The social organization of health care in China

Hillier, S.M., and J.A. Jewell. Health Care and Traditional Medicine in China 1800–1982. London: Routledge and Kegan Paul, 1983. xix + 453 pp. including plates, chapter references, appendix, and indices. $50.00 cloth.

Henderson, Gail E., and Myron S. Cohen. The Chinese Hospital: A Socialist Work Unit. New Haven: Yale University Press, 1984. xvi + 183 pp. including photographs, appendices, references, and index. $22.50 cloth.     

The geographies of crisis: exploring accessibility to health care in Canada

There is increasing concern in Canada that the health care system is in a state of crisis. It is argued that reductions in federal government transfers to the provinces have resulted in a health care system characterized by under‐funding in key areas and policy decisions based more on provincial fiscal concerns than the health needs of their constituents. Provincial governments have responded to reduced levels in federal funding by undertaking aggressive restructuring tactics such as the closure of hospitals and the deinsuring of medical services from provincial health plans. The end result of this restructuring, as argued by the media, consumer groups and indeed some health researchers, is a state of crisis' (i.e., lower levels of accessibility, long waiting lists, overcrowding in hospitals and increasing costs of medication). One crisis theme often mentioned is that fiscal decisions of various kinds are reducing economic and geographic accessibility, one of the five principles of the Canada Health Act (CHA) that defines the very essence of the Canadian health care system. Using data from the 1998‐99 National Population Health Survey (NPHS), this paper explores the extent to which an accessibility crisis exists within the Canadian health care system by examining access to health care services and the barriers encountered in trying to access services in each of the ten provinces. The results show that approximately 6.0 percent of Canadians report access problems, with values ranging from 4.5 percent in Newfoundland to 8.3 percent in Manitoba. Regional variations in barriers to accessing care were also observed. In particular, geographic accessibility appears to be a main barrier to care in Atlantic Canada while economic accessibility emerges as a main barrier to care in Western Canada. We discuss these findings in the context of the current debates on the Canadian health care system ‘crisis’. De plus en plus de Canadiens s'inquiétent que leur systéme de soins de santé soit en état de crise. On défend l'idée selon laquelle la réduction des paiements de transfert aux provinces par le gouvernement fédéral serait responsable de l'état d'un systeme de santé caractérisé par un sous‐financement dans les domaines‐clés et des décisions politiques de santé basées, non pas sur les besoins des membres de la société canadienne, mais sur la fiscalité provinciale. Les gouvernements provinciaux ont réagi à la réduction du financement fédéral par une tactique de restructuration agressive (fermeture d'hôpitaux et retrait de services médicaux des programmes d'assurance de santé provinciaux). Selon les médias, les groupes de consommateurs et même les chercheurs en soins de santé, cette restructuration a eu pour effet un système en état de ‘crise’ (diminution de l'aecès aux services, longues fetes d'attente, hôpitaux surchargés, augmentation des coûts des médicaments etc). Un des thèmes récurrent est celui des décisions flscales de toutes sortes qui entraînent une baisse de l'accessibilité financière et géographique. Cette accessibilité est pourtant un des cinq principes de la Loi canadienne sur la santé définissant l'essence même du système de santé au Canada. Utilisant les données tirèes de l'Enquête nationale sur la santé de la population, 1998‐99 et examinant l'accès aux services de santé et les obstacles rencontrés dans les 10 provinces canadiennes, cet article évalue dans quelle mesure une crise d'accessibilité existe au sein du système de santé canadien. Les résultats démontrent qu'environ 6.0 pour cent des Canadiens ont rencontré des problèmes d'accessibilité, avec des variantes allant de 4.5 pour cent à Terre‐Neuve jusqu'à 8.3 pour cent au Manitoba. On observe aussi des variantes régionales dans les obstacles rencontrés. L'accessibilité géographique en particulier semble un obstacle mqjeur dans les régions de l'Atlantique, alors que l'accessibilite financière semble être un obstacle majeur dans l'Ouest du Canada. Ces résultats sont présentés dans le contexte des débats actuels sur l'existence dune, ‘crise’ dans le système de santé au Canada.     

