Conceptualizing ‘social capital’ for health promotion in small local communities: a micro‐qualitative study

This paper reports on a micro‐qualitative case study of peoples' experiences of local community life in a south‐east English town. This material is used as the basis for a critical discussion of the suitability of Putnam's notion of social capital as a conceptual tool for the design and evaluation of ‘community strengthening’ policies and interventions. The study was motivated by a concern that too much debate about social capital has been conducted by academics and policy‐makers in a top‐down manner, with inadequate attention to the realities of life in the local communities that they refer to. Three‐hour semi‐structured interviews were conducted with 37 residents in two less affluent wards in our town of interest. Informants—half men and half women, and spread across the 15–75 age group—were encouraged to talk about their personal experiences of local community life. Interview findings are presented within the ‘norm’ categories of trust, neighbourliness and reciprocal help and support, and the ‘network’ categories of participation in informal networks, voluntary groupings and community activist groupings. Our case study points to a number of ways in which Putnam's concept needs to be refined if it is to inform ‘community strengthening’ policies and interventions in England. Far more notice needs to be taken of the role played by informal networks of friends and neighbours in the construction of local community life. Attention also needs to be given to the complex and shifting geographical spread of peoples' significant social networks. Putnam's conceptualization of cohesive local communities and his unitary notions of trust and local identity may also be unduly essentialist. In our particular communities of interest, they failed to capture the fluidity of local community norms and networks in a rapidly changing society. They also failed to do justice to the extent to which social distinctions—such as age, gender, ethnicity and housing tenure—shape and constrain the way in which people create, sustain and access social capital. Copyright © 2001 John Wiley & Sons, Ltd.     

疫病与外交：清末民初华洋互动视域下的瘟疫防治

瘟疫贯穿人类历史发展始终。近代以降,由于列强势力深入中国各地,围绕瘟疫防治而产生的华洋互动日趋频繁。一方面,外侨主导的防疫事业引发了中国社会各阶层收回防疫主权的外交诉求;另一方面,列强以防疫之名行侵略之实的行为使得华洋之间围绕国权展开了艰难博弈。在此过程之中,近代中国政府通过完善其行政能力,更有力地介入到防疫领域的管理中,推动了防疫事业的制度化发展,并以外交的方式维护公共卫生领域的国权,从而在应对公共卫生事件中逐步走向成熟。

     

Libertarianism vs. Marxism: Reflections on G. A. Cohen‘s Self-Ownership, Freedom and Equality

Self-Ownership, Freedom and Equality is G.A. Cohens attempt to rescue something of the socialist outlook on society from the challenge of libertarianism, which Cohen identifies with the work of Robert Nozick in his famous book, Anarchy, State, and Utopia. Sympathizing with the leading idea that a person must belong to himself, and thus be unavailable for forced redistribution of his efforts, Cohen is at pains to reconcile the two. This cannot be done – they are flatly contrary. Moreover, equality is a nonsense principle, calling for such things as equal distribution of natural resources. But resources, as goods, are not natural: all require work to utilize. The only thing exchanged on markets is services, and estimates of value received are relevantly made only by those party to the exchanges in question. Imposition from above on voluntary exchange can only be socially counterproductive.     

论医务人员在医疗事故技术鉴定过程中的法律地位

目前,医疗事故技术鉴定过程中忽视了医务人员应有的地位。从法律规定和程序正义、当事人理论等方面明确了医务人员在鉴定中的法律地位。论述了医务人员应当是医疗事故技术鉴定的当事人,其在鉴定中享有当事人的权利和义务,这对保护医务人员的合法权益有着重要意义。     

知情同意的临床实践存在的问题及对策

临床医疗实践中贯彻实施知情同意原则旨在保护病人的权益不受侵犯,然而知情同意原则实施起来并不简单,它常常会受到主客体两方面种种因素的制约,陷入意想不到的困境。分析了知情同意原则在实施过程中可能出现的一些难以回避的问题,并针对这些问题探讨了若干对策。     

