Unions,Parties, and the Politics of State Government Legacy Cost

Many American state governments have made extensive promises to pay for employees’ health care and other benefits in retirement. Currently estimated at over $1 trillion in unfunded liabilities, these other postemployment benefits (OPEB) are creating a major fiscal problem for state governments. In this article, we examine the politics of OPEB. We seek to explain the variation in the generosity of OPEB across U.S. states. We argue that party competition theories do not adequately explain the outcomes we observe. Instead, we draw on the emerging Schattschneiderian approach to the politics of public policy to show that public union strength conditions a party's incentives to represent unions’ interests. In states where public sector unions are strong, unions can find their way into either party's coalition. We find that Republicans are more responsive to public union interests than either their ideological brand or prior research would suggest. It is only in states where public employees are weak that Republicans can act unilaterally and enact their preference for less government spending. To test our theories, we carry out an empirical analysis using a newly assembled data set of per capita OPEB liabilities across 49 states.     

Political Ecologies of Global Health: Pesticide Exposure in Southwestern Ecuador's Banana Industry

Pesticide exposure in Ecuador's banana industry reflects political economic and ecological processes that interact across scales to affect human health. We use this case study to illustrate opportunities for applying political ecology of health scholarship in the burgeoning field of global health. Drawing on an historical literature review and ethnographic data collected in Ecuador's El Oro province, we present three main areas where a political ecological approach can enrich global health scholarship: perceptive characterization of multi‐scalar and ecologically entangled pathways to health outcomes; critical analysis of discursive dynamics such as competing scalar narratives; and appreciation of the environment‐linked subjectivities and emotions of people experiencing globalized health impacts. Rapprochement between these fields may also provide political ecologists with access to valuable empirical data on health outcomes, venues for engaged scholarship, and opportunities to synthesize numerous insightful case studies and discern broader patterns.     

Renegotiating the Primary School: Children's Emotional Geographies of Sport,Exercise and Active Play

The current UK policy concern with children's health has led to primary school practices of sport, exercise and active play aimed, in particular, at constructing children's bodies as ‘healthy’. Qualitative explorations of children's own values and experiences however, reveal that their understandings of sport in school differ considerably from its potential to be healthy, instead emphasising emotional geographies of pleasure and enjoyment. This article aims to develop a better understanding of children's ability to modify and reconstitute discursive corporeal regimes through their own agency, thus highlighting the fluid nature of the primary school as an institution. Adult discourses and children's bodily challenges to these mingle and intersect, creating spaces of competing values and discourses that work to transform and renegotiate the primary school. Although this article focuses particularly on the UK context, the findings will be relevant for any country in which child obesity is of current concern for social and education policy.     

Paying Attention to Politics: Public Responsiveness and Welfare Policy Change

In order for the democratic process to work properly, it is vital that the public pays attention to politics and signals its opinions and preferences back to its representatives; if this is not the case, representatives have less incentive to represent. This article deals with the question of whether and how the public responds to welfare policy change. The thermostatic model departs from the assumption that the public responds to policy change with negative feedback, in relation to its preferred level of policy. The empirical analysis tests this model on public responses following the implementation of a consumer's choice model in Swedish primary health care. Did the reform trigger a thermostatic response from the public, and how should this be interpreted? A contribution in relation to previous research is the inclusion of ideological orientation and proximity, variables which, I argue, condition the nature and direction of public responsiveness. The study was designed as a natural experiment in which preferences of privatization of health care were measured before and after the health care reform of 2009/2010. The results provide partial support for the thermostatic model: preferences for further privatization decrease after the reform, but primarily within one subgroup. Additionally, public responses are demonstrated to vary according to ideological orientation, where the right‐oriented react thermostatically and the left‐oriented do not. The article contributes to a further understanding of the relation between policymaking and public opinion and to the expansion of thermostatic theory.     

‘War against the mosquito’: Allies,Italians and malaria during the occupation of Puglia, 1943–1946

War and healthcare are inextricably linked. In fact, the prevalence of disease in the armed forces can inflict more damage than the enemy. The case of endemic malaria during the Italian campaign of 1943–1945 in the Second World War is an excellent example. The region of Puglia was one of the most malarial regions in Italy and provides a noteworthy case of Anglo-American endeavours to eliminate the mosquito during the Second World War. The high prevalence of endemic malaria in the area represented a substantial threat to the health of Allied forces and as a result to the Allied war effort. This article explores Allied efforts to protect both Italian civilians and Allied troops from malaria, in order to demonstrate how Allied health policies affected the Allied–Italian relationship.     