The Meaning of Normality: the controversy about the mental health campaign in Sweden 1969

At the height of the Swedish welfare society, a campaign with the aim of promoting mental health issues within the Swedish labour market was launched. The title and purpose of the campaign, ‘Mental health – an action of increased understanding and solidarity at work’, was to illuminate mental health issues at work. Surprisingly to the organizers, the mental health campaign stirred up major opposition, especially from the political left. The idea of mental hygiene in an industrial and workplace setting, a cross-breed between the values of the Human Relations School and psychiatric science, was received with deep mistrust. The campaign caused an agitated debate in the media about power relations between employers and employees. The political disagreements were exposed in a number of articles in the daily newspapers and in the evening papers during the summer of that year. This article undertakes an investigation of the campaign literature and the media debate. The interpretation of the debate highlights different opinions about the meaning of normal mental health. Four different views of normality and mental health which demonstrate the complexity of the issue are presented. Mental health could mean adjustment and harmony, it could be a medical weapon to suppress the working class, it could even mean a neutral state of absence of mental problems, or lastly it could be a claim for the right to live a normal life.     

Rural mental health and social geographies of caring

This paper contributes to an emerging geographical literature on the social geographies of caring. Drawing on recently undertaken empirical work in the Scottish Highlands, personal accounts about the provision of both formal and informal care for people with mental health problems are evaluated. The notion of ‘community care’ is critiqued, as too are claims about how rural and remote rural locations engender particular configurations of caring roles, practices and relations. It is shown that geographical distance, social proximity, stoic cultures and rural gossip networks all have a part to play in how caring occurs in such places. The paper concludes by suggesting areas of future research.     

怎样在小学语文教学中渗透心理健康教育

语文学科《课程标准》明确地提出“知识与能力,态度与方法,情感、态度与价值观”的课程目标与要求,强调对学生能力的培养与人格的养成。“在语文学习过程中,培养爱国主义感情、社会主义道德品质,逐步形成积极的人生态度和正确的价值观,提高文化品位和审美情趣。”     

Toward a care ethical approach to access to health care in neoliberal times

In December 2017, the Republican-controlled US Congress closed its session by pushing through a comprehensive tax overhaul bill, HR 1. Additional provisions of the ‘must pass’ bill included a last-ditch effort to quash the Affordable Care Act (ACA), otherwise known as Obamacare. In this article, I unpack some of the immediate and long-term net-positive impacts that the ACA has had on access to health care for women, infants, and children in the US while also acknowledging the continued unevenness of health outcomes along race, gender, and income differences. I argue that if we take seriously the potential of a care ethical analysis to respond to neoliberal ethics, then there is a need for a more robust engagement with intersectional analysis in order to address interlocking oppressions that exacerbate ongoing inequalities. By extension, I show how HR 1 clearly highlights the racist, classist, and gendered neoliberal logics that permeate contemporary US political and legislative debates related to health care access, underscoring the uncaring nature of US democracy and making plain a need to ‘care with’ others. I end by posing a set of speculative possibilities, asking what might be possible if we take seriously care and caring relations as fundamental to imagining worlds-otherwise.     

Social geographies of rural mental health: experiencing inclusions and exclusions

A dominant urban focus in previous research on the social geographies of mental health has obscured the experiences of people with mental health problems living in rural localities. Critiquing this urban focus, we report on research conducted in the rural and remote Scottish Highlands. Evidence derived from in-depth interviews with over 100 users of psychiatric services in the Highlands is deployed to investigate the complex socio-spatial dynamics of inclusion and exclusion experienced by these users on a daily basis. A discussion of the explanations that users themselves offer of their experiences is accompanied by a theoretical framing of these issues pivoting on relations of proximity–distance and intimacy–repulsion.     

Gender disparities in child health care seeking in northern Vietnam

Vietnam recently demonstrated a skewed sex ratio at birth. Little research has examined postnatal impacts of son preference in Vietnam, such as in child health care seeking. Past research in other Asian countries with son preference has found that parents are more likely to take sons to a health facility when they are sick, to do so more promptly, and invest more resources in care, than daughters. Using data from a paediatric hospital emergency department, we analyse gender differences in illnesses, referral patterns, and outcomes among children to understand how gender disparities in paediatric hospital admissions arise. Almost twice as many boys were brought into the facility as girls. Compared to girls, boys were significantly more likely to have bypassed lower-level facilities and entered care at the tertiary facility, controlling for severity of illness and socio-demographic characteristics. This suggests parents provide preferential treatment to boys, potentially leading to excess morbidity among girls who become ill. However, we find no significant differences in delay of care seeking or evidence of provider bias. Ensuring that girls are able to access appropriate, quality care when needed, will improve equity of access to care for all children.