Animal spare parts? A Canadian public consultation on xenotransplantation

Xenotransplantation, or the use of animal cells, tissues and organs for humans, has been promoted as an important solution to the worldwide shortage of organs. While scientific studies continue to be done to address problems of rejection and the possibility of animal-to-human virus transfer, socio-ethical and legal questions have also been raised around informed consent, life-long monitoring, animal welfare and animal rights, and appropriate regulatory practices. Many calls have also been made to consult publics before policy decisions are made. This paper describes the Canadian public consultation process on xenotransplantation carried out by the Canadian Public Health Association in an arm’s length process from Health Canada, the ministry overseeing government health policy and regulation. Focusing on six citizen fora conducted around the country patterned after the citizen jury deliberative approach, the paper describes the citizen panelists’ recommendations to hold off on proceeding with clinical trials and the rationales behind this recommendation. The consultation process is discussed in the context of constructive technology assessment, a framework which argues for broader input into earlier stages of technology innovation, particularly at the technology design stage. This study was supported by a grant to the first author from the Social Sciences and Humanities Research Council in Canada.     

Conflict of interest in medicine in Lithuania: legal and ethical aspects

The current legal framework within the Lithuanian health system is described including a review of the physician’s autonomy, rights and duties, and patients’ rights including the right to reimbursement. The role of ethical codes and the law are discussed. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Hotep's Story: Exploring the Wounds of Health Vulnerability in the US

A wide variety of forms of domination hasresulted in a highly heterogeneous health riskcategory, ``the vulnerable.' The study of healthinequities sheds light on forces thatgenerate, sustain, and alter vulnerabilities toillness, injury, suffering and death. Thispaper analyzes the case of a high-risk teenfrom a Boston ghetto that illuminatesintersections between ``race' and class in theconstruction of vulnerability in the US.Exploration of his ``wounds' helps specify howlarge-scale social and cultural forces becomeembodied as individual experience of disparatehealth risk. The case demonstrates that healthinequities would not occur if resources –employment, income, wealth, education, housing,profiling in the legal system, and health care– were more justly managed in keeping withstandards outlined in the Universal Declarationof Human Rights. Professional responses to the``wounds of vulnerability' may reveal importantaspects of who we are and what our work asscholars, practitioners, and advocates mustbecome.     

Religion and the Quality of Life

Subjective and objective indicators of the quality of life (QOL) are used to test relationships with religious involvement, participation, and belief. Findings from other studies show religious involvement to be associated with longer life. The percent of religious adherents in a state is correlated with the harmony domain of the QOL and negatively with an indicator of stress. After reviewing relevant previous studies, I examine data from the 1972–1996 General Social Survey Cumulative File. It shows happiness to be associated with the frequency of attendance at religious services, with denominational preference, and with doctrinal preference. Happiness also is associated with certain religious-related beliefs: belief that the world is evil or good but not belief in immortality. In a discussion of these and other findings, hypotheses are suggested to explain and to further explore the effects of religion upon the QOL. Among the conclusions: our conception of the "good life" rests heavily upon Judeo-Christian ideals; religious organizations contribute to the integration of the community, hence enhancing the QOL; since frequency of attendance is imperfectly associated with the QOL, other influences are at work; the doctrine of the religion may attract persons of happy disposition; religion may explain a purpose in life that fosters well-being; and others. I suggest implications of the findings for programs of religious organizations.     

From case management to prevention of scientific dishonesty in Denmark

In 1992, The Danish Medical Research Council established a national committee on scientific dishonesty with the twofold task of handling cases of scientific misconduct and taking preventive initiatives. Scientific dishonesty was proven in only five cases, but in another nine cases lesser degrees of deviations from good scientific practice were found. The experiences from a total of 24 treated cases indicated that three key areas were at the basis of most of the accusations and the deviations from good practice: uncertainty about 1) authorship, about 2) rights and duties to use scientific data and about 3) agreements at the initiation of joint studies. As a consequence guidelines on good practice have been issued on these key subjects. An earlier version of this paper was presented at a symposium, Scientific Misconduct. An International Perspective, organised by The Medical University of Warsaw, 16 November, 1998.