Social science & medicine
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Social science & medicine · Mar 1995
An organizational analysis of the World Health Organization: narrowing the gap between promise and performance.
The World Health Organization's (WHO's) nearly half century amelioration of suffering stands as a singular achievement in international cooperation. But after 45 years, the Organization has grown into a complex bureaucracy with an outdated organizational structure. A multidisciplinary framework, which emphasizes organizational theory, yields some insights into these problems. ⋯ For more complex social and economic issues, newer, often non-medical, approaches are needed. The internal and external rules, which shape the incentives of WHO staff and leaders, need to be realigned to close the gap between WHO's myths and its day to day work. In the short run it is possible for WHO to do more with its limited budget if it changes its organizational structure; in the long run a reorganized WHO will be able to garner more funding and attract wider international participation.
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Social science & medicine · Feb 1995
Heavy users of emergency services: social construction of a policy problem.
A relatively small subgroup of emergency department (ED) patients is responsible for a disproportionate amount of ED visits and costs. This subgroup, the heavy users of ED services, is identified as a medically and socially vulnerable population. ⋯ The problem is nested within a complex of larger, interdependent problems including access to care, lack of primary/preventive services, absent or inadequate social services, and fragmented service delivery. This article uses the literature on heavy users of ED services to argue that social constructions of the problem and articulation of solutions by different key players in health care reform are based on divergent and often conflicting premises.
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Social science & medicine · Jan 1995
ReviewThe political economy of responsibility in health and illness.
This article addresses the question: to what extent do health care strategies in a given political economy increase people's perceptions of responsibility to take charge of their health, but do not structurally empower them to satisfy their health needs. In shaping health care policies, societies typically adopt one of three broad strategies, linking their larger political economy and modes of exercising power: a marketplace strategy, a state-managerial strategy or a national participatory strategy. Because of their different arrangements of structural power, these strategies result in three very different approaches to responsibility for health and illness. Changes in the political economy of health in Nicaragua during the Somoza, Sandinista and Chamorro periods illustrate the changing fields of choice within which care-seekers must make their health care decisions.
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Social science & medicine · Sep 1994
The relationship between infants' preceding appetite, illness, and growth performance and mothers' subsequent feeding practice decisions.
Data from a longitudinal study of 153 low-income Peruvian infants were used to examine (i) whether infant characteristics such as appetite, illness and past growth performance are related to subsequent changes in their feeding practices (e.g. addition of non-human milks, solid foods, weaning), and (ii) whether this relationship depends on maternal characteristics such as feeding exposure and experience (MFEE). With one exception, infants were breastfed from birth. Feeding practices during the first month of life were related to practices throughout infancy. ⋯ However, when analyzed separately, the relationships between low weight gains and subsequent feeding changes were observed for high but not low MFEE mothers. The prevalences of anorexia and infection (diarrhea, respiratory, and/or fever), and poor length gain during the previous month were not related to subsequent changes in feeding practices. These results suggest that poor growth influences feeding practices from 2 to 4 months, when exclusive breastfeeding is recommended.
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Social science & medicine · Aug 1994
An analysis of home-based oral rehydration therapy in the Kingdom of Lesotho.
Mothers in developing countries are being successfully taught to give an oral rehydration solution (ORS) at home. The quantity of oral rehydration fluid that mothers administer to their child remains a critical question. Inadequate quantities render oral rehydration therapy (ORT) ineffective. ⋯ The average dose was 65 ml/kg. Younger children got about the same volume as older children; thus, they received a higher ml/kg dose. Mothers gave more ORS to children who had more symptoms of diarrhoeal disease at the time they were brought to the clinic.(ABSTRACT TRUNCATED AT 250 WORDS)