Living with everyday environmental risks: giving a voice to young people in the design of community-based risk communication programs in the city of San Luis Potosí, México

Risk communication programs (RCPs) can contribute to the improvement of community health in marginalized settlements by improving health-related information and practices. Yet, there is a need to include young people's concerns in the design and implementation of RCPs. This study analyses young peoples’ risk perceptions in the city of San Luis Potosí, Mexico, using visual methods such as drawings and photography. Research was conducted with 74 students from two deprived urban neighborhoods. Results indicate that the use of visual techniques enabled them to identify environmental health risks such as unhealthy sedentary habits and the exposure to hazardous items. We conclude that visual methods may help young people to critically reflect on everyday elements in their environment that affect their well-being. By giving them a voice in a reflexive way, visual methods may engage young people as key multipliers in the awareness raising process, and promote their sense of everyday agency.     

Measuring Inuit Health from Ungava to Nunavik via Nouveau Québec: Episodes in the History of Researcher–Subject Relations

ABSTRACT

Inuit have been the subject of research attention since the earliest encounters with Europeans. Using the Foucauldian concept of biopolitics this article explores the history of researcher–research subject relations produced through health knowledge in the region now known as Nunavik. This history is organized in three time periods: The first is the “Ungava” era and is explored in the observations of members of the Hudson Bay Expedition and subsequent mapping efforts. The second “Nouveau Québec” era begins in 1912 when the current borders of Québec were established and lasts until 1975. After a period of indifference, research interest grows rapidly in the post-war period with a focus of social adaptation and culture change. The third era begins in 1975 with the signing of the James Bay and Northern Quebec Agreement. This marks the beginning of Inuit political development within an Inuit-controlled regional governance structure. The conceptualization of three different health surveys during this period shows an emerging complexity in how Inuit health is imagined. An upcoming fourth survey which marks the first time the study of Inuit physical, social, and community health will be initiated by an Inuit-led health authority.     

Voluntarism and long-term care in the countryside: the paradox of a threadbare sector

This article contributes to the burgeoning literature on the geographies of voluntarism by addressing how voluntary sector providers in rural communities respond to the downloading of responsibilities for health and social care associated with public service restructuring. Drawing on a qualitative analysis of long-term care in Ontario, it focuses on the consequent actions of non-profit organizations, community support groups and volunteer caregivers in three different rural settings. Despite evidence of increasingly disproportionate levels of voluntarism amongst rural communities, the results reveal sector- and place-specific opportunities that allow voluntary sector providers to overcome the limitations of the rural service environment. The findings suggest that in the longer run, however, the growing dependence on local solutions will only exacerbate the uneven geographies of health and social care across rural space. Resolving this paradox remains a critical yet neglected challenge for sustainable rural services and communities.     

Treatment or Placebo: Are State Programs Decreasing the Proportion of Uninsured?

Currently there are over 45 million Americans without health insurance. Recent growth in Medicaid and State Children's Health Insurance Program (SCHIP) enrollment of children has filled in the sizable gap created by decreased employer‐sponsored insurance since 2000. While the share of children who are uninsured actually decreased between 2000 and 2003, little progress was made in expanding public insurance to adults. As a result, advocates and policymakers at the federal and state level are searching for approaches to deal with the growing number of the uninsured. Conservatives advocate encouraging individuals to buy private insurance while liberals advocate the provision of health coverage through publicly financed health care. Using a 50‐state multilevel individual growth model, this study estimates the net effect of two state approaches in terms of reducing the uninsured: tax incentives (the conservative approach) and direct‐coverage programs (the liberal approach). The results suggest that these approaches have not achieved the results that many advocates had suggested. In the case of tax incentives, the results suggest that states with tax incentives experience increases in the rate of the uninsured. In the case of direct‐coverage programs, results suggest that states receive no relief in the number of uninsured individuals. Finally, the analysis suggests that the efforts originating at the federal level are most successful. These programs are a continuation of the incremental approach policymakers in America have taken to address the problem of the uninsured, rather than taking steps toward a truly comprehensive solution.