blame-free culture.